In-house Capacity Research Articles

Initial impact of COVID-19 on dialysis provision; review of international guidelines and adaptation of a hub unit's service.

The COVID-19 pandemic has put a strain on many aspects of health care including the provision of dialysis. Two categories of patients have had the greatest impact on dialysis capacity. Those with COVID-19-related acute kidney injury and those chronic dialysis patients who required isolation or cohort dialysis because of the pandemic. Limited information on incidence hampers capacity planning and the rapid change in demand provides further challenges. In the 4weeks after our first patient, the incidence of confirmed infection in our dialysis population has been 5.1%. By the third week, hemodialysis had to be provided in critical care as the in-house capacity for hemofiltration had been overwhelmed. The interventions that enabled these needs to be met are detailed in this paper alongside a review of international recommendations and how they have been adapted to meet local pressures.

SWARM: A regional health system’s intervention approach to COVID-19 outbreaks in nursing and adult care homes in rural eastern North Carolina

Background: Incessant, COVID-19 outbreaks occurring in nursing and adult care homes are a serious public health concern that continues to create significant healthcare crisis management challenges. Adult care facilities often lack in-house capacity and capability to safely treat its ill residents, while hospitals are strained to balance the influx of patients, allocate scarce resources and protect healthcare workers.Objectives: This project sought to implement a regional, community engaged, intervention model to assist nursing and adult care homes in reducing or preventing outbreaks and risks associated with COVID-19 in rural eastern North Carolina (N.C.).Methods: Design/Setting: Through collaborations between Vidant Health (VH), health departments and a network of community partners, a shared intervention plan was created and implemented to monitor nursing and adult care homes for COVID-19-related outbreaks across 29 counties in rural eastern N.C. A “Strike” team or “Swarm (SWARM) approach was developed as an operationalized concept for rapidly responding to nursing and adult care home outbreaks while providing an array of services and interventions to help prevent the spread of COVID-19. Comparative analysis was conducted between the mean number of COVID-19-related cases, deaths and length of outbreak time in VH service contracted, SWARM facilities (n = 12) and all other non-service contracted, or non-SWARM facilities (n = 155) in N.C.Results: Nursing and adult care homes under service contract using our SWARM approach experienced fewer average number of COVID-19-related resident ill cases (24.4 vs 29.0), and deaths (1.2 vs. 3.9). The length of outbreak recovery time was far less among SWARM facilities than non-participating, non-SWARM facilities (17.1 vs. 25.4; p < .034).Conclusions: By actively monitoring key indicators, engaging in daily communication with local partners and providing rapid response, VH’s SWARM approach provides a proactive method for preventing further spread of COVID-19 in adult care facilities and communities.

Fabrication Cycle Time and Shipment Decision for A Multiproduct Intra-Supply Chain System with External Source and Scrap

Managers of today’s transnational firms, facing competitive global business environments, always intend to optimize their intra-supply chain systems to meet customers’ multiproduct demands with perfect quality goods, timely delivery, and minimum fabrication-shipping expenses. In the production units of intra-supply chain systems, random scraps are inevitable due to various unforeseen factors. Also, since the in-house capacity is limited, implementing a partial outsourcing plan can help release machine workloads, smooth production schedule, and reduce fabrication uptime. Inspired by these facts, this study explores an intra-supply chain system with random scraps and an external source. We build a mathematical model to portray the characteristics of the studied problem. Model analyses and the renewal reward theorem help us to obtain the expected system cost function. Optimization techniques and Hessian matrix equations are used to jointly decide the optimal cycle time and shipment policy that minimize the expected system cost. Through numerical illustration, we expose the individual and joint impact of diverse system features on the optimal operating policies and other crucial parameters of the studied problem, thus, facilitate managerial decision makings.

MANAGEMENT OF AIR QUALITY THROUGH ENERGY MEDIATION

Air Quality and its management has been quite strained in the past few years and a cumulative approach in dealing with it would help reduce the emission and enhance the air quality index. As the government focuses on raising in-house technical capacities, the extent of Micro, Small and Medium Enterprises are shooting up. MSMEs contribute to majority of the country’s industrial enterprises and considerable amount of its carbon emissions. It is imperative to concentrate on their environmental impacts based on their energy consumption pattern. However, understanding this key challenge – the MSMEs are to check on their Energy consumption patterns and the source of energy, thus eliminating the over-utilization of resources. This would not only make the MSMEs Energy Efficient but also lead to a decreased emission load and carbon footprint. GHG emission reduction could be mapped over the years. Mapping out the impact of these ambitious policies and its enablers would be critical. This work would aim at building an advanced understanding of potential benefits/impacts of MSMEs on the emissions/concentration of air pollutants v/s business as usual – based on varying levels of Energy Efficient equipment penetration and the fuel being used. This would involve a combination of Air emissions inventory and dispersion modelling approaches based on scientific understanding of comprehensive industrial structure in the industrial clusters. Broadly, energy demands and their usage details – coupled with established local air emissions would be used for establishing a detailed understanding of air quality impacts.

Strategic partial outsourcing in the presence of single-source components

We study the sourcing decision of a manufacturer in choosing between sole sourcing and multi-sourcing for a production component, when available sources are under different efficiency levels. In our model, the manufacturer can either produce the component in-house, or outsource to less efficient external suppliers. Without any demand uncertainty or ex-ante capacity constraint with in-house production, we find that the manufacturer may establish only limited in-house production capacity and eventually outsource to less efficient external suppliers. Such partial outsourcing is purely strategic and is due to the existence of single-source components, with which the manufacturer solely relies on key suppliers who possess great market power. Partial outsourcing enables the manufacturer to mitigate the pricing power of key suppliers, which is optimal to the manufacturer so long as the associated efficiency loss of outsourcing is not too pronounced. Moreover, cost increase in outsourcing may lead the manufacturer to outsource even more in order to boost its profitability.

Entrepreneurship in a transformative and resource-rich state: The case of Qatar

Countries blessed with natural resources have generally struggled to achieve sustainable economic development and prosperity. Population growth, the depletion of natural resources coupled with mismanagement, and sharp fluctuations in prices of those resources are among the main reasons for sub-optimal economic performance. Some resource-rich countries have been expending effort and money in an attempt to change this inverse relationship (a.k.a. “the resource curse”) by designing policies to diversify their economies with high value-added industries and sectors. Qatar is a such country and point of the interest in this article. Qatar's political and economic structure, its efforts to diversify its economy, and the potential for improved entrepreneurial outcomes with high value-added products, services, businesses, and industries are analyzed. The country has been very effective in maximizing the benefits of its oil resources and especially its large natural gas reserves, becoming the largest exporter of liquefied natural gas (LNG) in the world. Revenues from oil and gas sales have been invested in the domestic economy and global assets. Thus far, however, it has not shown the in-house capacity for innovation and entrepreneurship critical for sustainable economic diversification going forward.This publication was made possible in part by NPRP grant #10–1203–160007 from the Qatar National Research Fund (a member of the Qatar Foundation).

Capacity Planning With Outsourcing Opportunities Under Reliability And Maintenance Constraints

This paper investigates capacity planning with outsourcing under reliability-maintenance constraints. The considered supply-chain consists of a single-manufacturer and multiple-subcontractors. The manufacturer's company is composed of a single unit subject to random failures. Corrective maintenance is endorsed when failures occur, and preventive maintenance can be carried out to reduce the degradation. The high in-house costs and the incapacity motivate the manufacturer outsourcing to independent subcontractors. In addition, based on the principle of comparative advantage, the manufacturer balances between in-house capacities and outsourcing services, which minimises the total cost. The aim is to propose a new policy based on the combination between integrated-maintenance and outsourcing policies. A mathematical model and an optimisation procedure have been developed in order to determine the best in-house production-maintenance and outsourcing plans for the manufacturer while minimising the total cost. In order to show the applicability of our approach, we conduct experimentations to study the management insights.

Supporting the Healthcare Workforce in Response to the COVID-19 Pandemic

ARS-CoV-2, a new coronavirus disease first identified in 2019 (COVID-19), is responsible for the pandemic that is presently straining the Illinois’ healthcare workforce and is expected to continue doing so for the next several years. Prior pandemics and disasters have demonstrated that the scope of responsibilities for all types of healthcare workers evolves as a disaster unfolds, from meeting surging needs by prioritizing patient care, to re-balancing activities as each surge waxes and wanes, to recovery and mitigation, and finally to preparing for future disasters. This report presents a high-level summary of the current and expected impact of the COVID-19 pandemic on the healthcare workforce and makes a series of recommendations about how to minimize the adverse impact of the COVID-19 pandemic on healthcare workers and their families in Illinois, now and over time. The report draws on well-established frameworks for response to pandemics and disasters distilled from a body of research and practice. We conclude that focused supportive actions are necessary to facilitate work responsibilities under new pressures—people, information, process, technology, equipment, space—and to promote personal wellness—physical and psychosocial. Many steps taken to ensure public and workforce safety have also introduced economic challenges that must be addressed in order to sustain these efforts to support the workforce throughout the response and recovery phases of the pandemic. Key supports for individual providers, such as hazard pay provided by employers or government1 and free hotel rooms or meals provided by private companies,2 have already begun in many places across the country, but applying these at scale remains a challenge. We include two case studies showing it is possible to respond to real needs of workers even in the midst of a pandemic, if institutions are committed, creative and nimble. CONCLUSION: EXTEND WHAT WORKS Some of the innovations highlighted in the case studies above may be promising statewide if they can be brought to scale, shared across the industry, and made sustainable. For example, hospitals that have significant human capital have developed protocols for insuring worker safety. By contrast, home healthcare workers, who have been deemed essential in Illinois and many states, say they lack sufficient information about ensuring their own safety and the safety of their clients. While trade groups can assist with best practices, adapting detailed protocols developed by hospitals with greater in-house capacity can help workers who work for smaller companies. Just as reimbursement rules have been modified to allow for telemedicine services, policymakers and insurers should explore whether similar flexibility is possible for community health services. Increasing coverage for their services will help vitally important community health workers to assist persons in need.20 Coordination and sharing of information (e.g., best practices, operational manuals) can reduce the costs to healthcare organizations that face tremendous strain now. The Illinois Department of Public Health (IDPH) promulgates best practices for public health efforts but is actively managing a pandemic. Ideally in partnership with IDPH, the new Illinois Innovation Network (IIN)21 with its 15 hubs, drawing on the expertise of 12 universities, provides an existing architecture for transferring knowledge learned at UI Health and other Chicago hospitals to hospitals across the state, including Illinois’ vital critical access hospitals. IIN is also helping with development of the healthcare workforce across the state. Some innovations may improve the way healthcare is delivered going forward. For example, changes in reimbursement for telehealth may provide the necessary conditions to serve as model of care for some patients and some conditions moving forward. Also, the efforts to provide temporary housing to workers seeks to allay the strain from long hours in high-pressure conditions. Policymakers should ask whether each innovation and recommendation above can lead to sustainable chan

When Suppliers Shift My Boundaries: Supplier Employee Mobility and Its Impact on Buyer Firms’ Sourcing Strategy

Buyer firms are found to respond to supplier employee mobility by reshuffling work among suppliers. However, the extant literature has not considered plural-sourcing firms which can bring work back in-house. Here, we develop a governance framework in which buyers engage in a comparative assessment of the costs associated with different sourcing modes following supplier employee mobility. Due to the imperfect transferability of social capital and associated uncertainty, buyers face increased contracting costs when supplier employees move. This prompts plural-sourcing buyers to increase their reliance on insourcing when the costs of adjusting in-house capacity are relatively low and when the costs of switching to alternative suppliers are relatively high. The analysis of data on patent prosecution activities and patent attorney mobility provides support to our theory.

Monitoring of the National Oil and Wheat Flour Fortification Program in Cameroon Using a Program Impact Pathway Approach

ABSTRACTBackgroundSince 2011 Cameroon has mandated the fortification of refined vegetable oil with vitamin A and wheat flour with iron, zinc, folic acid, and vitamin B-12. In 2012, measured fortification levels for flour, and particularly oil, were below target.ObjectivesWe assessed Cameroon's food fortification program using a program impact pathway (PIP) to identify barriers to optimal performance.MethodsWe developed a PIP through literature review and key informant interviews. We conducted interviews at domestic factories for refined vegetable oil (n = 9) and wheat flour (n = 10). In 12 sentinel sites distributed nationally, we assessed availability and storage conditions of fortified foods in markets and frequency of consumption of fortified foods among women and children (n = 613 households). Food samples were collected from factories, markets, and households for measurement of micronutrient content.ResultsTwo-thirds of factories presented quality certificates for recent premix purchases. All factories had in-house capacity for micronutrient analysis, but most used qualitative methods. Industries cited premix import taxes and access to external laboratories as constraints. Mean vitamin A levels were 141% (95% CI: 116%, 167%), 75% (95% CI: 62%, 89%), and 75% (95% CI: 60%, 90%) of target in individual samples from factories, markets, and households, respectively. Most industry flour samples appeared to be fortified, but micronutrient levels were low. Among composite flour samples from markets and households, the mean iron and zinc content was 25 mg/kg and 43 mg/kg, respectively, ∼45% of target levels; folic acid (36%) and vitamin B-12 (29%) levels were also low. In the previous week, the majority of respondents had consumed “fortifiable” oil (63% women and 52% children) and wheat flour (82% women and 86% children).ConclusionsIn Cameroon, oil fortification program performance appears to have improved since 2012, but fortification levels remain below target, particularly for wheat flour. Consistent regulatory monitoring and program support, possibly through premix procurement and micronutrient analysis, are needed.

A Framework for ICT Implementation in School Education in India

It is widely accepted that digital technologies (popularly known as Information and Communication Technologies or ICT) have the potential to strengthen and reform school education. However, in the absence of clear framework for program design, the impact on learning processes and outcomes from numerous attempts by different governments and other actors has not lived up to this potential. This note provides a holistic framework for such a design, covering infrastructure, teacher education, curriculum and content and education administration, aiming to support the creation of an ecosystem of ICT integration. The note assumes certain principles- firstly ICT program should aim to support the achievement of educational aims. A deep understanding of aims, philosophies, contexts, needs and priorities of education in India, is indispensable for meaningful and effective program design. Secondly, ICT implementation must support the achievement of education policy. The thrust of these policies has been to support constructivist classroom pedagogies, make learning connected to local contexts and responsive to learner needs, make the school culture democratic and participatory, support decentralized school system administration by strengthening school autonomy, teacher agency and connecting the school to the local community, going beyond a narrow focus on learning outcomes. The ‘public’ nature of education aligns strongly with free and open ICT architectures. It is recommended by the National ICT policy that the ICT implementation in school education use free and open technologies, including FOSS (Free and Open Source Software) and OER (Open Educational Resources). The design of ICT programs must consciously aim for sustainability, where the schools and other institutions can continue the integration of ICT beyond the initial investment period. Developing in-house capacities of teachers and teacher educators to appropriate free and open ICTs for their work, can sustain the use of ICT, freed from vendor lock-ins. Using ICT to build peer networks of teachers can support continuing professional development and sustain ICT implementation in the school.

Meeting multiproduct demand with a hybrid inventory replenishment system featuring quality reassurance

Globalization has not only generated immense business opportunities, but also created a very competitive marketplace. To retain competitive advantage, a manufacturer must satisfy a client's multiproduct and quality requirements with limited in-house capacity. An outsourcing strategy can overcome capacity constraints and shorten the fabrication cycle time. This study explores a hybrid multiproduct single-machine inventory replenishment system incorporating an outsourcing plan. The in-house multiproduct fabrication process is under a common cycle time policy. That is, each product receives one replenishment in a common cycle length. All fabricated items are inspected for quality; items with random defects are sorted out as scrap and repairable, and the rework occurs immediately after the regular fabrication. All reworked products that fail the quality reassurance test are scrapped. The quality of outsourcing items is assumed to be guaranteed by the outside provider. Our objective is to determine the optimal common cycle time that minimizes the total relevant cost. An accurate model is constructed to represent the characteristics of the system studied; furthermore, we utilize mathematical analysis to derive the total system costs and apply differential calculus to find the optimal cycle length. A numerical example illustrates the applicability of our result and highlights the effect of variations in outsourcing- and quality-related attributes on the optimal solution, as well as the various performance indicators that facilitate planning and controlling decisions.

Under what conditions can an application service firm with in-house computing benefit from cloudbursting?

Cloudbursting, a hybrid cloud computing model, helps firms supplement their internal computing capacity from a private cloud by using external computing resources from a public cloud to meet increased demand. This paper examines whether cloudbursting benefits an application service firm that uses only its in-house capacity. Cloudbursting provides computing scalability and cost-effectiveness, but poses potential risks from data leakage when bursting into a public cloud. A private cloud reduces such risks, however, is constrained by resource limitations. We develop quantitative models under both non-competitive and competitive systems, and then determine the best choice between cloudbursting and a private cloud. Overall, we show that a profit-maximizing firm will benefit from migrating to cloudbursting if risk is considerably low and will maintain a private cloud if risk is considerably high. Interestingly, one exception occurs in a competition system whereby two competing firms access external resources as needed from the same public cloud. In this case, one firm will counterintuitively remain in a private cloud even though risk is considerably low while its competitor will migrate to cloudbursting. The numerical study conducts a sensitivity analysis to link a firm's profit performance with its best cloud choice.

Exploration of finite production rate model with overtime and rework of nonconforming products

This study explores a finite production rate (FPR) model featuring overtime option and rework of nonconforming products. Classic FPR model assumed all items produced are of perfect quality. However, in real fabrication systems, owing to diverse uncontrollable conditions, production of nonconforming items is inevitable. To maintain high product quality and lower production cost allow present-day’s manufacturing firms to gain competition advantage. Also, due to limited in-house capacity, to be able to smooth production schedule enables management to meet due dates and better allocate fabrication resources. Motivated by these practical issues, the present study investigates a FPR model considering overtime and rework of nonconforming items. An exact model is developed to specifically describe the problem. Mathematical analysis and differential calculus are employed to help obtain the expected system cost function and prove its convexity, and then derive the optimal lot size per replenishment cycle. Moreover, sensitivity analysis and diverse effects of key system factors on the problem are demonstrated via numerical illustrations to help managerial decision-making.

How is the Lives Saved Tool (LiST) used in the global health community? Results of a mixed-methods LiST user study

BackgroundThe Lives Saved Tool (LiST) is a computer-based model that estimates the impact of scaling up key interventions to improve maternal, newborn and child health. Initially developed to inform the Lancet Child Survival Series of 2003, the functionality and scope of LiST have been expanded greatly over the past 10 years. This study sought to “take stock” of how LiST is now being used and for what purposes.MethodsWe conducted a quantitative survey of LiST users, qualitative interviews with a smaller sample of LiST users and members of the LiST team at Johns Hopkins University, and a literature review of studies involving LiST analyses.ResultsLiST is being used by donors, international organizations, governments, NGOs and academic institutions to assist program evaluation, inform strategic planning and evidenced-based decision-making, and advocate for high-impact interventions. Some organizations have integrated LiST into internal workflows and built in-house capacity for using LiST, while other organizations rely on the LiST team for support and to outsource analyses. In addition to being a popular stand-alone software, LiST is used as a calculation engine for other applications.ConclusionsThe Lives Saved Tool has been reported to be a useful model in maternal, newborn, and child health. With continued commitment, LiST should remain as a part of the international health toolkit used to assess maternal, newborn and child health programs.

Capacity planning on key work stations in a hybrid MTO-ETO production system: a case-study on Siemens AG

The focus of this study is on tactical-level capacity management which refers to the determination of in-house workforce production capacity in an optimal cost-efficient manner in a multi-period mode. Two options for capacity planning are investigated for rapid prototyping with the help of a mixed-integer linear optimisation model: smoothing the capacity utilisation over time vs. a higher level of capacity availability. A sensitivity analysis based on real empirical data in Siemens AG is used for the revealing the impact of workforce and capacity flexibility on operational performance. The results suggest that the number of workers decreases if production orders have not to be completed within only one week. On the contrary, if the binary restriction on the order fulfilment within one week is released, the production orders can be split into different weeks and this results in a higher smoothing rate and thus in a higher capacity utilisation degree.

Voter Mobilization, Experimentation, and Translational Social Science

Field experiments on voter mobilization enable researchers to test theoretical propositions while at the same time addressing practical questions that confront campaigns. This confluence of interests has led to increasing collaboration between researchers and campaign organizations, which in turn has produced a rapid accumulation of experiments on voting. This new evidence base makes possible translational works such asGet Out the Vote: How to Increase Voter Turnoutthat synthesize the burgeoning research literature and convey its conclusions to campaign practitioners. However, as political groups develop their own in-house capacity to conduct experiments whose results remain proprietary and may be reported selectively, the accumulation of an unbiased, public knowledge base is threatened. We discuss these challenges and the ways in which research that focuses on practical concerns may nonetheless speak to enduring theoretical questions.

Metro de Quito: Better or Bitter? Analysis of "Getting Around Quito"

The case study illustrates not only the policy dilemma faced by Barrera (mayor of Quito) but also expounds on his decisions favoring over Rapid Train Light Rail System (TRAQ) and the Bus Rapid Transit System (BRT). While Barrera considers TRAQ and BRT as temporary patches to the permanent problem of Quito public transit, in order to understand and justify the mayor's decision, the Metro de Quito: Better or analysis employs the concepts of Public Administration (including efficiency and public-service efficiency and the new public management, rational choice and public choice, public authority and bureaucracy, blame-avoidance and conflict of interest etc.) Making 'quality transit' as a campaign promise and then living up to the promise; this reflects the way Barrera enshrines the public amid other stakeholders such as council members, the city officials and investors. Finally, now that metro is actually in the second phase of construction, the analysis suggests mitigation planning, financing schemes, historic heritage protection, transparency unit and building of in-house capacity to ensure long-term maintenance of the huge infrastructure. Importantly, to make de Quito better, the way to go is to forget the bitter past.CITACION: Salar Khan, M. (2016). de Quito: Better or Bitter? Analysis of “Getting Around Quito.” Podium, 29, 95–105. doi:10.31095/podium.2016.29.6ENLACE DOI: https://doi.org/10.31095/podium.2016.29.6

In-house Production and Sourcing Competition under Demand Uncertainties

In this paper, we consider a supply chain where two buyers compete by investing in in-house capacity and outsourcing the remaining part of its production requirements to a common supplier to serve their individual markets with uncertain demand. The supplier has the option to sell capacity to these buyers and to an alternative market with random demand. We determine the buyers’ optimal sourcing and in-house production capacity decisions under such scenario.

FDA's Activities Supporting Regulatory Application of "Next Gen" Sequencing Technologies.

Next-generation sequencing (NGS) technologies are enabling breakthroughs in how the biomedical community is developing and evaluating medical products. One example is the potential application of this method to the detection and identification of microbial contaminants in biologic products. In order for the U.S. Food and Drug Administration (FDA) to be able to evaluate the utility of this technology, we need to have the information technology infrastructure and bioinformatics tools to be able to store and analyze large amounts of data. To address this need, we have developed the High-performance Integrated Virtual Environment, or HIVE. HIVE uses a combination of distributed cloud storage and distributed cloud computations to provide a platform that is both rapid and responsive to support the growing and increasingly diverse scientific and regulatory needs of FDA scientists in their evaluation of NGS in research and ultimately for evaluation of NGS data in regulatory submissions.