Personnel Hours Research Articles

Alternative Models of Nurse Staffing May Be Dangerous in High-Stakes Hospital Care.

Hospitals are resurrecting the outdated "team nursing" model of staffing that substitutes lower-wage staff for registered nurses (RNs). To evaluate whether reducing the proportion of RNs to total nursing staff in hospitals is in the best interest of patients, hospitals, and payers. Cross-sectional, retrospective. In all, 6,559,704 Medicare patients in 2676 general acute-care US hospitals in 2019. Patient outcomes: in-hospital and 30-day mortality, 30-day readmission, length of stay, and patient satisfaction. Avoidable Medicare costs associated with readmissions and cost savings to hospitals associated with shorter stays are projected. A 10 percentage-point reduction in RNs was associated with 7% higher odds of in-hospital death, 1% higher odds of readmission, 2% increase in expected days, and lower patient satisfaction. We estimate a 10 percentage-point reduction in RNs would result in 10,947 avoidable deaths annually and 5207 avoidable readmissions, which translates into roughly $68.5 million in additional Medicare costs. Hospitals would forgo nearly $3 billion in cost savings annually because of patients requiring longer stays. Reducing the proportion of RNs in hospitals, even when total nursing personnel hours are kept the same, is likely to result in significant avoidable patient deaths, readmissions, longer lengths of stay, and decreased patient satisfaction, in addition to excess Medicare costs and forgone cost savings to hospitals. Estimates represent only a 10 percentage-point dilution in skill mix; however, the team nursing model includes much larger reductions of 40-50 percentage-points-the human and economic consequences of which could be substantial.

Fully-automated CT derived body composition analysis reveals sarcopenia in functioning adrenocortical carcinomas

Determination of body composition (the relative distribution of fat, muscle, and bone) has been used effectively to assess the risk of progression and overall clinical outcomes in different malignancies. Sarcopenia (loss of muscle mass) is especially associated with poor clinical outcomes in cancer. However, estimation of muscle mass through CT scan has been a cumbersome, manually intensive process requiring accurate contouring through dedicated personnel hours. Recently, fully automated technologies that can determine body composition in minutes have been developed and shown to be highly accurate in determining muscle, bone, and fat mass. We employed a fully automated technology, and analyzed images from a publicly available cancer imaging archive dataset (TCIA) and a tertiary academic center. The results show that adrenocortical carcinomas (ACC) have relatively sarcopenia compared to benign adrenal lesions. In addition, functional ACCs have accelerated sarcopenia compared to non-functional ACCs. Further longitudinal research might shed further light on the relationship between body component distribution and ACC prognosis, which will help us incorporate more nutritional strategies in cancer therapy.

Red light game identifies ineffective criminal deterrence

AbstractThe proceeding investigates the ineffectiveness of law enforcement placement in specific circumstances from the penological framework of rational choice theory. This work employs game theory modeling to determine an individual's propensity to commit a crime. The succeeding illustrates how it is counterproductive to nudge potential criminals where socially preferable behavior corresponds to a pure strategy Nash equilibrium in a simultaneous two‐player game. The result of this analysis demonstrates an addendum to contemporary rational choice theory in criminology. The solutions of these stage games show that increasing the placement of criminal deterrents, like surveillance or fines intended to reduce the number of opportunities to commit deviant behavior, is dysfunctional under particular circumstances. This suggests that law enforcement resources should not be directed to enforcing certain crimes. The implications of this work could help optimize department assets and personnel hours.

Developing patient safety scale for hospitals.

The study aimed to contribute to the literature with a reliable and valid scale for hospitals to be used in determining the current patient safety culture and following up on its development. The study was conducted with the participation of 1137 healthcare professionals selected using the convenience sampling method in 3 secondary-care state hospitals and three research and training hospitals, one of which was affiliated with a medical faculty, and two were affiliated with the Health Sciences University. To begin with, to discover the latent structure of the items on the scale, an Exploratory Factor Analysis (EFA) was performed. Additionally, to determine the factor structure of the scale, the Confirmatory Factor Analysis (CFA) method was used. The Cronbach's alpha coefficient was calculated to check the reliability of the responses. According to Kaiser-Meyer-Olkin (KMO = 0.924) coefficient and the result of Bartlett's test of sphericity (χ 2 = 9748.777, df = 770), it was determined that the data structure was suitable for factor analysis. The Cronbach's alpha coefficient of the total scale was found to be 0.921. According to the EFA results, the scale was determined to have seven subscales, which were 1. Organizational Learning, Development, and Communication, 2. Management Support and Leadership, 3. Reporting Patient Safety Events, 4. Number of Personnel and Working Hours, 5. Response to Error, 6. Teamwork, and 7. Working Environment. The goodness-of-fit index results of the scale showed a good model fit (χ 2 / df = 3.04, RMSEA = 0.06, CFI = 0.97, NFI = 0.95, IFI = 0.97, SRMR = 0.06). The Cronbach's alpha coefficients of the subscales varied between 0.66 and 0.91. The results showed that the Patient Safety Scale for Hospitals is a valid and reliable measurement instrument for healthcare professionals.

Development of novel compact wind tunnel for testing efficacy of insecticide formulated products in mosquitoes.

Ultra-low volume (ULV) space sprays aerosolize insecticide formulated products (FP) to contact flying mosquitoes, while barrier sprays expose mosquitoes to FP residue on vegetation and other surfaces. Centers for Disease Control and Prevention bottle bioassays used to assess insecticide resistance are based on residual active ingredient (AI) exposure and do not directly relate to FP efficacy. The current pilot study developed a novel compact wind tunnel for mosquito exposure to FP. Caged Aedes albopictus and Culex pipiens/quinquefasciatus were exposed to undiluted Biomist®3 + 15 FP (permethrin AI) or air (control) within the wind tunnel, transferred to new cages, and held in a 28 °C incubator. Separate mosquitoes were exposed to residual permethrin AI (8 μg mL-1) in bottle bioassays. Mortality was monitored 15, 30, 60, and 120 min post-exposure. Chi-square tests (P < 0.05) showed significantly higher mortality in Aedes compared to Culex populations for most time points in both bioassay and wind tunnel exposure groups. As expected, mosquitoes exposed to Biomist®3 + 15 showed higher mortality rates than bottle bioassay exposure to permethrin. Two Culex colonies resistant to permethrin in bottle bioassays were susceptible to Biomist®3 + 15 in the wind tunnel. The novel compact wind tunnel developed here may be an alternative to field trials for testing FP efficacy, avoiding factors such as weather, logistical planning, and extended personnel hours. The wind tunnel could allow programs to conveniently test efficacy of multiple FP. Comparisons of different insecticide exposure methods provide practical information to inform operational decisions. © 2024 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Evaluating registry-based trial economics: Results from the STRESS clinical trial

BackgroundRegistry-based trials have the potential to reduce randomized clinical trial (RCT) costs. However, observed cost differences also may be achieved through pragmatic trial designs. A systematic comparison of trial costs across different designs has not been previously performed. MethodsWe conducted a study to compare the current Steroids to Reduce Systemic inflammation after infant heart surgery (STRESS) registry-based RCT vs. two established designs: pragmatic RCT and explanatory RCT. The primary outcome was total RCT design costs. Secondary outcomes included: RCT duration and personnel hours. Costs were estimated using the Duke Clinical Research Institute's pricing model. ResultsThe Registry-Based RCT estimated duration was 31.9 weeks greater than the other designs (259.5 vs. 227.6 weeks). This delay was caused by the Registry-Based design's periodic data harvesting that delayed site closing and statistical reporting. Total personnel hours were greatest for the Explanatory design followed by the Pragmatic design and the Registry-Based design (52,488 vs 29,763 vs. 24,480 h, respectively). Total costs were greatest for the Explanatory design followed by the Pragmatic design and the Registry-Based design ($10,140,263 vs. $4,164,863 vs. $3,268,504, respectively). Thus, Registry-Based total costs were 32 % of the Explanatory and 78 % of the Pragmatic design. ConclusionTotal costs for the STRESS RCT with a registry-based design were less than those for a pragmatic design and much less than an explanatory design. Cost savings reflect design elements and leveraging of registry resources to improve cost efficiency, but delays to trial completion should be considered.

A quantitative case study assessment of the biophysical and economic effects of three different feed management systems in a Northland farmlet trial

A three-year farm-systems trial was conducted in Northland from 2018–2021 with three independent 28-ha farms: 1) PAST: 2.7 cows/ha, no imported feed; 2) PKE: 3.1 cows/ha, palm kernel to meet pasture deficits; 3) PKE-PLUS: 3.1 cows/ha, palm kernel plus other supplementary feeds to meet pasture deficits. On average, cows on the PKE-PLUS farm were fed more supplementary feed and produced more milksolidsthan cows in the PAST and PKE farms (1328, 916 and 1209 kg MS/ha, respectively). Due to large variability in climate, pasture grown, milk and feed prices, there was no significant difference in mean operating profit ($2,636, $3,053, and $2,939 for the PAST, PKE and PKE-PLUS farms, respectively). The PAST farm had least personnel and machinery hours, and lowest methane emissions per hectare (316, 386 and 412kg methane/ha, for PAST, PKE and PKE-PLUS, respectively). The low-input system was more affected by climate, whereas supplementary-feed systems were affected by externalities (milk and feed prices). With increasing environmental challenges and the need to ensure appropriate staff, farm systems should be evaluated by considering environmental, personnel and profit, rather than just milk production. Greaterproduction may lead to more hours worked and more methane emissions, without any increase in profit.

Evaluation of Sexually Transmitted Disease Surveillance System Electronic Laboratory Processing in Florida: Automating Case Creation, Reporting, and Closure of Chlamydia and Gonorrhea Cases.

Each year, Florida Department of Health staff process hundreds of thousands of electronically received laboratory results for chlamydia (CT) and gonorrhea (GC). These processing steps are currently performed manually in Florida's surveillance system and divert from other sexually transmitted disease prevention efforts. We developed processes that would automate these procedures and evaluated the impact on potential programmatic time savings. We evaluated 575,952 electronic CT/GC laboratory results from January 2019 to December 2021. Laboratory results were processed through the newly automated procedures and algorithms. Expected time savings were projected using conservative estimates of 1 minute saved every time an automated process replaced a current manual procedure: profile matching, profile creation, event record creation, case review, and case reporting. Exceptions to automatic case reporting applied to certain higher-priority populations needing intervention. During this period, 297,348 electronic CT/GC laboratory results were received for people with no previous recorded history of sexually transmitted diseases and required profile creation. In total, 386,763 new surveillance infection records were created for reporting. Of reported cases, 127,345 were from higher-priority groups. The proposed automations would have saved an estimated 33,121 hours of staff time, about 11,040 hours or the work of 5.3 full-time staff annually. Automating current CT/GC laboratory processing would save thousands of personnel hours that could be redirected to higher-priority activities. Flexibility in prioritization criteria for automated case reporting allows programs to adjust automation to disease prevention priorities and resources. Similar automation procedures could be developed by other jurisdictions or health programs.

Workflow assessment of an augmented reality application for planning of perforator flaps in plastic reconstructive surgery: Game or game changer?

In contrast to the rising amount of financial investments for research and development in medical technology worldwide is the lack of usability and clinical readiness of the produced systems. We evaluated an augmented reality (AR) setup under development for preoperative perforator vessel mapping for elective autologous breast reconstruction. In this grant-supported research pilot, we used magnetic resonance angiography data (MR-A) of the trunk to superimpose the scans on the corresponding patients with hands-free AR goggles to identify regions-of-interest for surgical planning. Perforator location was assessed using MR-A imaging (MR-A projection) and Doppler ultrasound data (3D distance) and confirmed intraoperatively in all cases. We evaluated usability (System Usability Scale, SUS), data transfer load and documented personnel hours for software development, correlation of image data, as well as processing duration to clinical readiness (time from MR-A to AR projections per scan). All perforator locations were confirmed intraoperatively, and we found a strong correlation between MR-A projection and 3D distance measurements (Spearman r = 0.894). The overall usability (SUS) was 67 ± 10 (=moderate to good). The presented setup for AR projections took 173 min to clinical readiness (=availability on AR device per patient). In this pilot, we calculated development investments based on project-approved grant-funded personnel hours with a moderate to good usability outcome resulting from some limitations: assessment was based on one-time testing with no previous training, a time lag of AR visualizations on the body and difficulties in spatial AR orientation. The use of AR systems can provide new opportunities for future surgical planning, but has more potential for educational (e.g., patient information) or training purposes of medical under- and postgraduates (spatial recognition of imaging data associated with anatomical structures and operative planning). We expect future usability improvements with refined user interfaces, faster AR hardware and artificial intelligence-enhanced visualization techniques.

Programmable magnetic robot (ProMagBot) for automated nucleic acid extraction at the point of need.

Upstream sample preparation remains the bottleneck for point-of-need nucleic acid testing due to its complexity and time-consuming nature. Sample preparation involves extracting, purifying, and concentrating nucleic acids from various matrices. These processes are critical for ensuring the accuracy and sensitivity of downstream nucleic acid amplification and detection. However, current sample preparation methods are often laboratory-based, requiring specialized equipment, trained personnel, and several hours of processing time. As a result, sample preparation often limits the speed, portability, and cost-effectiveness of point-of-need nucleic acid testing. A universal, field-deployable sample preparation device is highly desirable for this critical need and unmet challenge. Here we reported a handheld, battery-powered, reconfigurable, and field-deployable nucleic acid sample preparation device. A programmable electromagnetic actuator was developed to drive a magnetic robot (ProMagBot) in X/Y 2D space, such that various magnetic bead-based sample preparations can be readily translated from the laboratory to point-of-need settings. The control of the electromagnetic actuator requires only a 3-phase unipolar voltage in X and Y directions, and therefore, the motion space is highly scalable. We validated the ProMagBot device with a model application by extracting HIV viral RNAs from plasma samples using two widely used magnetic bead kits: ChargeSwitch and MagMAX beads. In both cases, the ProMagBot could successfully extract viral RNAs from 50 μL plasma samples containing as low as 102 copies of viral RNAs in 20 minutes. Our results demonstrated the ability of ProMagBot to prepare samples from complex mediums at the point of need. We believe such a device would enable rapid and robust sample preparation in various settings, including resource-limited or remote environments, and accelerate the development of next-generation point-of-need nucleic acid testing.

The performance of wildfire danger indices: A Swedish case study

Wildfire danger indices, or fire danger rating systems, are widely used to inform decision-making related to wildfire risk management. Several studies have compared different indices’ performance; however, results have shown that this varies in different parts of the world. Further, many of these indices have not yet been assessed for Swedish conditions. In this study, four different weather-based wildfire danger indices have been investigated by comparing their performance in predicting wildfire activity when applied to Swedish conditions. Daily index values were calculated for seven Swedish geographical regions during 2018, a year with high wildfire activity. The aim of the study has been to rank the ability of the methods to predict wildfire danger in Sweden which is why a single year with high fire frequency has been chosen as the “test year”. The daily index values were compared to wildfire incident data, i.e.: fire and rescue service personnel hours spent on a fire, total burned area, and number of daily fire ignitions. Kendall’s Taub correlation coefficient was calculated for each index and wildfire data in the seven regions. The indices were then ranked based on the strength of the correlation. It was found that three of the indices (those based on cumulative weather data) exhibited a significantly higher correlation with wildfire activity than the fourth index. Further, the Fire Weather Index, developed in Canada and currently used in Sweden, was identified as a good choice for Swedish conditions when compared to the three other indices.

Comparing output from two methods of participatory design for developing implementation strategies: traditional contextual inquiry vs. rapid crowd sourcing

BackgroundParticipatory design methods are a key component of designing tailored implementation strategies. These methods vary in the resources required to execute and analyze their outputs. No work to date has examined the extent to which the output obtained from different approaches to participatory design varies.MethodsWe concurrently used two separate participatory design methods: (1) field observations and qualitative interviews (i.e., traditional contextual inquiry) and (2) rapid crowd sourcing (an innovation tournament). Our goal was to generate and compare information to tailor implementation strategies to increase the use of evidence-based data collection practices among one-to-one aides working with children with autism. Each method was executed and analyzed by study team members blinded to the output of the other method. We estimated the personnel time and monetary costs associated with each method to further facilitate comparison.ResultsObservations and interviews generated nearly double the number of implementation strategies (n = 26) than did the innovation tournament (n = 14). When strategies were classified into implementation strategies from the Expert Recommendations for Implementing Change (ERIC) taxonomy, there was considerable overlap in the content of identified strategies. However, strategies derived from observations and interviews were more specific than those from the innovation tournament. Five strategies (13%) reflected content unique to observations and interviews and 3 (8%) strategies were unique to the innovation tournament. Only observations and interviews identified implementation strategies related to adapting and tailoring to context; only the innovation tournament identified implementation strategies that used incentives. Observations and interviews required more than three times the personnel hours than the innovation tournament, but the innovation tournament was more costly overall due to the technological platform used.ConclusionsThere was substantial overlap in content derived from observations and interviews and the innovation tournament, although there was greater specificity in the findings from observations and interviews. However, the innovation tournament yielded unique information. To select the best participatory design approach to inform implementation strategy design for a particular context, researchers should carefully consider unique advantages of each method and weigh the resources available to invest in the process.

Cost benefit analysis of survey methods for assessing intertidal sediment disturbance: A bait collection case study

Coastal management requires cost-effective, yet accurate, assessments of habitat condition, especially in areas protected by statutory conservation measures. Unmanned Aerial Vehicles (UAVs) provide alternatives to manned aircraft and walk-over (WO) surveys. To support coastal managers with method selection, we compare the costs and benefits of the three techniques using the extent of bait collection (sediment scarring from manual digging) on intertidal mudflats from three UK sites. UAV and WO surveys were conducted in parallel and aerial photography was downloaded from the Channel Coastal Observatory (CCO). Digging was digitised from estimations on foot (WO) or by manually labelling imagery with confidence assigned (UAV/CCO). Method efficacy is compared with respect to spatial coverage, control over survey time/location, spatial resolution, positioning accuracy, and area of digging detected. Personnel hours and up-front costs (e.g. training/equipment), costs for personnel time standardised by shore area, personnel risk, and environmental impact are also compared. Regarding efficacy, CCO imagery had extensive shore coverage compared to UAV and WO, however, assessments are restricted to times/locations with available imagery. Each method's resolution was sufficient to detect digging. WO achieved the highest resolution (on foot), but the lowest positioning accuracy, in contrast to accurate feature delineation on aerial imagery. An additive two-way ANOVA revealed a significantly higher percent area of ‘dug’ sediment (all confidence levels) recorded by UAV than WO. CCO was the most cost-effective with no fieldwork/equipment costs. UAV had the highest up-front costs, but WO was more costly for personnel hours/km2 for survey time and digitisation. For all methods, digitisation was the most time-consuming aspect. Compared to WO, UAV achieved rapid shore surveys and the CCO and UAV methods minimise personnel risks. UAV and WO both cause wildlife disturbance, with trampling an additional WO impact. With each method suited to sediment disturbance assessment, selection will depend on resources and objectives and will be aided by this holistic cost-benefit analysis. Cost-effectiveness will improve with evolving regulations that facilitate UAV use and technological developments (e.g. machine learning for disturbance detection) that could significantly expedite imagery analysis and enable broadscale assessments from CCO or satellite imagery.

Introduction to this special section: Seismic acquisition

In the life cycle of a seismic product, the lion's share of the budget and personnel hours is spent on acquisition. In most modern seismic surveys, acquisition involves hundreds of specialized personnel working for months or years. Seismic acquisition also must overcome potential liabilities and health, safety, and environmental concerns that rival facility, pipeline, construction, and other operational risks. As only properly acquired data can contribute effectively to processing and interpretation strategies, a great deal of importance is placed on acquisition quality. Arguably, many of the advances the seismic industry has experienced find their origin arising from advances in acquisition techniques. Full-waveform inversion (FWI), for example, can reach its full potential only when seismic acquisition has provided both low frequencies and long offsets.

Detection of aflatoxin M1 by fiber cavity attenuated phase shift spectroscopy.

Aflatoxin M1 (AFM1) is a carcinogenic compound commonly found in milk in excess of the WHO permissible limit, especially in developing countries. Currently, state-of-the-art tests for detecting AFM1 in milk include chromatographic systems and enzyme-linked-immunosorbent assays. Although these tests provide fair accuracy and sensitivity, they require trained laboratory personnel, expensive infrastructure, and many hours to produce final results. Optical sensors leveraging spectroscopy have a tremendous potential of providing an accurate, real-time, and specialist-free AFM1 detector. Despite this, AFM1 sensing demonstrations using optical spectroscopy are still immature. Here, we demonstrate an optical sensor that employs the principle of cavity attenuated phase shift spectroscopy in optical fiber cavities for rapid AFM1 detection in aqueous solutions at 1550 nm. The sensor constitutes a cavity built by two fiber Bragg gratings. We splice a tapered fiber of < 10 μm waist inside the cavity as a sensing head. For ensuring specific binding of AFM1 in a solution, the tapered fiber is functionalized with DNA aptamers followed by validation of the conjugation via FTIR, TGA, and EDX analyses. We then detect AFM1 in a solution by measuring the phase shift between a sinusoidally modulated laser input and the sensor output at resonant frequencies of the cavity. Our results show that the sensor has the detection limit of 20 ng/L (20 ppt), which is well below both the U.S. and the European safety regulations. We anticipate that the present work will lead towards a rapid and accurate AFM1 sensor, especially for low-resource settings.

The effect of measurement geometry on patient specific QA pass/fail rates for stereotactic body radiation therapy (SBRT) Plans.

Patient quality assurance (QA) is a required part of the treatment care path, and plan failure can lead to increased personnel hours or delay of treatment. The recommendation by the American Association of Physicists in Medicine is that gamma analysis be used to evaluate measured volumetric modulated arc therapy plans. Vendors have developed many different measurement geometries for patient QA devices which could yield varying pass rates when used with the recommended tolerances, normalization, and criterion. For this study, clinically treated stereotactic body radiation therapy plans were used to evaluate differences in gamma dose tolerances and sampled dose distribution complexity for centralized or peripheral measurement geometries on a cylindrical phantom. Random errors were then introduced into a subset of these plans, and the differences in pass rates between the geometries were correlated with differences in the observed mathematical differences. Finally, a single clinically relevant target coverage deviation was introduced to another subset of plans to evaluate whether a particular geometry is measurably better at identifying clinically relevant errors. It was found that centralized geometries resulted in more lenient dose tolerances and less complex sampled dose distributions compared to peripheral geometries. Pass rates were uniformly lower in the peripheral measurement geometry, and the difference in pass rates between the geometries correlated strongly with the difference in dose tolerance and weakly with the difference in the chosen complexity metrics. However, neither of the geometries were sufficiently sensitive enough to detect clinically relevant changes to target coverage when using recommended tolerances and criteria, and no statistically significant difference was found between their pass rates. Given these findings, the authors concluded that stereotactic body radiation therapy plans could fail patient QA when measured in the peripheral geometry but pass in the centralized geometry, with possibly neither having correlation to true clinical deviation.

How the COVID-19 Epidemic Affected Prehospital Emergency Medical Services in Tehran, Iran.

IntroductionCoronavirus disease 2019 (COVID-19) has substantially impacted the healthcare delivery system in Tehran, Iran. The country’s first confirmed positive test for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was on February 18, 2020. Since then, the number of cases has steadily increased in Iran and worldwide. Emergency medical services (EMS) quickly adapted its operations to accommodate a greater number of patients, and it worked to decrease the risk of COVID-19 spread among EMS personnel, given the disease’s high transmissibility.MethodsWe evaluated the chief complaint as well as the pattern and number of EMS calls and dispatches during the 28-day intervals before and after the February 18, 2020, COVID-19 outbreak in Iran.ResultsEMS calls increased from 355,241 in the pre-outbreak period to 1,589,346 in the post-outbreak period, a 347% increase (p<0.001). EMS dispatches rose more modestly from 82,282 to 99,926, a 21% increase (p<0.001). The average time on telephone hold decreased from 10.6 ± 12.7 seconds pre-outbreak to 9.8 ± 11.8 seconds post-outbreak, a 7% decrease (p<0.001). The average length of call also decreased from 1.32 ± 1.42 minutes pre-outbreak to 1.06 ± 1.28 minutes post-outbreak, a 20% decrease (p<0.001). The highest number of daily dispatches occurred during the second and third weeks of the four-week post-outbreak period, peaking at 4557 dispatches/day. After the first reported case of SARS-CoV-2, there were significant increases in chief complaints of fever (211% increase, p<0.001) and respiratory symptoms (245% increase, p<0.001).ConclusionThe number of EMS calls and dispatches in Tehran increased 347% and 20%, respectively, after the outbreak of COVID-19. Despite this, the time on hold for EMS response decreased. The Tehran EMS system accomplished this by increasing personnel hours, expanding call-center resources, and implementing COVID-19-specific training.

Business process centric energy modelling

PurposeSustainability is an accepted measure of business performance, with reductions in energy demand a commonly practised sustainability initiative by multinational corporations (MNCs). Traditional energy models have limited scope when applied to the entire MNC as the models exhibit high data and time intensity, high technical proficiency, specificity of application and omission of non-manufacturing activities. The purpose of this paper is to propose a process centric energy model (PCEM), which adopts a novel approach of applying business processes for business energy assessment and optimisation. Business processes are a fundamental requirement of MNCs across all sectors. The defining features of the proposed model are genericity, reproducibility, minimum user input data, reduced modelling time and energy evaluation of non-manufacturing activities. The approach forwards the adoption of Industry 4.0, a subset of which focuses on business process automation or part thereof.Design/methodology/approachA quantitative approach is applied in development of the PCEM. The methodology is demonstrated by application to the procure to pay and electroplating business processes.FindingsThe PCEM quantifies and optimises the business energy demand and associated carbon dioxide emissions of the procure to pay and electroplating business processes, validating the application of business processes. The application demonstrates minimum user inputs as only equipment operational parameters are required and minimum modelling time as business process models and optimisation options are pre-defined requiring only user modification. As MNCs have common business processes across multiple sites, once a business process energy demand is quantified, its inputs are applied as the default in the proceeding sites, only requiring updating. The model has no specialist skills requirement enabling business wide use and eliminating costs associated with training and expert’s services. The business processes applied in the evaluation are developed by the researchers and are not as comprehensive as those in actual MNCs, but is sufficiently detailed to accurately calculate an MNC energy demand. The model databases are not exhaustive of all resources found in MNCs.Originality/valueThis paper provides a new approach to MNC business energy assessment and optimisation. The model can be applied to MNEs across all sectors. The model allows the integration of manufacturing and non-manufacturing activities, as it occurs in practice, providing holistic business energy assessment and optimisation. The model analyses the impacts of the adoption of Industry 4.0 technologies on business energy demand, CO2 emission and personnel hours.

Comparing the efficacy and cost-effectiveness of sampling methods for estimating population abundance and density of a recovering carnivore: the European pine marten (Martes martes)

Many methods are available to gather data on wildlife population parameters, such as population abundance and density, yet few have been compared or validated. We compared the efficacy of three survey methods (live trapping, hair tubes and scats) for estimating abundance and population density of the European pine marten (Martes martes) in Galloway Forest, Scotland. We evaluated these methods by, firstly, comparing the accuracy of the population estimate derived from each method, and, secondly, comparing the financial cost of each method. Molecular analysis of samples from all three methods was used to determine sex and individual genotype. Population abundance estimates were derived from capture-recapture programme Capwire. The non-invasive methods (hair tubes and scats combined) detected 81% of known individuals, although hair tubes and scats performed poorly alone, detecting 48% and 52% of individuals, respectively. Live trapping was the individual method that detected the most individuals (77%). Hair tubes were the most expensive method, both in financial cost and personnel hours, whilst scat sampling was the cheapest method. There was a highly significant association between the sex of the animal and the total number of detections by method. The population abundance estimate from all methods combined was 32 (95% CI 31–35) and the population density estimate was 0.27 martens/km2. This study indicates that a combined sampling approach comprising hair tubes and scats maximises the number of detections and provides a viable alternative to invasive live trapping.

Time Analysis of CIBMTR Forms: A Reporting Center's Perspective into Determining Personnel Hours and Reporting Burden.

There is a lack of published data on personnel time required to complete CIBMTR forms. Therefore, calculating the Full Time Employees (FTE) needed to complete Transplant Essential Data (TED) or Comprehensive Report Forms (CRF) is challenging. Reporting center supervisors are required to generate business justifications for the number of FTEs needed to meet the required data submission. Intuition or estimates are what guide FTE justification without quantified data. Barnes Jewish Hospital/Washington University School of Medicine performed a time analysis to determine actual personnel hours needed to complete forms, giving us the ability to calculate FTEs needed to meet current reporting burden and to anticipate future FTE needs. An opening meeting with Data Managers was scheduled to discuss the project and determine relevant forms to track. A paper data collection tool was created utilizing the feedback from this meeting. Time was recorded using a simple kitchen timer. Any time applied to complete the form was counted i.e. reviewing chart, completing form, and resolving any issues. No breaks or interruptions were counted. Reporting centers interpreting the data should take into account several considerations. The period of data collection was only six months. During data collection, Data Managers utilized both electronic and paper health records and had a specific transplant software to collect, integrate, and submit data through AGNIS. Other centers applying the data should make appropriate adjustments, depending on the institution's software and reporting practices. Despite the limitations, the time analysis data can provide a platform for reporting center supervisors to justify current FTEs and project future personnel requirements based on growth projections.