A combined modelling of fuzzy logic and Time-Driven Activity-based Costing (TDABC) for hospital services costing under uncertainty

Hospital traditional cost accounting systems have inherent limitations that restrict their usefulness for measuring the exact cost of healthcare services. In this regard, new approaches such as Time Driven-Activity based Costing (TDABC) provide appropriate information on the activities needed to provide a quality service. However, TDABC is not flawless. This system is designed for conditions of relatively accurate information that can accurately estimate the cost of services provided to patients. In this study, the fuzzy logic in the TDABC model is used to resolve the inherent ambiguity and uncertainty and determine the best possible values for cost, capacity, and time parameters to provide accurate information on the costs of the healthcare services. This approach has not yet been tested and used in determining the costs of services of a healthcare setting. Therefore, the aim of this study is to present a new Fuzzy Logic-TDABC (FL-TDABC) model for estimating healthcare service costs based on uncertainty conditions in hospitals. The proposed model is implemented in a sample of the hospital laboratory section and the results are compared with the TDABC system. The TDABC model, by allocating the activity costs including fixed costs and not considering the uncertainty regarding the cost, capacity, and time required for each patient, often estimates the unused capacity and costs with a higher margin of error. The results show that the maximum difference in the prescribed costs was 4.75, 3.72, and 2.85 in blood bank, microbiology, and hematology tests, respectively, mostly due to uncertainty in the costs of consumables, equipment and manpower (on average 4.54, 3.8, and 3.59, respectively). Also, The TDABC system, in comparison with the proposed system, estimates the unused capacity of the resource with more error. Cost of unused capacity derived using FL-TDABC were 80 of costs derived using TDABC. In conditions where the information is ambiguous, using the new system in hospitals can lead to a more accurate estimate of the cost compared to the TDABC system. Moreover, it helps hospital managers to make appropriate decisions about the use of capacity, capital budgeting, cost control, and etc. © 2018 Elsevier Inc

Sustained strain applied at high rates drives dynamic tensioning in epithelial cells

Epithelial cells experience long lasting loads of different magnitudes and rates. How they adapt to these loads strongly impacts tissue health. Yet, much remains unknown about the evolution of cellular stress in response to sustained strain. Here, by subjecting cell pairs to sustained strain, we report a bimodal stress response, where in addition to the typically observed stress relaxation, a subset of cells exhibits a dynamic tensioning process with significant elevation in stress within 100 s, resembling active pulling-back in muscle fibers. Strikingly, the fraction of cells exhibiting tensioning increases with increasing strain rate. The tensioning response is accompanied by actin remodeling, and perturbation to actin abrogates it, supporting cell contractility’s role in the response. Collectively, our data show that epithelial cells adjust their tensional states over short timescales in a strain-rate dependent manner to adapt to sustained strains, demonstrating that the active pulling-back behavior could be a common protective mechanism against environmental stress

Automotive Industry Response to its Global QMS Standard ISO/TS-16949

With increasing globalization, the intense competition and customer-pressure have spurred many producers from developing/ emerging countries to adopt the best management and organizational practices. The quality issues are paramount for automotive manufacturing. The multiplicity of Quality Management System (QMS) Standards prevalent till the 1990s finally gave way to development of a harmonized automotive industry-specific QMS, namely ISO/TS-16949. This paper analyzes the major factors motivating firms to adopt this Standard: its quality signaling function, especially in international business, and facilitative role in moving up the supply chain. We investigate the inter-national and inter-regional concentration of ISO/TS-16949 certificates and relate those changes to the automotive industry dynamics. Among the top certifying nations - China, India and Brazil included - these certificates and ‘cars and commercial vehicles’ produced are highly correlated. A moderate-to-high worldwide growth of this certification is probable in near future with its gaining popularity among Tier-2 suppliers and for two/ three-wheeler automotive production. The Indian evidence indicates a sizeable proportion of car and commercial vehicle plants being ISO/TS-16949 certified and a high certification incidence among large and medium-large auto component firms. We suggest the creation of a Centre to encourage and prepare SMEs and provide financial assistance for ISO/TS-16949 certification

Surface properties of glass micropipettes and their effect on biological studies

In this paper, an investigation on surface properties of glass micropipettes and their effect on biological applications is reported. Pipettes were pulled under different pulling conditions and the effect of each pulling parameter was analyzed. SEM stereoscopic technique was used to reveal the surface roughness properties of pipette tip and pipette inner wall in 3D. More than 20 pipettes were reconstructed. Pipette heads were split open using focused ion beam (FIB) milling for access to the inner walls. It is found that surface roughness parameters are strongly related on the tip size. Bigger pipettes have higher average surface roughness and lower developed interfacial area ratio. Furthermore, the autocorrelation of roughness model of the inner surface shows that the inner surface does not have any tendency of orientation and is not affected by pulling direction. To investigate the effect of surface roughness properties on biological applications, patch-clamping tests were carried out by conventional and FIB-polished pipettes. The results of the experiments show that polished pipettes make significantly better seals. The results of this work are of important reference value for achieving pipettes with desired surface properties and can be used to explain biological phenomenon such as giga-seal formation

Utilising neural networks and closed form solutions to determine static creep behaviour and optimal polypropylene amount in bituminous mixtures

WOS: 000311554400007The testing procedure in order to determine the precise mechanical testing results in Marshall design is very time consuming. Also, the physical properties of the asphalt samples are obtained by further calculations. Therefore if the researchers can obtain the stability and flow values of a standard mixture with the help of mechanical testing, the rest of the calculations will just be mathematical manipulations. Determination of mechanical testing parameters such as strain accumulation, creep stiffness, stability, flow and Marshall Quotient of dense bituminous mixtures by utilising artificial neural networks is important in the sense that, cumbersome testing procedures can be avoided with the help of the closed form solutions provided in this study. Marshall specimens, prepared by utilising polypropylene fibers, were tested by universal testing machine carrying out static creep tests to investigate the rutting potential of these mixtures. On the very well trained data basis, artificial neural network analyses were carried out to propose five separate models for mechanical testing properties. The explicit formulation of these five main mechanical testing properties by closed form solutions are presented for further use for researches

An Assessment Model for Hospital Resilience according to the Simultaneous Consideration of Key Performance Indicators: A System Dynamics Approach

Background: Globalization allows the effects of disruptions to cascade in the systems rapidly and a small disruption could lead to a broad catastrophe. Nowadays, disruptions are becoming more unpredictable, more frequent and more damaging. Hospitals are critical facilities which play an important role after disruptions. Number of deaths and injuries from disasters depends heavily on how hospitals serve people. Therefore, assuring the proper performance of hospitals under disruption is an important issue. Our approach to improve hospital performance is modelling the performance from resilience engineering perspective. Methods: First step towards building or designing a resilient organization is assessment and based on that a set of strategies or actions could be defined to increase resilience level. To address this issue, we considered hospital resilience as the maximum disruption that a hospital can tolerate and not be turbulent. We have proposed a model to assess hospital resilience. Four Key Performance Indicators (KPI) of hospitals, consisting patient satisfaction, patient waiting time, staff burnout and staff satisfaction, as well as variables affecting them were considered. System dynamics approach has been used to investigate the effect of disruptions on the four KPIs and multiple scenarios has been developed to assess the toleration of the hospital KPIs. Results: The results showed that human resources related factors has a significant impact on the resilience of the hospitals and their changes could lead to performance loss. In addition, number of beds can change the resilience level of the hospital dramatically. Conclusion: Disruptions change the exogenous factors. Therefore, hospital managers should define some strategies in order to prevent them such as staff related factors. The most important factor is number of beds and they should consider some extra capacities for emergency circumstances. © 202

A three-stage optimization model for scheduling facility maintenance considering random failure rates

The increasing value of facilities, on the one hand, and the complexity of the equipment used in them, on the other, have increased the importance of planning for the maintenance of facilities, especially for companies whose facilities are located in di erent locations. In this paper, a new hybrid model is presented to optimize facility maintenance scheduling by a combination of Genetic Algorithms (GA), Particle Swarm Optimization (PSO), and the Monte Carlo Simulation for organizing facilities located in di erent locations as well as determining the optimum number of crews with mechanical, electrical and simple skills. The main contributions of this paper include: (a) optimizing the number of crews by di erent skills in the rst stage; (b) evaluation of tness value for each solution through the Monte Carlo Simulation model; and (c) scheduling by considering di erent failure rates for di erent facilities in di erent locations. In order to evaluate the performance of the proposed model, the model has been compared with Golpira model, the results of which demonstrate that it is possible to reduce the cost by just over 39% and reduce Mean Time Between Failures (MTBF) by over half.</p

Study of sedative preanaesthetic and anxiolytic effects of herbal extract of Tilia platyphyllos scop in comparison with diazepam in the rat

Tilia platyphyllos scop belongs to the Tiliaceae family and mainly grows in northern parts of the country. It has various pharmacological effects including anxiolytic, antibacterial, anticonvulsant, spasmolytic, tranquilization and sedation, hypnotic and muscular relaxation. In order to study sedative, preanaesthetic and anxiolytic effects herbal extract of Tiliaplatyphyllos scop in comparison with diazepam in different groups of female Wistar rats with the same age and weight, doses of 150 mg/kg, 300 mg/kg and  450 mg/kg of herbal extract, 1.2 mg/kg of diazepam and equal volumes of dimethyl sulfoxide as a placebo were injected to rats intraperitoneally 30 minutes prior to evaluation of sedative and preanaesthetic effects (induced sleep duration following 40 mg/kg administration intraperitoneally) and anxiolytic effects (using elevated plus maze and Rotarod test). Statistical results obtained represent a significant increase in sleep time induced with ketamine and also a significant increase in time spent by rats in open arms of maze with high and low doses of Tiliaplatyphyllos scop herbal extract (

An optomechanogram for assessment of the structural and mechanical properties of tissues

AbstractThe structural and mechanical properties of tissue and the interplay between them play a critical role in tissue function. We introduce the optomechanogram, a combined quantitative and qualitative visualization of spatially co-registered measurements of the microstructural and micromechanical properties of any tissue. Our approach relies on the co-registration of two independent platforms, second-harmonic generation (SHG) microscopy for quantitative assessment of 3D collagen-fiber microstructural organization, and nanoindentation (NI) for local micromechanical properties. We experimentally validate our method by applying to uterine cervix tissue, which exhibits structural and mechanical complexity. We find statistically significant agreement between the micromechanical and microstructural data, and confirm that the distinct tissue regions are distinguishable using either the SHG or NI measurements. Our method could potentially be used for research in pregnancy maintenance, mechanobiological studies of tissues and their constitutive modeling and more generally for the optomechanical metrology of materials.</jats:p