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BACKGROUND: The American College of Surgeons requires continuous process improvement review to maintain trauma center verification. Paper-based systems to monitor and track performance improvement are commonly used but can be inadequate to monitor concurrent ongoing improvement effectively. OBJECTIVE: To describe the implementation of an electronic process to capture and monitor performance improvement in near real time. METHODS: In 2020, a Midwestern U.S. Level I adult trauma center and a Level II pediatric trauma center's trauma programs transitioned from a paper to an electronic file-sharing system for performance improvement. We converted our primary, secondary, and tertiary review documentation into a single electronic performance improvement file stored on the institution's virtual hard drive, accessible to designated staff, allowing continuous real-time updates. RESULTS: The electronic file-sharing and monitoring process reinvigorated the team and enhanced performance improvement efforts, leading to increased efficiency through documentation and effective loop closure. Real-time monitoring allowed the trauma program to identify opportunities for improvement and enact timely action plans, including targeted performance improvement projects, department education, and ongoing training. CONCLUSION: We found that implementing an electronic file-sharing system enhanced the trauma team's ability to monitor and trend performance improvement in real time. [ABSTRACT FROM AUTHOR]

This position paper aims to pave the way for a debate on a few under-explored, at least, perhaps even neglected, challenges we face when trying to improve building overall performance. Specifically, we suggest focusing on how the efforts to increase building energy efficiency, building safety, the home and workplace healthiness, and the comfort perceived by the users can be impaired by budget constraints, especially while operating in critical scenarios. On the one hand, restraints on capital expenditures by property owners and other investors affect the decision-making processes for the construction of new buildings or the renovation of existing ones. More beyond, rapidly developing demographic and other anthropological changes, as well as frequently occurred natural disasters, pose extra burdens on the players in the building industry and the real estate market. It has been a fact that the need to adapt to both budget constraints and challenging situations is seldom fully embedded in the studies focusing on improving building performance. Therefore, we call for attentions in research and publications to advocate for complementing the need. [ABSTRACT FROM AUTHOR]

The British government proposal to introduce drug budgets will compel general practitioners to consider the financial consequences of prescribing. In our country, the practitioner neither in the past nor now has an incentive to consider the cost of his prescription, and few efforts have been made to influence it, if we exclude the pharmacy industry. In the present article, the situation of both countries is analyzed and the answers of the general practitioners of Girona and Scotland to questions that examine their predisposition towards considering costs when prescribing are compared. The reduction of the prescription costs must be formulated as a part of a rational prescription and should employ a combination of approaches: education, feedback, administrative changes, and incentives. The procedures to encourage a more efficient use of medicines require an active participation of the practitioners in managing the resources of their practices.

Residency recruitment practices have undergone significant changes in the last several years. Interviews are nowconducted fully virtually leading to both positive and negative downstream effects, including decreased cost to applicants and programs, decreased time away from clinical activities, flexibility in scheduling, and increased applications for applicants and program directors. In response to these changes, the Association of Academic Physiatrists Residency and Fellowship Program Directors Council convened a workgroup consisting of program directors, program coordinators, residents, and medical students who reviewed the available literature to provide an evidence-based set of best practices for program leaders and applicants. Available data from the Association of American Medical Colleges and its relevance to future recruitment cycles are also discussed. [ABSTRACT FROM AUTHOR]

Based on publications related to the use of micro- and nanofibrillated cellulose (MNFC) in papermaking applications, three sets of parameters (intrinsic and extrinsic variables, furnish composition, and degree of dispersion) were proposed. This holistic approach intends to facilitate understanding and manipulation of the main factors describing the colloidal behavior in systems comprising of MNFC, pulp fibers, and additives, which directly impact paper product performance. A preliminary techno-economic assessment showed that cost reductions driven by the addition of MNFC in paper furnishes could be as high as USD 149 per ton of fiber (up to 20% fiber reduction without adverse effects on paper's strength) depending on the cost of papermaking fibers. It was also determined that better performance in terms of strength development associated with a higher degree of MNFC fibrillation offset its high manufacturing cost. However, there is a limit from which additional fibrillation does not seem to contribute to further strength gains that can justify the increasing production cost. Further research is needed regarding raw materials, degree of fibrillation, and combination with polyelectrolytes to further explore the potential of MNFC for the reduction of weight of paper products. [ABSTRACT FROM AUTHOR]

As acetonitrile is a widely used solvent for the chemical industry, the recovery of acetonitrile from acetonitrile wastewater is significant for both industrial cost reduction and environmental protection. In this article, a simple, low‐energy, and low‐cost strategy is proposed for the effective separation of acetonitrile from high‐concentration acetonitrile wastewater. The approach is based on a sequential combination of two steps: salt‐induced phase separation and hydrophobic filtration. The acetonitrile wastewater was first induced to split into two phases by salt, that is, the acetonitrile‐rich phase and the water‐rich phase, then the above two phases were poured into the hydrophobic filter paper funnel for the separation. It was shown that NaCl is a suitable salting‐out reagent, and that hydrophobic filter papers—obtained from modification by butyltrichlorosilane and octyltrichlorosilane were the optimal choice for hydrophobic filtration. The salt‐induced phase separation process is able to increase the volume fraction of acetonitrile in the acetonitrile‐rich phase up to 92%. The acetonitrile‐rich phase can pass through the hydrophobic filter paper, whereas the water‐rich phase was intercepted. The hydrophobic filter paper retained strong hydrophobicity and high acetonitrile‐separating capacity after 3 months storage, or upon immersion in acetonitrile‐water mixtures for 12 h, or applied for 25 consecutive separations. [ABSTRACT FROM AUTHOR]

Purpose - Demanding customers, legislation and raw materials shortages in the modern world have forced companies to minimize the system's environmental impact. The paper seeks to analyze the economic impact of blending in sustainable paper industries in countries such as India. Design/methodology/approach - A linear programming model for a paper supply chain is proposed to minimize paper manufacturing cost by optimally blending wood pulp and after-use paper under various conventional supply chain constraints. The issues of quality, environmental concern and reusability in the paper industry have also been taken into account. Findings - Improving quality of after-use paper by proper recovery network reduces the manufacturing cost. Increasing proportion of wood fiber in the finished paper decreases the cost, even at the cost of degradation in the environment. Thus, it is up to the manufacturer to reflect its degree of environmental concern to the government and society by assigning appropriate environmental and quality opportunity costs in the model. Research limitations/implications - Difficulty in obtaining the estimates of the environmental and quality cost is a major limitation of the study. Practical implications - This research provides manufacturers with a simple mathematical model to compare the economic feasibility of blending wood pulp and after-use paper depending on the market situation. Originality/value - The major contribution of the model is its capability to study the economic impact of blending by considering some of the important sustainable development issues like environment, quality, shortage, and reusability under one objective function. [ABSTRACT FROM AUTHOR]

In this work, poly(para-phenylene terephthalamide) (PPTA) paper sheets composed of PPTA fibers and PPTA fibrids filled with highly crystalline and high ratio of length to diameter potassium titanate whiskers (PTW) were investigated in view of possible employment as reinforcement and cost-reducing materials. The morphological characteristics and the role of PPTA fibrids, the influence of PTW on the mechanical properties, interfacial adhesion, and thermal stability of the PPTA paper sheets were discussed. The results showed that the ductile, flexible and rough morphological characteristics of PPTA fibrids are helpful to improve the properties of PPTA paper. PTTA fibrids strongly wrapped PTW in the PPTA paper sheet was observed, which largely enhanced the retention rate of PTW and further improved the interfacial combination. The presence of PTW improved the mechanical properties and thermal stability of PPTA paper sheets. This research demonstrated the improvement of thermal and mechanical performances of PPTA paper sheets by incorporating of PTW, suggesting a significant cost-reducing potential for the production of PPTA paper composite materials. POLYM. COMPOS., 38:1390-1395, 2017. © 2015 Society of Plastics Engineers [ABSTRACT FROM AUTHOR]

High-yield pulp can replace hardwood kraft in wood-free coated papers to increase bulk and reduce costs. This research was undertaken to study the effects of pulp substitution on brightness stability. Light-induced brightness loss was found to occur as a result of both high-yield pulp substitution and the yellowing of the coating color. However, coating improves the brightness stability. The improvement can be significant, depending on the extent of pulp substitution and the coat weight. For a 15% substitution of high-yield pulp, a coat weight of 20 g/m² gave the same brightness stability as a 100% kraft sheet coated at 4 g/m². An empirical model was developed to estimate the effect of high-yield pulp and coat weight on the brightness stability of wood-free coated papers. [ABSTRACT FROM AUTHOR]

Abstract: Reverse osmosis approach was used to dispose pulp and paper wastewater from a papermaking company. To meet the requirements of reverse osmosis membranes for water quality, a proper pretreatment had been done before raw water into RO membranes. A new efficient composite flocculant named PAFSSB had been used in the pre-treatment of pulp and paper wastewater. In the paper, the results showed that the treatment effect of PAFSSB was better, COD content was down to 10mg/L and COD removal rate was up to 75%. The pre-treatment process was simplified and processing costs were reduced. [Copyright &y& Elsevier]

Paper industry is one of major material and energy users in Finland, material costs being far bigger than energy costs. Energy saving is promoted in Finland by an energy service centre, subsidies and energy service companies (ESCOs). Material savings in production processes are typically used to reduce costs while life cycle material efficiency rather would require focusing, e.g. on product design. This could be promoted by total producer responsibility, economic instruments and environmental permits. For industrial sites with limited resources, MASCOs’ (Material Saving Companies) services could manage material savings, e.g. by funding the investments, planning and running the project. Authorities should put more emphasis on material auditing and information on material saving technologies and logistics. Material savings should also be included into the environmental permitting procedures. Materials saving services are developing and the projected Finnish material efficiency service centre could support new businesses. This article is based on a literature review and interviews of persons in paper producing companies and environmental authorities. We also analyse experiences of the first MASCO project in Finland. [Copyright &y& Elsevier]

This article examines the theory of a paperless workplace and its possible implementation in Extension, based on the advantages and disadvantages involved. Despite decades of discussion, many organizations, including Extension, have still failed to fully implement a paperless system. Paper is an integral part of our work; however, with budgetary cutbacks and the "going green" move, we need to reevaluate our dependency on hard copy documents. Consider the benefits of a paperless workplace and impacts of implementation for Extension and the community we serve. [ABSTRACT FROM AUTHOR]

Space Resource Utilization could reduce the mass, cost, and risks of future space activities. The many nonlinear and compounding effects mean that seemingly insignificant concept of operations choices can invalidate the conclusions of sophisticated analyses. Here we successively relax self-imposed constraints in a recent publication to demonstrate that the proximity of a market and the benefits of aerobraking cannot be omitted. • Earth Moon proximity allows a high cadence of space resource transportation. • Higher cadence allows costs to be amortized over a higher mass of delivered product. • A powerful economic advantage of the proximity of lunar resources is demonstrated. • Modifying a published model, we can show orders of magnitude reduction in costs. • Fair comparison of resource locations must incorporate multiple missions over time. [ABSTRACT FROM AUTHOR]

Abstract: Inventory pooling occurs when different actors share their inventories with the aim of reducing costs while improving performances. The paper-making industry requires large amounts of ready to install spares aimed at assuring high availability, but presents the drawback of excessive inventory costs. Pooling inventories, with the support of appropriate IT solutions, can be considered an effective strategy to improve availability while reducing the total costs. In the present work a real-life implementation within an important Italian paper-making district has been successfully carried out. Throughout the study the most recent theoretical models have been adapted after a methodical analysis that has been devoted to allow the identification and of the most significant issues and the building of a wide and solid agreement among the participants. Indeed, this required a thorough investigation, since the involved actors are generally competitors and only agree to pool inventories if this leads to increasing profits for themselves. [Copyright &y& Elsevier]

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Perinatal depression can have enduring adverse effects on women and their children and families, incurring substantial ongoing economic and personal costs. A significant proportion of the cost of perinatal depression relates to adverse impacts on the child, most likely mediated through impairment to the mother‐infant relationship. In recognition of this problem, Australia has invested in routine perinatal depression screening. Our previous research produced convergent findings suggesting that expected benefits for children have not yet been realised through perinatal depression screening. We question the potential of including a measure of personality in current perinatal depression screening for identifying maternal mental health problems and suboptimal mother‐infant relationships. This paper reviews our previous research findings within the broader context of perinatal depression screening. We propose a position, that perinatal depression screening in Australia should be redesigned to more precisely detect vulnerable mother‐infant relationships, parenting, maternal mental health, and infant psychosocial and psychological development. Practice change to appropriately target antenatal interventions may more efficiently improve both maternal and child outcomes, thereby contributing to greater efficiency and cost savings for the health system. [ABSTRACT FROM AUTHOR]

There has been a huge excess of low-cost paper on the market and a global price erosion of manufactured product. Paper Products Limited (PPL) -- a Trinidad-based tissue paper manufacturer, was ruthlessly exposed to this changing environment. This paper reviews a strategic realignment exercise which was done to determine the root causes of project failures, and to tailor-make a project management (PM) framework to govern process improvement projects at PPL. In order to quantify historical project performance and determine the reasons for historical project failure at PPL, a four (4) phase study was initiated. Phase-1 involved the analysis of projects undertaken from 2012 to 2015 on the cost, schedule and scope variances. Phase-2 determined the root cause of project failures, Phase-3 comprised the development of a PM framework, incorporating the common processes advocated in literature and the final phase involved testing the efficacy of the framework using selected projects at PPL. Trial implementation of the customised PM framework achieved a reduction in budget, schedule and scope variation by 20%, 18% and 1%, respectively. These performance improvements were attributable to enhancements in the framework's approach to developing the risk management plan, the work breakdown structure and the stakeholder management. As validated by an executive review of the PM framework, the adoption of the framework could enhance PM practices and sustain PM performance improvements at PPL. This case study demonstrates an initiative in fostering PM practices and performance in business. The results and implications of the analyses discussed are of potential value to the field of studies. Evaluations are suggested to examine critical processes and individual steps, and future studies could validate the key elements identified for the customised PM framework. [ABSTRACT FROM AUTHOR]

The article focuses on the costs of the existence of a maintenance, repair and operations (MRO) storeroom in a paper mill citing duplicated cost in the MRO supply chain which can be eliminated. Cost reduction programs, electronic procurement and other internet programs may provide levels of cost recovery for manufacturers.

Using the two criteria of potential CO2 reduction and cost of CO2 reduction, technical energy measures in Swedish pulp and paper mills are investigated. Principal CO2-reducing measures analysed are: decreased specific energy utilisation, fuel switch, and CO2 capture and sequestration. Among the investigated measures, conventional technologies for electricity conservation and improved electrical conversion efficiency in existing systems for cogeneration of heat and power are identified as the most cost-effective alternatives that also have large CO2 reduction potentials. For commercially available technologies, the results indicate an accumulated reduction potential of up to 8 MtCO2/y (14% of the Swedish net emissions). If emerging technologies for black liquor gasification (BLG) with pre-combustion CO2 capture and sequestration are considered, the CO2 reduction potential increases by up to 6 MtCO2/y (10% of the Swedish net emissions). Commercialised BLG, CO2 capture and reliable CO2 sequestration technologies are identified as important potential contributors to Swedish compliance with Kyoto Protocol targets, especially in a scenario of nuclear power closure. [Copyright &y& Elsevier]

Paper mill sludge (PMS) can be efficiently utilized to produce fuels and chemicals. However, wastewater is usually generated during the de-ashing step of the PMS for fibrous materials recovery. Per process requirements, the wastewater stream must be treated which results in an increase in the overall process production cost. Therefore, this research aims at reusing the wastewater produced during the de-ashing step as a substitute for freshwater addition during the conversion of PMS into ethanol. The advantages of this approach include reducing the amount of wastewater produced and enhancing the overall efficiency of the process. It will contribute to the circular economy of zero waste discharges. The results showed that 30% of the process wastewater can be recycled without affecting the enzymatic hydrolysis and ethanol fermentation. Hence, the amount of wastewater that needs to be treated is reduced by 30% resulting in a cost reduction of 22.5%. The results also showed that wastewater recycling minimized the energy demands in the distillation and evaporation units by 1206 kJ/kg. The energy reduction is due to the increase of metals and total soluble solids in the broth stream after fermentation. This process configuration enhanced the process economy, saved energy and managed waste streams. • Reuse of wastewater in the paper mill sludge conversion. • A certain degree of recycling has no impact on the glucose yield. • Wastewater recycling reduced the energy demand of the process by 1251 kJ/kg metric tons wastewater. • Cost-saving of wastewater treatment by 22.5% when a 30% recycling degree achieved. [ABSTRACT FROM AUTHOR]

The construction industry is characterized by its complex and dynamic nature, requiring efficient resource management practices for successful project execution. This systematic literature review aims to comprehensively analyze and synthesize existing research on resource management practices within the construction sector. By examining a wide array of scholarly articles, conference papers, and industry reports, this review identifies and evaluates the various methodologies, strategies, and tools employed for effective resource management in construction projects. The review encompasses an extensive analysis of key themes, including but not limited to labor management, equipment utilization, material procurement, and technological advancements in resource optimization. It delves into the challenges faced by the construction industry concerning resource allocation, skill shortages, cost control, sustainability concerns, and the impact of unforeseen disruptions. Furthermore, this review critically assesses the implications of resource management practices on project performance, encompassing aspects such as project timelines, budget adherence, quality control, and stakeholder satisfaction. The findings from this systematic review provide a comprehensive understanding of the current state of resource management practices in the construction industry. Additionally, it identifies gaps in the literature and suggests areas for future research, emphasizing the need for innovative approaches and adaptive strategies to address the evolving demands and complexities within construction project management. [ABSTRACT FROM AUTHOR]

Pulp and paper wastewater ozonation was tested at pilot-scale in a medium-potentiality wastewater treatment plant (143,000 population equivalent). Single wastewater lines (bleaching and process water), as well as wastewater mixture (before and after secondary biological treatment) were investigated to evaluate the best ozonation conditions. The aim of the work was to evaluate the feasibility of substituting current tertiary physicochemical treatment with an ozonation unit, reducing operating costs and improving management operations. The tests were useful to identify the ozone dosage required to achieve the desired COD abatement. Ozone effectiveness was more pronounced in process water (60% COD removal), rather than bleaching water (28% COD removal); ozone showed a significantly higher efficiency on pulp and paper wastewater mixture after biological treatment (up to 81% COD removal) rather than before biological process (46% mean COD abatement). COD removal efficiency at a dosage of 100 mg O 3 /L was comparable to existing physicochemical treatment (mean 50%); a good TSS abatement (up to 20–30 mg/L) was observed as well. Toxicity analysis revealed that ozonation treatment did not modify treated effluent toxicity characteristics (mean Daphnia Magna mortality of 23.3%). Economic analysis proved that ozonation installation cost would be 1.5–2.0 M€, for total flowrate to be treated of 1200 m3/h. Ozonation would lead to an economic saving of about 300,000 €/y compared to actual physicochemical treatment and the investment cost could be recovered in about 7 years. The proposed innovative approach, including plant analysis, pilot-ozonation tests, data regression, respirometric fractionation, toxicity and economic analysis, could be exported to other industrial wastewater treatment plants to allow an increased advanced oxidation processes diffusion. • Full-scale pulp and paper ozonation applicability was assessed with a pilot study. • Respirometry was coupled with pilot-tests, toxicity assays and economic analysis. • Wastewater mixture effectiveness was related to streams biodegradability. • Daphnia Magna toxicity in ozonated stream was comparable with secondary effluent. • An economic saving of about 300,000 €/y was estimated for full-scale operations. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to study the internationalisation of management accounting research in the German-speaking countries and to analyse whether researchers from these countries rely on their intellectual heritage or adapt to the conventions prevailing in the international community. Design/methodology/approach: This paper provides a research taxonomy of 273 papers published by management accounting researchers from the German-speaking countries between 2005 and 2018 in domestic and international journals with regard to topics, settings, methods, data origins and theories of these papers. The study also systematically compares these publications with the publications by international scholars as synthesised in selected prior bibliometric studies. Findings: The findings suggest that German-speaking researchers increasingly adapt to the conventions prevailing in the international management accounting literature. Indicative of this development is the crowding out of traditional core areas of German-speaking management accounting such as cost accounting by management control topics. The study also finds that German-speaking researchers increasingly rely on the research methods and theories prevailing internationally. Research limitations/implications: The paper documents considerable changes in the publications of management accounting researchers from the German-speaking countries. These changes raise the question how other national research communities internationalise and whether these processes lead to a greater homogenisation of international management accounting research, which might impair the advancement of management accounting knowledge. Originality/value: This paper provides first empirical evidence on how management accounting research conducted in the German-speaking countries has changed in the course of the internationalisation of the research community and builds an important basis for future research in other geographic settings. [ABSTRACT FROM AUTHOR]

Direct internal reforming (DIR) operation of a solid oxide fuel cell (SOFC) is a very attractive concept for downsizing and cost reduction of SOFC systems. This study aimed to develop stable operation of a DIR-SOFC fuelled by biogas. The current-voltage (I-V) curves of 2 × 2 cm 2 planar SOFCs (anode- and electrolyte-supported cells, ASC and ESC, respectively.) were measured at 800 °C in the direct feed of a simulated biogas mixture (CH 4 /CO 2 = 1), and the flexible structured catalyst material (paper-structured catalyst (PSC)) was applied on the anode material for performance enhancement. By applying a hydrotalcite (HT)-dispersed PSC (HT-PSC), the sulfur tolerance of the SOFC in the DIR operation was remarkably improved. By the effect of the HT-PSC, for both ASC and ESC, a stable cell voltage higher than 800 mV was obtained over 200 h at 0.2 A cm −2 in the direct feed of simulated biogas under 5 ppm H 2 S poisoning. [ABSTRACT FROM AUTHOR]