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Background: Community health workers (CHWs) remain an underutilized resource in social risk diagnostics in the primary care setting. This process evaluation study seeks to assess the role of CHWs in social risk screening, referral, and follow-up through process mapping to identify barriers to the process for future quality improvement efforts. Methods: Researchers at the Arizona Prevention Research Center (AzPRC) engaged with two Federally Qualified Health Centers (FQHCs) in two of Arizona's major urban areas to evaluate their internal processes for social risk screening and intervention. The Consolidated Framework for Implementation Research (CFIR) was used to direct a process mapping exercise to visually describe the workflow, gaps, and barriers to identifying and addressing social risk. Results: The process unveiled key areas for health system improvements in the community setting, the organizational setting, and in the implementation of social risk screening, referral, and follow-up. Further, process maps highlight the potential resources needed for effective CHW integration to address social risk in the primary care setting. Conclusions: Our findings demonstrate the importance of organizational tools, such as process mapping, to assist primary care settings in evaluating internal processes for quality improvement in addressing social risk and in effectively integrating the CHW workforce. Subsequent research will evaluate rates of social risk screening, referral, and follow-up within all of Arizona's FQHCs and propose models for CHW integration to address social risk in primary care and strengthen social risk screening reach and effectiveness. [ABSTRACT FROM AUTHOR]

Abstract Background Community health workers (CHWs) remain an underutilized resource in social risk diagnostics in the primary care setting. This process evaluation study seeks to assess the role of CHWs in social risk screening, referral, and follow-up through process mapping to identify barriers to the process for future quality improvement efforts. Methods Researchers at the Arizona Prevention Research Center (AzPRC) engaged with two Federally Qualified Health Centers (FQHCs) in two of Arizona’s major urban areas to evaluate their internal processes for social risk screening and intervention. The Consolidated Framework for Implementation Research (CFIR) was used to direct a process mapping exercise to visually describe the workflow, gaps, and barriers to identifying and addressing social risk. Results The process unveiled key areas for health system improvements in the community setting, the organizational setting, and in the implementation of social risk screening, referral, and follow-up. Further, process maps highlight the potential resources needed for effective CHW integration to address social risk in the primary care setting. Conclusions Our findings demonstrate the importance of organizational tools, such as process mapping, to assist primary care settings in evaluating internal processes for quality improvement in addressing social risk and in effectively integrating the CHW workforce. Subsequent research will evaluate rates of social risk screening, referral, and follow-up within all of Arizona’s FQHCs and propose models for CHW integration to address social risk in primary care and strengthen social risk screening reach and effectiveness.

Simple Summary: Amphibians are vitally important in biomedical research and conservation. Preserving germplasm materials (e.g., sperm, egg, embryos) in cryopreserved form can reduce the costs and risks associated with maintenance of live organisms. The goal of this work was to establish an initial practical sperm cryopreservation pathway for axolotls (Ambystoma mexicanum) to provide a foundation for development of germplasm repositories. The specific objectives were to (1) establish an efficient approach for sperm collection and quality evaluation; (2) evaluate the effects of osmotic pressure of extender solutions on sperm quality during refrigerated storage; (3) evaluate the effects of cryoprotectants on post-thaw sperm quality; (4) evaluate the feasibility of fertilization with thawed sperm; and (5) establish a cryopreservation pathway by integrating the findings into a comprehensive process flow map. With this approach, axolotl offspring were produced with cryopreserved sperm for the first time. Future research can build from this work with the goal of developing a germplasm repository based on community-level integration at the Ambystoma Genetic Stock Center. The axolotl (Ambystoma mexicanum) draws great attention around the world for its importance as a biomedical research model, but housing and maintaining live animals is increasingly expensive and risky as new transgenic lines are developed. The goal of this work was to develop an initial practical pathway for sperm cryopreservation to support germplasm repository development. The present study assembled a pathway through the investigation of axolotl sperm collection by stripping, refrigerated storage in various osmotic pressures, cryopreservation in various cryoprotectants, and in vitro fertilization using thawed sperm. By the stripping of males, 25–800 µL of sperm fluid was collected at concentrations of 1.6 × 106 to 8.9 × 107 sperm/mL. Sperm remained motile for 5 d in Hanks' Balanced Salt Solution (HBSS) at osmolalities of 100–600 mOsm/kg. Sperm cryopreserved in 0.25 mL French straws at 20 °C/min in a final concentration of 5% DMFA plus 200 mM trehalose and thawed at 25 °C for 15 s resulted in 52 ± 12% total post-thaw motility. In six in vitro fertilization trials, 20% of eggs tested with thawed sperm continued to develop to stage 7–8 after 24 h, and a third of those embryos (58) hatched. This work is the first report of successful production of axolotl offspring with cryopreserved sperm, providing a general framework for pathway development to establish Ambystoma germplasm repositories for future research and applications. [ABSTRACT FROM AUTHOR]

Systems‐theoretic process analysis (STPA) is a prospective safety assessment tool increasingly applied in healthcare. A problem hampering STPA proliferation is the difficulty of modeling systems for analysis by creating control structures. In this work, a method is proposed to use existing process maps—commonly available in healthcare—when creating a control structure. The proposed method entails (1) extract information from the process map, (2) determine the modeling boundary of the control structure, (3) transfer the extracted information to the control structure, (4) add additional information to complete the control structure. Two case studies were conducted: (1) ambulance patient offloading in the emergency department and (2) ischemic stroke care with intravenous thrombolysis. The amount of process map‐derived information in the control structures was quantified. On average, 68% of the information in the final control structures was derived from the process map. Additional control actions and feedback were added from nonprocess map sources for management and frontline controllers. Despite the differences between process maps and control structures, much of the information in a process map can be used when creating a control structure. The method enables the creation of a control structure from a process map to be done in a structured fashion. [ABSTRACT FROM AUTHOR]

A model has been developed for describing the competition between the formation of microalloyed carbonitrides by strain-induced precipitation (SIP) and by epitaxial growth on pre-existing TiN particles in γ-Fe. It is assumed that Nb and C/N atoms in the matrix will either feed the growth of pre-existing TiN precipitates or precipitate as new strain-induced particles. The model is successfully applied to the data set obtained by transmission electron microscopy (TEM) in a model alloy. Using this model, it is possible to estimate the effects of process parameters (T, applied strain), the number density of pre-existing TiN, and the Nb, C, N and Mn content on precipitate evolution and precipitation hardening. Notably, it is shown that the presence of a high number density of pre-existing TiN precipitates can suppress SIP. The conditions where epitaxial growth dominates and those in which strain-induced precipitation dominates are predicted and summarized in the form of processing maps.

Purpose: Health systems worldwide have sustainability concerns due to rising demand and healthcare services costs. Value-based healthcare (VBHC) may solve all sustainability challenges by improving health outcomes. Improving outcomes is the only effective approach to cutting healthcare expenses. Cost-assessment methodologies that can give high-quality cost information are required to implement value-based initiatives. Time-driven activity-based costing (TDABC) method, a cost component of VBHC, has been increasingly adopted to close the cost-information gap. Materials Methods: The study calculates prosthetic dental treatment costs with the time-driven activity-based costing method. Data for this study were collected from the prosthesis department of a dental hospital in 2019. Results: The department's total practical capacity was estimated as 1,365,888 min for dentists and 328,320 minutes for patient consultants. The dentist capacity cost rate was calculated as 1.71 TL/min and for a patient consultant as 0.69 TL/min. Total prosthetic dental treatment costs range between 252.7TL and 304TL, depending on complications, emergencies, consultation or sedation needs. Conclusion: Activity-Based Costing provides accurate cost information and improves the process by making costs and activities more transparent. The prosthetic dental treatment process was presented transparently in the study. The costing model was designed to be expanded concerning the patient's urgency, the consultation and sedation needs. The cost of only one procedure was calculated in the study, and it is planned to evaluate all department activities in future research.

Background: The effective and efficient operation of emergency services at healthcare depends on triage decisions. Successfully implementing a triage system improves patient care, communication, and self-assurance. Methods: A baseline audit was conducted by reviewing a sample of 554 triage health records in September 2021. Many gaps were identified in the practice, and action plans were developed for improving it. Following the implementation of the action plan, a re-audit was conducted in September 2022 with a sample of 470 medical records. Results: Evidence suggested that nurses had made progress in correctly allocating the medical emergency triage category from 63% at baseline to 90% at the reaudit. The over-triage decreased in accordance with this adjustment, from 37% to 10%. Compliance with the suggested time target of 5 minutes for physicians to attend medical emergencies has shown a small improvement from 48% at baseline to 55% in the re-audit. Similar improvements were demonstrated in the other triage categories. Conclusion: A problem may have several causes, and since it is impossible to address every one of them, prioritizing the causes is usually the best course of action. Inadequate triage classification by nurses was one of the key reasons for the delay in physician appointment times in triage clinics. Triage nurses' abilities should be enhanced to make this triage judgment. The audit team suggested that nurses should be given problem-based training, which will enhance the entire triage procedure. [ABSTRACT FROM AUTHOR]

Despite the importance of life cycle assessment (LCA) in inspecting environmental impacts, its execution through manual methods affects the quality of the results, besides consuming the time and effort of decision-makers in the construction industry, such as designers, implementers, facility managers, and consultants. When LCA relies on building information modeling (BIM), it encounters many difficulties and obstacles, such as human intervention, conflicts among platforms and environmental databases, and no coordination to integrate or manage information. Thus, the research aims to support LCA through automatized integration with BIM depending on BIM's role in information management, promoting decisions, and activating BIM implementation success factors to make the BIM model qualified for the LCA. Then, the BIM and LCA overlap methods were analyzed and exemplified. Also, the requirements of their integration strategies were identified for LCA to become automated from now. Accordingly, the process map that supports and coordinates the automatized integration of LCA and BIM, overcomes integration difficulties, and conducts LCA through automated methods was deduced and structured. The analytical hierarchy process was applied through the survey using questionnaires and interviews to validate this map. The survey affirmed that the BIM model acquired new characteristics and will play an essential role in the LCA's accuracy, reliability, and comprehensiveness. This map supports the standardization and alternative strategies of the workflow. Furthermore, the interconnected stages of this map as a scenario can conduct an LCA within any project's life stage and guarantee its quality. [ABSTRACT FROM AUTHOR]

An efficient approach for virtual prediction of melt pool geometry and temperature distribution in selective laser melting (SLM) is required to optimize the process parameters for eventually printing high-fidelity parts. In this study, the melt pool geometry in the SLM process was simulated by employing Ansys Additive, the commercial finite element analysis software tool. First, a single track of 4 mm length was modeled for Inconel 718 material by varying the process parameters. Validations with existing studies were performed to ensure the reliability of the FE model. Further, a process map exhibiting the optimum process parameters window for SLMed Inconel 718 was developed, which can be used to avoid process-induced defects such as lack of fusion, balling, and keyholing. The response surface methodology design of experiment technique and ANOVA-based regression modeling were used to relate the vital SLM process parameters with the melt pool geometry. The statistical analysis results showed that maximum melt pool depth and width are obtained at maximum laser power and at minimum scan speed and layer thickness. The proposed approach facilitates robust 3D printing by avoiding common process-induced defects as well as allows the tuning of vital process parameters for fabricating superior quality SLM builds. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to estimate prosthetic dental treatment costs and demonstrate that more accurate clinical cost information can be reached by using the time-driven activity-based costing method in a medical faculty hospital. Materials and Methods: The research is a retrospective descriptive study that analyzes and assesses financial, administrative, and medical data. The population of the study is comprised of the prosthesis department of a dental hospital in 2019. Time Driven Activity Based Costing method was applied for the cost estimation of dental prosthesis treatment. Results: After estimating the cost of the treatment, results were compared to the social security institution payment amount for dental prosthesis treatment, and total dental prosthesis treatment costs were calculated as $133.22. Conclusions: The research findings indicate that the Time Driven Activity Based Costing approach provides more precise insights into the cost structure of dental practices and can be easily adopted by other healthcare providers. [ABSTRACT FROM AUTHOR]

VDM Alloy 780 is a novel Ni-based superalloy that allows for approximately 50 °C higher operating temperatures, compared to Inconel 718, without a significant decrease in mechanical properties. The age hardenable NiCoCr Alloy combines increased temperature strength with oxidation resistance, as well as improved microstructural stability due to γ′-precipitation. These advantages make it suitable for wear- and corrosion-resistant coatings that can be used in high temperature applications. However, VDM Alloy 780 has not yet been sufficiently investigated for laser metal deposition applications. A design of experiments with single tracks on 316L specimens was carried out to evaluate the influence of the process parameters on clad quality. Subsequently, the quality of the clads was evaluated by means of destructive and non-destructive testing methods, in order to verify the suitability of VDM Alloy 780 for laser metal deposition applications. The single-track experiments provide a basis for coating or additive manufacturing applications. For conveying the results, scatter plots with regression lines are presented, which illustrate the influence of specific energy density on the resulting porosity, dilution, powder efficiency, aspect ratio, width and height. Finally, the clad quality, in terms of porosity, is visualized by two process maps with different mass per unit lengths. [ABSTRACT FROM AUTHOR]

In order to capitalize on the cost-effectiveness of additive manufacturing (AM), it is critical to understand how to build components with consistency and high quality. Directed energy deposition (DED) is an AM method for creating parts layer by layer through the use of a moving heat source and powder material inserted into the melt pool generated on the substrate. DED, like most AM processes, is highly complex due to the rapid thermal gradients experienced during processing. These thermal gradients are determined by a variety of processing parameters, which include laser power, powder feed rate, travel speed, layer height hatch spacing, etc. A lot of effort has been carried out in the additive manufacturing community to understand what these critical parameters are and how they influence the thermal gradients. Despite all these efforts, AM industries rely on a trial-and-error-based approach to find the right set of parameters to produce a quality part. This is time-consuming and not a cost-effective use of AM technology. The aim of our research is to reduce the amount of experimental data in combination with numerical analysis to optimize this relationship. Physics-based two-dimensional melt-pool modeling and experimental results from an OPTOMEC 850M LENS will be utilized to investigate the effects of processing parameters on melt-pool geometry, and the results from this study will provide key processing guidelines to achieve desirable clad geometry and powder efficiency for the DED method. [ABSTRACT FROM AUTHOR]

Objectives A number of regulatory and accrediting bodies require the reporting of critical results on a timely basis (immediately or within the time frame established by the laboratory) to “the responsible, licensed caregiver” as timely notification of critical laboratory results can pivotally affect patient outcome. The aim of the study was to decrease the turnaround time (TAT) of critical result notification along with assurance of notification to the concerned caregiver or clinicians. The objectives was 30% reduction in the critical value notification TAT and identify factors associated with delayed reporting and root cause analysis for these factors by application of quality tools. Materials and Methods The study was conducted at the Institute of Human Behavior and Allied Sciences, Delhi, a tertiary center teaching Hospital, from April 2019 to June 2021. A value streamed Process Map of critical alert was prepared. The incidents related to failure were presented through Pareto chart. The possible causes were analyzed through the fishbone model. The failure mode prioritization was executed with Failure Mode and Effect Analysis (FMEA). Through extensive brainstorming, appropriate and feasible corrective actions were implemented. The effectiveness of the implemented plan was analyzed by reassessing the TAT of critical alert and feedback received by clinical caregivers. Results After implementation of corrective action plan using quality tools for 3 months, the average critical alert TAT was reduced to 21 minutes from 30 minutes (30% reduction). The median critical alert TAT for ICU, emergency, and IPD were reduced to 3 minutes (IQR: 1–7). During the pilot project, 156 critical value data were sent for feedback with treatment plan but was received only for 88 patients (56%). Conclusion Comprehensive utilization of quality tools has a potential role in patient safety by reducing the critical alert TAT as well as establishing an effective communication between laboratory personnel and clinicians.

Less polluting and more efficient projects can be developed when considering sustainability and constructability in the initial phases of building design. The building information modeling (BIM) methodology uses 3D graphical modeling and parametrized objects and, thus, provides an environment that can seamlessly assess these factors. An in-depth systematic literature review revealed that when these issues are addressed using BIM, they are not considered within the same framework. To address this gap in knowledge, the present work proposes a BIM-based workflow that involves the different agents in a construction, in order to promote a greater participation of builders and environmental specialists at the initial stages of the design. In addition, a plugin is developed in the Autodesk Revit software, named ECOS, that quantifies the constructability and sustainability of a project and identifies which aspects of the project are deficient within this context. ECOS also provides a cost criterion, as this is also an important aspect when evaluating a project. The proposed workflow and the plugin are tested and validated through a survey in conjunction with interviews of sixteen architectural and engineering professionals. The results show that the proposed process map associated with ECOS form a useful framework to promote greater participation of builders and environmental engineers in the initial stages, and, thus, can promote more sustainable designs with better constructability. [ABSTRACT FROM AUTHOR]

The axolotl (Ambystoma mexicanum) draws great attention around the world for its importance as a biomedical research model, but housing and maintaining live animals is increasingly expensive and risky as new transgenic lines are developed. The goal of this work was to develop an initial practical pathway for sperm cryopreservation to support germplasm repository development. The present study assembled a pathway through the investigation of axolotl sperm collection by stripping, refrigerated storage in various osmotic pressures, cryopreservation in various cryoprotectants, and in vitro fertilization using thawed sperm. By the stripping of males, 25–800 µL of sperm fluid was collected at concentrations of 1.6 × 106 to 8.9 × 107 sperm/mL. Sperm remained motile for 5 d in Hanks’ Balanced Salt Solution (HBSS) at osmolalities of 100–600 mOsm/kg. Sperm cryopreserved in 0.25 mL French straws at 20 °C/min in a final concentration of 5% DMFA plus 200 mM trehalose and thawed at 25 °C for 15 s resulted in 52 ± 12% total post-thaw motility. In six in vitro fertilization trials, 20% of eggs tested with thawed sperm continued to develop to stage 7–8 after 24 h, and a third of those embryos (58) hatched. This work is the first report of successful production of axolotl offspring with cryopreserved sperm, providing a general framework for pathway development to establish Ambystoma germplasm repositories for future research and applications.

Background and purpose: Online magnetic resonance-guided adaptive radiotherapy (MRgART) is a new technology of radiotherapy and requires a new quality control program in many aspects. This study aimed to gain a deeper understanding of risks in online MRgART through the application of failure mode and effect analysis (FMEA) for more enhanced and effective quality assurance (QA) programs. Materials and methods: We present an FMEA conducted by a multidisciplinary team with more than two years of experience. A process map describing the whole process of online MRgART was developed and potential failure modes were identified. High-risk failure modes and their potential causes and corrective measures were also identified. Failure modes were classified into three categories, MRgRT, online ART, and conventional RT, to investigate their features. A comparison with previous studies was also conducted to gain a general perspective. Results: In total, 153 failure modes and 49 high risks were identified. Among all failure modes, 51, 63, and 66 were related to MRgRT, online ART, and conventional RT, respectively. The hazardous processes were structure segmentation, treatment planning, and treatment beam delivery. Lists of failure modes identified in this study and previous studies were presented. Based on the results, characteristics and general aspects of the risks were discussed. Conclusion: Exploring the results of the FMEA enhanced our understanding of risk characteristics to improve QA program of online MRgART.

Understanding students' learning characteristics is central to successfully designing student-centered learning. Particularly in the problem-solving area, it is vital to know that students can possess their styles to solve problems, which should be considered central to addressing adaptive learning. To date, analyzing students' learning characteristics has been mainly based on their final answers. However, there is a limit to understanding the thinking process of students with the correct answer, because their responses are, de facto, singular and identical. With this background, we propose an approach for investigating students' cognitive behavior in problem-solving using response time in the process data. In this paper, we analyzed an item in Programme for International Student Assessment 2012 Creative Problem Solving (CP038q1). We analyzed log data from the PISA CPS item Ticket encompassing 30,453 students (7,196 students with the correct answer and 23,257 students with incorrect answers) from 42 countries. We found that students with the correct answer are categorized into four clusters, and the problem-solving patterns of each cluster are distinguishable. We also showed the internal validity of this approach by confirming that students with incorrect answers can also be similarly classified. Our results indicate that allotted response time in an item can shed light on several distinguished problem-solving patterns, which implies that adaptive learning and feedback are vital for them. [ABSTRACT FROM AUTHOR]

Copyright of Revista El Directivo al Día is the property of Centro de Informacion y Gestion Tecnologica (CIGET) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Safety is a well-researched yet underperforming management aspect of the construction industry. Building information modeling (BIM) can help, and some frameworks have addressed safety management in limited phases of the project lifecycle. This study positions BIM centrally in the safety management process and develops a safety management framework that covers the entire lifecycle of a construction project in the context of developing countries. A systematic literature review is conducted to identify the safety factors and BIM features that are synthesized to devise BIM-based safety improvement strategies. The strategies are presented to construction management professionals from developed and developing countries through an online questionnaire survey, and their level of agreement is identified. Afterward, construction safety experts are engaged to integrate these strategies into appropriate lifecycle phases. Additionally, these experts are also engaged to develop an automated hazard recognition process to leverage BIM potential in safety management. The integration of strategies into project lifecycle phases resulted in a comprehensive safety implementation framework leveraging the BIM platform. This framework takes a lead from the experience of developed countries and considers the limitations of developing countries in terms of resources and technology. Furthermore, a BIM-based process map for hazard identification is developed. The process map takes the BIM model as input and provides a detailed safety report. The process map can be automated to enhance effective safety management. This study expands the body of knowledge through a BIM-driven lifecycle safety management framework for developing countries where BIM adoption is still in its early stages. It is a fresh take on safety automation to make the construction industry safer and more reliable. However, it is limited due to inadequate safety reporting and documentation in developing countries. Future research can improve upon this limitation by positioning in a safety-compliant culture. [ABSTRACT FROM AUTHOR]

Comprehensive biomarker testing for patients with non-small cell lung cancer is critical for selecting appropriate targeted therapy or immunotherapy. Ensuring timely ordering, processing, and reporting is key to optimizing patient outcomes. However, various factors can prevent or delay patients from being offered the option of treatment selection based on comprehensive biomarker testing. These factors include problems with access to testing, tissue adequacy, turnaround time, and health insurance coverage and billing practices. Turnaround time depends on several logistical and tissue handling factors, which involve institutional policies, processes, resources, testing methodology, and testing algorithms that vary across different practices. In this article, the authors identify key factors that prolong biomarker testing turnaround time, propose strategies to reduce it, and present a process map to aid physicians and key organizational stakeholders in improving testing efficiency., (© 2024 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Background: Bolus materials have been used for decades in radiotherapy. Most frequently, these materials are utilized to bring dose closer to the skin surface to cover superficial targets optimally. While cavity filling, such as nasal cavities, is desirable, traditional commercial bolus is lacking, requiring other solutions. Recently, investigators have worked on utilizing 3D printing technology, including commercially available solutions, which can overcome some challenges with traditional bolus., Purpose: To utilize failure modes and effects analysis (FMEA) to successfully implement a comprehensive 3D printed bolus solution to replace commercial bolus in our clinic using a series of open-source (or free) software products., Methods: 3D printed molds for bespoke bolus were created by exporting the DICOM structures of the bolus designed in the treatment planning system and manipulated to create a multipart mold for 3D printing. A silicone (Ecoflex 00-30) mixture is poured into the mold and cured to form the bolus. Molds for sheet bolus of five thicknesses were also created. A comprehensive FMEA was performed to guide workflow adjustments and QA steps., Results: The process map identified 39 and 30 distinct steps for the bespoke and flat sheet bolus workflows, respectively. The corresponding FMEA highlighted 119 and 86 failure modes, with 69 shared between the processes. Misunderstanding of plan intent was a potential cause for most of the highest-scoring failure modes, indicating that physics and dosimetry involvement early in the process is paramount., Conclusion: FMEA informed the design and implementation of QA steps to guarantee a safe and high-quality comprehensive implementation of silicone bolus from 3D printed molds. This approach allows for greater adaptability not afforded by traditional bolus, as well as potential dissemination to other clinics due to the open-source nature of the workflow., (© 2024 The Author(s). Journal of Applied Clinical Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.)

This study aims to optimize the process parameters for PBF-LB of Inconel 718 using the surface texture and density of the as-built specimen to fabricate high-quality products. In order to achieve this aim, the melting and solidification phenomena of the melt pool were examined using a high-speed camera, and the process map of laser power and scan speed was constructed by evaluating the surface texture and density of the as-built specimen to optimize the process parameters. In addition, the mechanical properties of the as-built specimens fabricated at the optimum process parameter derived from the process map were examined. Consequently, it was found that the optimum process parameter should be determined by consideration of the melting and solidification phenomena because the phenomena such as spattering and instability of the melt pool change with the process parameters. It was also found that the morphology of the track is affected by the spot size of the laser beam. It was revealed that the similarity of the process maps evaluated by surface texture and density of the specimens results in the correlation between the surface texture and the density. The optimum laser power and scan speed can be determined using the process maps evaluated by the surface texture and density of the specimens. The as-built specimen fabricated at the optimum process parameter showed anisotropic tensile behavior, and the tensile strength of the transverse specimen was higher than that of the longitudinal specimen. The tensile properties of the as-built specimen fabricated in this work were similar to those of the as-built specimen reported by the other works.

In order to capitalize on the cost-effectiveness of additive manufacturing (AM), it is critical to understand how to build components with consistency and high quality. Directed energy deposition (DED) is an AM method for creating parts layer by layer through the use of a moving heat source and powder material inserted into the melt pool generated on the substrate. DED, like most AM processes, is highly complex due to the rapid thermal gradients experienced during processing. These thermal gradients are determined by a variety of processing parameters, which include laser power, powder feed rate, travel speed, layer height hatch spacing, etc. A lot of effort has been carried out in the additive manufacturing community to understand what these critical parameters are and how they influence the thermal gradients. Despite all these efforts, AM industries rely on a trial-and-error-based approach to find the right set of parameters to produce a quality part. This is time-consuming and not a cost-effective use of AM technology. The aim of our research is to reduce the amount of experimental data in combination with numerical analysis to optimize this relationship. Physics-based two-dimensional melt-pool modeling and experimental results from an OPTOMEC 850M LENS will be utilized to investigate the effects of processing parameters on melt-pool geometry, and the results from this study will provide key processing guidelines to achieve desirable clad geometry and powder efficiency for the DED method.

Copyright of Management & Quality / Zarządzanie i Jakość is the property of Scientific Society of Organization & Management / Towarzystwo Naukowe Organizacji i Kierownictwa and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article is devoted to process mapping and the design of a process map of the air transport process using available open-source online software/tools. The air transport process is a complex process that requires mutual coordination of individual activities to meet the process's objectives. At the input of this process are the requirements of the passenger, which enter the provision of the flight, and at the output is the measurement of customer satisfaction. Processes usually have duplication and inefficiencies, that can be effectively corrected once the process is appropriately documented. The process map provides a holistic view of the processes, describes their relationships, stakeholders involved and clearly explains them. At the same time, it enables the subsequent modification of the process, which is based on the needs of the air carrier and the fulfilment of the requirements of the customer. There is currently very little research on mapping the air transport process, and such a process map is a new perspective. [ABSTRACT FROM AUTHOR]

Abstract Background Achalasia is a rare motility disorder affecting the oesophagus, which is associated with a range of symptoms and different treatment strategies. Currently, little is known about people's experiences with achalasia and its management. This study aimed to understand the experiences of people living with achalasia, from the initial onset of symptoms to long‐term management. Method This qualitative study explored the journey of people living with achalasia and outlined the care pathway using a process map. Ten female and five male participants living with achalasia (age range: 40‐73) took part, and all aspects of their diagnosis, treatment and management were discussed. A process map showing people's experiences by separating the management of their condition into a series of steps was developed to present the pathway in the participants’ journey. The analysis involved discussing the process map within the research team. Results The process map comprised of 10 steps, which occurred before and after diagnosis. The developed map indicates that most participants managed their on‐going symptoms through stress management techniques and dietary changes. Key issues that participants highlighted about their journey managing achalasia were misdiagnosis, delay in diagnosis and lack of support in the long‐term management of achalasia. Conclusions This research was a novel study exploring patients’ experiences and management of achalasia and mapping their journey. Two distinct phases to their journeys were identified: before and after diagnosis. Areas highlighted by this study can provide a basis for future research, in particular behaviour change to support the long‐term management of achalasia.

VDM Alloy 780 is a novel Ni-based superalloy that allows for approximately 50 °C higher operating temperatures, compared to Inconel 718, without a significant decrease in mechanical properties. The age hardenable NiCoCr Alloy combines increased temperature strength with oxidation resistance, as well as improved microstructural stability due to γ′-precipitation. These advantages make it suitable for wear- and corrosion-resistant coatings that can be used in high temperature applications. However, VDM Alloy 780 has not yet been sufficiently investigated for laser metal deposition applications. A design of experiments with single tracks on 316L specimens was carried out to evaluate the influence of the process parameters on clad quality. Subsequently, the quality of the clads was evaluated by means of destructive and non-destructive testing methods, in order to verify the suitability of VDM Alloy 780 for laser metal deposition applications. The single-track experiments provide a basis for coating or additive manufacturing applications. For conveying the results, scatter plots with regression lines are presented, which illustrate the influence of specific energy density on the resulting porosity, dilution, powder efficiency, aspect ratio, width and height. Finally, the clad quality, in terms of porosity, is visualized by two process maps with different mass per unit lengths.

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The scientific paper proposes a pragmatic perspective of presenting some theoretical and practical aspects regarding a new approach within the studied organization, a process-based approach. The point of view submitted is a small part of the possibilities to implement the process-based approach. For an overview, I did a presentation of the organization in which I carry out my activity, the Sibiu County Directorate for the Registration of Persons, I showed the place and the role of the organization. Later, I explained the way, was organized and the activities that take place in the organization. An important aspect was the realization, in the organization, of personal analysis to make a new, process-based approach. Based on these processes we have made a current map of processes. A further direction of research is building a new process map following analysis to improve the processes within the studied public organization. Subsequently, we intend to execute the modeling of processes with a method that we will establish later. [ABSTRACT FROM AUTHOR]

Additive manufacturing (AM) is a layer-by-layer material deposition process that allows for more manufacturing flexibility and design complexity than traditional manufacturing processes. However, the print quality in metal AM is hard to be predicted and controlled due to its high process variability. Numerous process parameters are correlated/intertwined and have a direct/indirect relationship with the final build quality. However, these interconnections among the process parameters and print qualities are not yet fully understood and identified. To achieve a functional part without additional post-processing to improve the surface finish/mechanical properties, the comprehensive process model, which includes the semantic and qualitative connections among the process inputs-signatures-qualities, is urgently needed. Currently, surrogate models (regression models/ physical-based models) are widely used for predicting part qualities, specifically thermal distortion. These surrogate models can provide a simulated result based on the user-defined parameter settings. However, the reverse determination of the highly correlated parameters that can manage the print qualities in the desired standard cannot be achieved through these surrogate models. Understanding this interconnectivity is the top priority in building process models that will help to make the process more predictable and controllable. An ontology-based process map that captures the complicated metal AM processes, including all input parameters, physical, thermal model, and resultant build qualities (microstructure and mechanical properties), is provided in this manuscript. The connections among these factors are used to diagnose the relevant process variables regarding the specific build qualities, which can further combine with experimental data to contribute to a "printable" zone. The ontology-based process map links variable selection to quality requirements, creating a printable zone. A printable zone indicates the allowable process parameter selections, contributing to the desired part quality. Ultimately, the selected variable process data from the ontological process map will scope the parametrical analysis. The implementations of the ontology-based process map and printable zone are presented to demonstrate this proposed method's effectiveness by demonstrating that the proposed printable zone's validity and desired build quality can be achieved. [ABSTRACT FROM AUTHOR]

Case Management is a paradigm to support knowledge-intensive processes. The different approaches developed for modeling these types of processes tend to result in scattered information due to the low abstraction level at which the inherently complex processes are represented. Thus, readability and understandability are more challenging than in imperative process models. This paper extends a case modeling language—the fragment-based Case Management (fCM) language—to a so-called fCM landscape (fCML) with the goal of modeling a single knowledge-intensive process from a higher abstraction level. Following the Design Science Research (DSR) methodology, we first define requirements for an fCML, and then review how literature—in the fields of process overviews and case management—could support them. Design decisions are formalized by specifying a syntax for an fCML and the transformation rules from a given fCM model. The proposal is empirically evaluated via a laboratory experiment. Quantitative results imply that interpreting an fCML requires less effort in terms of time—and is thus more efficient—than interpreting its equivalent fCM case model. Qualitative results provide indications on the factors affecting case model interpretation and guidelines for future work. [ABSTRACT FROM AUTHOR]

The University of Michigan's Taubman Health Sciences Library is a significant partner in collaborating with National Institutes of Health (NIH) grantees to maintain continued funding at our institution. The National Institutes of Health (NIH) Public Access Policy (NIHPAP) requires grantees to submit final peer-reviewed journal manuscripts that arise from NIH funds to PubMed Central (PMC), the NIH open-access digital repository. Because NIH is the University of Michigan's largest research sponsor, the continuation of that funding is dependent on compliance with NIHPAP. This paper describes the development of a process map (PM) to improve clarity and efficiency in complying with NIH funding requirements. [ABSTRACT FROM AUTHOR]

Healthcare facilities face major challenges as patients require for the continuous improvement of the healthcare quality. We have used as research method the study of the scientific literature from the medical databases, and we have identified the categories of processes that ensure the quality in a healthcare facility. It is drawn a detailed map of the basic medical processes which highlights the sequence and interaction of medical processes that take place on requesting patients until they become resolved patients. The particularization of quality improvement methods for the improvement of critical medical processes is presented. By using the Pareto diagram it is analyzed the adverse events associated with healthcare and by employment of Ishikawa diagram it is analyzed the causes of associated infections highlighting the factors that contributed to the increase of confirmed healthcare associated infections, which are assigned to the hospital information system and the hospital monitoring system. [ABSTRACT FROM AUTHOR]

The purpose of this research is to identify possible failures modes in the process of producing Kurdistan sugar factory. In this research, firstly, the Process map of the production process by using the IDEF0 modeling logic was extracted accurately in order to schematically analyze all the aspects and processes of sugar production from raw sugar. Then, in the form of teamwork and at various expert meetings, 49 major and potential failures were identified in all processes and activities of the sugar production process. In the following sessions, the failure severity, the probability of occurrence of failures and the probability of error detection were determined. Using the RPN (risk priority number) was extracted for each failure. In the following, the root causes of the 24 priority failures were determined by FTA, and due to the causes of the errors, suitable solutions to reduce the effects of failures were documented. Finally, the origins of process failures were analyzed. [ABSTRACT FROM AUTHOR]

To quantify the cost of performing an intravitreal injection (IVI) utilizing activity-based costing (ABC), which allocates a cost to each resource involved in a manufacturing process. A prospective, observational cohort study was performed at an urban, multi-specialty ophthalmology practice affiliated with an academic institution. Fourteen patients scheduled for an IVI-only visit with a retina ophthalmologist were observed from clinic entry to exit to create a process map of time and resource utilization. Indirect costs were allocated with ABC and direct costs were estimated based on process map observations, internal accounting records, employee interviews, and nationally-reported metrics. The primary outcome measure was the cost of an IVI procedure in United States dollars. Secondary outcomes included operating income (cost subtracted from revenue) of an IVI and patient-centric time utilization for an IVI. The total cost of performing an IVI was $128.28; average direct material, direct labor, and overhead costs were $2.14, $97.88, and $28.26, respectively. Compared to the $104.40 reimbursement set by the Centers for Medicare and Medicaid Services for Current Procedural Terminology code 67028, this results in a negative operating income of -$23.88 (−22.87%). The median clinic resource-utilizing time to complete an IVI was 32:58 minutes (range [19:24–1:28:37]); the greatest bottleneck was physician-driven electronic health record documentation. Our study provides an objective and accurate cost estimate of the IVI procedure and illustrates how ABC may be applied in a clinical context. Our findings suggest that IVIs may currently be undervalued by payors. [ABSTRACT FROM AUTHOR]

The optimal process parameters of grade 250 maraging steel for hot forging were investigated with a process map and microstructure analysis. To generate the process map, hot compression tests were performed at 800–1200 °C and strain rates of 0.01–5 s−1. The flow stress–strain curves were calibrated by Bayesian artificial neural network (ANN) modeling to compensate the heat generated by dynamic deformation. The Ni and Mo segregation during the solidification of the ingot caused alternating layers of Ni- and Mo-rich and -lean bands, which affected the recrystallization behavior during hot compression. According to the calculated process map, 1100–1200 °C × 0.01–0.7 s−1 and 1000–1200 °C × 0.01–0.2 s−1 are favorable process conditions that ensure wide process windows in terms of strain rate and temperature, respectively. The common features of the microstructure deformed under both conditions were relatively coarse martensite blocks and low values in the electron backscattered diffraction (EBSD) kernel average misorientation (KAM) results (i.e., low residual stresses), which were attributed to a low fraction of fine martensite block region. [ABSTRACT FROM AUTHOR]

Background: Achalasia is a rare motility disorder affecting the oesophagus, which is associated with a range of symptoms and different treatment strategies. Currently, little is known about people's experiences with achalasia and its management. This study aimed to understand the experiences of people living with achalasia, from the initial onset of symptoms to long‐term management. Method: This qualitative study explored the journey of people living with achalasia and outlined the care pathway using a process map. Ten female and five male participants living with achalasia (age range: 40‐73) took part, and all aspects of their diagnosis, treatment and management were discussed. A process map showing people's experiences by separating the management of their condition into a series of steps was developed to present the pathway in the participants' journey. The analysis involved discussing the process map within the research team. Results: The process map comprised of 10 steps, which occurred before and after diagnosis. The developed map indicates that most participants managed their on‐going symptoms through stress management techniques and dietary changes. Key issues that participants highlighted about their journey managing achalasia were misdiagnosis, delay in diagnosis and lack of support in the long‐term management of achalasia. Conclusions: This research was a novel study exploring patients' experiences and management of achalasia and mapping their journey. Two distinct phases to their journeys were identified: before and after diagnosis. Areas highlighted by this study can provide a basis for future research, in particular behaviour change to support the long‐term management of achalasia. [ABSTRACT FROM AUTHOR]