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The phenomenon of value creation is witnessing a shift towards value co-creation, particularly in collaborative relationship. This study explores and prioritizes drivers enabling value co-creation from the perspectives of client and service provider in the context of IT-services outsourcing. An extensive literature review and subsequent pilot study suggest six probable value drivers that are further, statistically validated and prioritized. The unit of analysis is front-line professionals, working with either party. A web-based survey was administered to collect data from 256 respondents, drawn using judgemental sampling. Strategic Intent and Service Actualization are found to be significant and common value drivers for both parties (client and service provider), though with different priorities. The other significant value drivers are found to be Collective Capabilities for client and Intrapreneurship for service provider (these value drivers are not common to the client and service provider). This study reiterates and crystallizes the understanding of value co-creation process in the context of IT-services outsourcing. The identified drivers would enable practitioners to understand and to reconcile the drivers for client(s) and service provider(s) in order to realize the respective value outcome. The commonality of two value drivers; strategic intent and service actualization for both clients and service providers indicates the opportunity for co-creation of value.

Adverse drug reactions (ADRs) are a significant cause of morbidity and mortality and contribute to the incidence of adverse events, resulting in increased healthcare costs. Healthcare providers need to understand their role and responsibility in the detection, management, documentation, and reporting of ADRs. The purpose of this study is to provide guidelines regarding the procedure of reporting ADRs to hospital authority. It was a descriptive cross-sectional study carried out between April and August 2013. The study population included doctors, nursing personnel, paramedical staff and quality managers of tertiary care hospital from one public and two private hospitals. Interaction was done with study population against the back drop of the checklist and ADR policy was formulated. How to cite this article Singh S, Gupta SK, Arya S, Sharma DK, Aggarwal V. Adverse Drug Reaction Policy in a Tertiary Care Hospital. Int J Res Foundation Hosp Healthc Adm 2015; 3(1):41-47.

Hand hygiene diminishes the carriage of potential pathogens on the hands. It results in reduction in patient morbidity and mortality from nosocomial infection. Eighty percent of nosocomial disease transmission is thought to be via hands. The purpose of this study is to provide policy with regard to hand hygiene which can be followed in tertiary care hospitals. It was a descriptive cross-sectional study carried out between April and August 2013. The study population included doctors, nursing personnel, paramedical staff and quality managers of tertiary care hospital from public and private hospitals. Checklist was made after an exhaustive review of literature which was then improvised. Validation of the checklist was done by experts in infection control in various private and public hospitals. Subsequently, interaction was done with study population against the back drop of the checklist and hand hygiene policy was formulated. How to cite this article Singh S, Gupta SK, Arya S, Aggarwal V, Thuilephy T. Hand Hygiene Policy for a Tertiary Care Hospital. Int J Res Foundation Hosp Healthc Adm 2015;3(2):103-109.

Purpose To evaluate the effect of bulb height of hollow bulb obturator prosthesis on articulation and nasalance. Method A total of 10 patients, who were to undergo maxillectomy falling under Aramany class-I and II, with normal speech and hearing pattern were selected for the study. They were provided 2 maxillary obturators, one extending full height of the defect and other with bulb height approximately up to inferior nasal concha. The patients were asked to wear each obturator for 6 weeks and the speech analysis was done to measure changes in articulation and nasalance at 6 different stages of treatment i.e. preoperative, postoperative (after complete healing), 24h and 6 weeks after providing full bulb height obturator and reduced bulb height obturator. Articulation was measured objectively for distortion, addition, substitution and omission by speech pathologist and nasalance was measured by Dr. SPEECH software. Result Comparison between full and reduced bulb height for nasalance and articulation, showed that there was no statistical significant difference ( P >0.05) between the two for both the parametres. Conclusion Articulation and nasality improves after providing obturator. Articulation and nasalance both are independent of bulb height.

We aimed to study the voice profiles of patients with Parkinson's disease (PD) and correlate the profiles with disease severity. A total of 133 patients with PD were recruited. Patients were divided into two groups: Group 1 with a Unified Parkinson's Disease Rating Scale (UPDRS) score of ≤45; and Group 2 with a UPDRS >45. Speech was analyzed using the Indian Speech and Hearing Association (ISHA) articulation assessment and Vaghmi software. A total of 87 patients (65.41%) reported a history of speech problems. Examination revealed slow reading speed (64.7% of patients), hoarseness of voice (60.2%), articulatory defect (39.8%) and jerky speech (32.3%) as common abnormalities. Misarticulation was most often observed among the labial (42.1%), followed by lingual and palatal syllables. The ISHA articulation test demonstrated significant differences in mean numbers of words distorted (p

This article proposes a more objective methodology to classify and position commodities (works and services) in the Kraljic Portfolio Matrix (KPM) in a continuous scale around the two dimensions of supply risk and profit impact—the two dimensions which mainly influence the choice of a firm's purchasing strategy. Fuzzy multi-attribute scoring is used to assign performance scores to different commodities on supply risk as well as profit impact attributes. With a multidimensional scaling approach the commodities are placed in the KPM. An application of the proposed approach is attempted on commodities procured by the Rural Development Department of a state government in India.

This article develops an artificial neural network (ANN) based forecasting model using the past profit records of hotel commodities. Based on forecasting, hotel commodities are categorised into two kinds: ones that push up the revenue, and others, which pull it down. Thereafter, long and short term goals are formulated for fixing quota and proper revenue management under uncertainty. For long term goal, analytical network process (ANP) framework is adopted to establish interrelationships among the factors using DEMATEL methodology. Risk adjusted maximum expected profit is employed for short term goal. Subsequently optimal numbers of commodities are obtained using a fuzzy goal programming approach, and favourable price of the individual commodities is determined keeping the price elasticity as one. Finally, a comparison is made between the respective revenue generated with the new quota and price from the proposed revenue maximization model, and that of the old practised price and quota. The paper demonstrates the superiority of the proposed approach. A case study of a hotel has been taken up to demonstrate the model.

After years of being thought to be an inevitable fact of life, demand information distortion (Bullwhip effect) is now increasingly coming under scrutiny by researchers, with conflicting findings being reported about its existence. The conflicting reports are partly due to the measurement issues surrounding Bullwhip, and partly due to the changed business practices in some sectors which the Bullwhip construct was perhaps not originally designed to capture. This article attempts to reconcile these issues. It integrates two distinct dimensions of information distortion: amplification of order variance and schedule instability, and proposes a framework to capture the underlying information distortion more comprehensively. The framework is illustrated through a case study of an automotive supply chain under real-world considerations such as capacity limits and contemporary IT-enabled information sharing practices. The ‘degree of over-ordering’ was found to be a good indicator of information distortion.

Heat exchangers are used in industrial processes to recover heat between two process fluids. Although the necessary equations for heat transfer and the pressure drop in a double pipe heat exchanger are available, using these equations the optimization of the system cost is laborious. In this paper the optimal design of the exchanger has been formulated as a geometric programming with a single degree of difficulty. The solution of the problem yields the optimum values of inner pipe diameter, outer pipe diameter and utility flow rate to be used for a double pipe heat exchanger of a given length, when a specified flow rate of process stream is to be treated for a given inlet to outlet temperature.

There is an increased emphasis in supply chain management on making all costs transparent. This has led to greater scrutiny of freight costs by the resellers who want to control their inbound logistics costs. An astute reseller may opt for paying freight when he sees an opportunity for savings. In some cases, a supplier may only sell on conditions of FOB origin. In this paper, we consider a reselling situation wherein the final demand is sensitive to the selling price and the reseller is responsible for paying for the freight. Given that transportation costs can be almost 50% of the logistics cost (S.R. Swenseth, M.R. Godfrey, Int. J. Prod. Econ. 77 (2002) 113), there is a need for coordination between the reseller's purchasing function and his pricing policy. In this study, we formulate a model for determining the optimal lot size and the selling price for the reseller. Existing models for the problem have treated freight breakpoints in the same way as price breakpoints in a quantity discount schedule. In doing so, they have ignored the option of over-declaring the weight of the shipment which is routinely available to the buyer/shipper in practice. In this paper, we assume that the reseller has such an option. We also assume that in setting the size of the order/shipment, the reseller can choose between less-than-full-truckload or full-truckload shipment.

There are outbreaks of dengue every year in India. They vary in the predominant serotype involved, clinical features and predominant laboratory findings. This study of the 2006 outbreak in Delhi highlights clinical features and laboratory parameters of dengue cases and compares the clinical features among the adult and paediatric age groups. The 2006 outbreak had higher bleeding manifestations and a greater involvement of the adult male population than in previous outbreaks. No correlation was observed between platelet count and different bleeding manifestations until they dropped

This article proposes a discrete event simulation (DES) framework to analyse the impact of disturbances, their parameter values, and their interactions, on production line efficiency. The framework is demonstrated by means of a case study of a manufacturing process in an Indian automotive manufacturer. Various scenarios are generated and studied using design of experiment (DOE) to investigate the effects of changes in product, technology, cycle time, and worker competency, and to derive the optimal set of process and decision parameters.

Educational institutions are complex organizations; equally complex are the issues involved in managing such institutions. The authors suggest that faculty feedback sessions, meant to develop an open and interactive culture among faculty members, can also provide the basis for analysis of the complex forces at work in academic institutions. They contend that while the collegiate system is most appropriate for institutions where there is a wide distribution of expertise, it is essential to recognize the integral nature of conflict in the management processes of such institutions.

In this article we consider the binary knapsack problem under disjoint multiple-choice constraints. We propose a two-stage algorithm based on Lagrangian relaxation. The first stage determines in polynomial time an optimal Lagrange multiplier value, which is then used within a branch-and-bound scheme to rank-order the solutions, leading to an optimal solution in a relatively low depth of search. The validity of the algorithm is established, a numerical example is included, and computational experience is described.

This paper considers a production-inventory system for a line of product in which the items are deteriorating at a constant rate, the demand rate decreases negative exponentially, and no shortages are allowed. We consider a finite planning horizon, and assume that the replenishments will occur through internal production at fixed intervals of time, but that flexible rates of production are available for each period. Mathematical models are developed to yield the optimal information on the production runs under various explicit time and cost implications of in-house production. Computational results are provided, and comparison of policies made with respect to the instantaneous replenishment situation. The model has important ramifications for just-in-time policies, flexible manufacturing environments, and make-buy strategic decisions.

Speech abnormalities are common to the three Parkinsonian syndromes, namely Parkinson's disease (PD), progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), the nature and severity of which is of clinical interest and diagnostic value.To evaluate the clinical pattern of speech impairment in patients with PD, PSP and MSA and to identify significant differences on quantitative speech parameters when compared to controls.Cross-sectional study conducted in a tertiary medical teaching institute.Twenty-two patients with PD, 18 patients with PSP and 20 patients with MSA and 10 age-matched healthy controls were recruited over a period of 1.5 years. The patients were clinically evaluated for the presence and characteristics of dysarthria. This was followed by quantitative assessment of three parameters: maximum phonation time (MPT), semantic fluency and reading speed. The outcome measures were compared between the patient groups and with controls.Patients with PD had hypophonic monotonous speech with occasional rushes of speech while patients with MSA and PSP had mixed dysarthria with ataxic and spastic elements respectively. All quantitative parameters were affected when compared to controls (P values0.001, 0.012 and 0.008 respectively). Maximum phonation time was significantly less in PSP when compared to MSA and PD (P=0.015). Reading speed also showed a similar trend which was not statistically significant. Semantic fluency was comparable in all three groups.Dysarthria in PD, PSP and MSA have many overlapping but certain distinctive features as well which could serve as a diagnostic clue. Patients with PSP had profound speech impairment probably indicative of the more severe frontostriatial pathology.

The main objective of this paper is to develop an analytical model for operational level decisions for convergent supply chain system controlled by kanban under JIT where a product is assembled from a number of components supplied by many multistage supply chains. It integrates production and shipment lot size across the various stages of supply chain so that components travel through the supply chain in a coordinated way without any mismatch and final product reaches the customer in time. A quantitative analytical approach has been followed to develop the non-linear integer program (NLIP) and a generic LINGO program also has been developed for NLIP using branch and bound method for optimisation. This model facilitates integrated supply chain optimisation for system wide inventory, logistic and production setup costs optimisation. The model has been validated using automotive supply chain data. However, it can be applied to any industry.

The Bullwhip Effect (BWE) has been a major challenge facing supply chains for several decades. An important stream of literature has developed around Supply Line Underweighting (SLU) and hoarding behaviour as the behavioural causes of BWE. The present study builds on these studies and devises novel experiments to replicate and verify them. The findings suggest that the aforementioned behavioural causes do not hold and point to a need to break new ground on this well-researched topic. The paper concludes with the managerial and research implications.

This paper addresses the problem of grouping a large volume of discrete data into a given number of groups. The algorithm is based on the well-known shortest path algorithm. It handles different criteria for minimizing the loss of information which might result during the process of grouping. The given problem is transformed into a directed graph and it then looks for a shortest path with a given number of edges. The algorithm is illustrated through an example of five data items. It has also been coded in Pascal and some test results are presented.

The problem of optimally coordinating the replenishments of the many items in stock with one another is dealt with in this article. Specifically, it considers this coordination based on classifying the items into a few groups with common order cycles for all the items in a particular group. Assuming that the cumulative distribution by value of the inventory can be characterized by a Pareto function of the type f(n) = n/(an + b), (a, b > 0), it establishes that the optimal boundaries of the groups can be obtained as closed-form expressions by solving a system of simultaneous equations. The composition of the successive groups thus obtained is found to equipartition the total cost and to follow geometric sequences in relation to the number of items, the value of items, and the lengths of the order cycles. Graphs have been proposed to aid the implementation of the grouping scheme. Simple iterative schemes are outlined within the framework of the Pareto function to handle other relevant costs.

We describe a simple, rapid method for determination of sulfonylureas that is not susceptible to significant interference from metabolites. An acidified plasma is extracted with toluene, followed by a back extraction from the toluene to methanolic trimethylanilinium hydroxide. The resulting compounds are measured by gas chromatography.

This paper addresses the problem of finding a minimal spanning tree in a network subject to a knapsack-type constraint. The problem is shown to belong to the class of NP -complete problems. Certain properties of an optimal solution to this problem are established considering a bicriteria spanning tree problem. Based on these, an algorithm is proposed which is mainly a branch and bound scheme branching from the test upper bound and generating efficient frontiers successively. It also uses certain effective heuristics and bounds that are obtained in polynomially bounded operations. The algorithm is validated and a numerical example is included.

SUMMARY A recent work obtained closed-form solutions to the.problem of optimally grouping a multi-item inventory into subgroups with a common order cycle per group, when the distribution by value of the inventory could be described by a Pareto function. This paper studies the sensitivity of the optimal subgroup boundaries so obtained. Closed-form expressions have been developed to find intervals for the subgroup boundaries for any given level of suboptimality. Graphs have been provided to aid the user in selecting a cost-effective level of aggregation and choosing appropriate subgroup boundaries for a whole range of inventory distributions. The results of sensitivity analyses demonstrate the availability of flexibility in the partition boundaries and the cost-effectiveness of any stock control system through three groups, and thus also provide a theoretical support to the intuitive ABC system of classifying the items.

A recent work obtained closed-form expressions for the problem of optimal partitioning multi-item inventories into a given number of groups, where each group has a common order cycle for all the items in the group, and a Pareto function characterizes the distributions by value of the inventory. The optimal order points so obtained for the groups may have no synchronization among themselves at all. This note extends the closed-form analysis to the requirement that the order cycles be coordinated so that each cycle is an integral multiple of the shortest order cycle. The extent of suboptimality which thus follows is investigated. Several alternatives to achieve integrality have been considered and compared through an illustrative example within the framework of the Pareto function.

Multi-item inventory control may be simplified by grouping items into subgroups with a common order cycle for all the items in each group. The methods provided in the literature for determination of the order cycle values are either suboptimal or computationally inefficient. This note proposes a procedure which finds the optimal values and is also computationally efficient.

This paper outlines a formal description for the distribution by value curve (DBV), which is widely employed to represent size distributions of multi-item inventories. It gives a convenient mathematical expression for the often used lognormal DBV curve and reveals its symmetrical nature when represented on a unit square. A Pareto DBV curve that has been used in the literature is detailed and shown to be skewed to one direction. Two alternative forms for the DBV curve are suggested: symmetric-Pareto and power, which may be more suited to mathematical manipulation. The latter can also represent a wider class of inventories.

A method Is presented for simultaneous gas chromatographic determinations of cocaine end benzoylecgonlne in biological fluids and tissues, The method involves an extraction cleanup and elkylation of benzoylecgonine using phase-transfer catalysis by tetrahexylammonlum chloride. Data regarding the distribution of cocaine end benzoylecgonlne In postmortem samples ore presented, and evidence is presented for the detection of clnnamoylcocalne and cinnamoyleogonlne in fluids from some cocaine abusers.

The gas-liquid chromatographic analysis of phenobarbital which uses trimethylanilinium hydroxide (TMAH)_as a methylating agent results in the formation of two products: previously identified N,N-dimethylphenobarbital and a heretofore unidentified decomposition product. By mass spectrometry and synthesis, this compound was identified as N-methyl-α-phenylbutyramide. Two parameters affecting its formation are the concentration of TMAH and the time phenobarbital is in TMAH prior to GLC injection. Using a high TMAH concentration (1.8 M ), the amount of N-methyl-α-phenylbutyramide formed is reproducible, a linear function of the phenobarbital concentration and a better basis for the quantitative determination of phenobarbital than N,N-dimethylphenobarbital. Application to the simultaneous determination of phenobarbital, primidone and diphenylhydantoin in 12 min is given.

This note considers a special case of the assignment problem when n jobs are to be grouped together into a set of m categories ( m > 3). Solving this particular case through the available transportation or assignment algorithms would entail a heavy computational burden, particularly in problems involving dense matrices. A preprocessing technique requiring sorting of ( 2 m ) n -arrays once is outlined, which is capable of reducing the dimension and eliminating several arcs for such a problem. The procedure offers an overall computational advantage over the other available algorithms applied directly. An illustrative example is included.

With use of a sample/solvent ratio of 8.5 ml to 100 µl, certain drugs may be extracted efficiently from urine that has been saturated with a solid buffer. An aliquot of this extract may be injected directly into a gas chromatograph. We show how this procedure is applied to confirmation of some drugs of abuse.

Cum ./LSTA_A_8828879_O_XML_IMAGES/LSTA_A_8828879_O_ILM0001.gif rule [Singh (1975)] has been suggested in the literature for finding approximately optimum strata boundaries for proportional allocation, when the stratification is done on the study variable. This paper shows that for the class of density functions arising from the Wang and Aggarwal (1984) representation of the Lorenz Curve (or DBV curves in case of inventory theory), the cum ./LSTA_A_8828879_O_XML_IMAGES/LSTA_A_8828879_O_ILM0002.gif rule in place of giving approximately optimum strata boundaries, yields exactly optimum boundaries. It is also shown that the conjecture of Mahalanobis (1952) “. . .an optimum or nearly optimum solutions will be obtained when the expected contribution of each stratum to the total aggregate value of Y is made equal for all strata” yields exactly optimum strata boundaries for the case considered in the paper.

Certain repetitive tasks of the anaesthesiologist are studied and modelled for automatic processing. These analyses make it possible for optimal control procedures to be programmed and administered by less trained anaesthesia professionals. A dynamic programming model is developed and validated with real data collected from several hospitals in the Cleveland, Ohio, area. By conjunctively monitoring certain transients in the anaesthesia administration process, the scarce supply of anaesthesiology manpower can be more efficiently deployed.