A Lean transportation approach for improving emergency medical operations

Abstract

This paper extends the approach of Lean transportation to improve the performance of emergency medical processes (EMP) by adapting its main concepts into the main characteristics of the EMP environment. The paper is based on an inductive theory-building process initiated from a case study in the field of emergency medical services. The development of the suggested performance improvement approach triggered from an exhaustive analysis of a process involved and an exploratory review of the existing improvement approaches available. The process of concern can be described as a specialized transportation process, where human lives are at risk. Its characteristics led to a natural application of Lean transportation. The results include, a novel approach for improving the agility and efficient EMS processes. This is validated with an application for improving ambulance response times and turnaround times of the Red Cross operations located in Monterrey, Mexico. The approach proved to be an integrated scheme for identifying waste opportunities at a systems level. This characteristic is important to let operations management prioritize improvement efforts in a limited budget situation. This work suggests the application of the emerging Lean transportation approach for increasing the agility performance of EMS processes.     

Travelling from New Spain to Mexico: Mapping Practices of Nineteenth-Century Mexico

James Horn, Adapting to a New World: English Society in the Seventeenth‐Century Chesapeake (1994), xv + 461 (University of North Carolina Press, Chapel Hill, $60.50).

Marguerite W. Dupree, Family Structure in the Staffordshire Potteries, 1840–1880 (1995), xx + 405 (Clarendon Press, Oxford, £48.00).

David B. Copian, In the Time of Cannibals: The Word Music of South Africa's Basotho Migrants (1994), xxi + 300 (University of Chicago Press, Chicago, $55.00, paperback $18.95).

Ellen Meiksins Wood, Democracy Against Capitalism: Renewing Historical Materialism (1995), 300 (Cambridge University Press, London, £35.00).     

Urbanization homogenizes the interactions of plant-frugivore bird networks

Urban Ecosystems - Anthropogenic activities are the main cause of habitat loss and fragmentation, which directly affects biodiversity. Disruption in landscape connectivity among populations may...     

The Touchard distribution

We present a novel model, which is a two-parameter extension of the Poisson distribution. Its normalizing constant is related to the Touchard polynomials, hence the name of this model. It is a flexible distribution that can account for both under- or overdispersion and concentration of zeros that are frequently found in non-Poisson count data. In contrast to some other generalizations, the Hessian matrix for maximum likelihood estimation of the Touchard parameters has a simple form. We exemplify with three data sets, showing that our suggested model is a competitive candidate for fitting non-Poisson counts.     

Conceptual design pattern for ergonomic workplaces

In this paper, we analyzed two laboratories of liquid chromatography (LC), separation technique of mixtures and identification of its components, in order to identify projectual gaps relating to the environment and the working station. The methodology used was the ergonomic analysis with interactional and participatory techniques applied during the activity performance. This work incorporated and adapted the concept developed by Alexander (1979)--pattern languages--passing from architectural projects to workstations project and physical arrangement of the work environment. The adaptation of the concept resulted in a list of recommendations, requirements and concepts that have brought design solutions for the problematic aspects observed in the ergonomic analysis. The employed methodology, strongly supported in ergonomics principles, and in interactional and participatory techniques, contributed to achieve our gold that is what we now call Conceptual Standards. The patterns go beyond of a usual model of book a of ergonomics specification, once incorporating the viewpoint of the end user, it is also a set of best project practices and of project management in conception ergonomics.     

The footwear factory's assembly sector: opposing organizational structure and quality from the ergonomic work analysis

Data from 2006 indicated that Brazilian footwear leather industry was composed of approximately 9,488 formally registered establishments, considering the leather industry, footwear and leather goods. It was responsible for 211,582 people employed. However, in spite of having many employees, this kind of organization found several problems when analyzed from the ergonomics view. With this premise, then, in order to identify bottlenecks and other engineering problems that could cause discomfort and motivation lack among workers, leading directly to the loss of the product quality, the assembly sector of women's shoes factory was characterized.     

The scoring rules in an endogenous election

Plurality rule is mostly criticized from being capable of choosing an alternative considered as worst by a strict majority. This paper considers elections in which the agenda consists of potential candidates strategically choosing whether or not to enter the election. In this context, we examine the ability of scoring rules to fulfil the Condorcet criterion. We show for the case of three potential candidates that Plurality rule is the only scoring rule that satisfies a version of the Condorcet criterion in two cases: 1) when preferences are single-peaked and, 2) when preferences are single-dipped.

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The Changing Role of the Central Planning Offices in Latin America

The central planning agencies in Latin America have undergone multiple transformations in their structural design. These agencies came to life during the late 1950s in response to a development strategy that required the state to provide long-run direction to development by means of economic planning. Five decades later, the same agencies were redeployed to perform an open-market development strategy. What explains the fact that the same agency, created with the purpose of planning economic development, has functioned across time and governments with sharp economic, and political differences? Following Mahoney and Thelen (2010), this paper highlights the idea that the basic properties of institutions provide some forceful elements that permit change. In this sense, the document shows how veto possibilities and compliance are key variables in understanding the changing role of the central planning offices in Latin America.     

Uncertainty Evaluation of Human Risk Analysis (HRA) of Chemicals by Multiple Exposure Routes

The application of an ISO standard procedure (Guide to the Expression of Uncertainty in Measurement (GUM)) is here discussed to quantify uncertainty in human risk estimation under chronic exposure to hazardous chemical compounds. The procedure was previously applied to a simple model; in this article a much more complex model is used, i.e., multiple compound and multiple exposure pathways. Risk was evaluated using the usual methodologies: the deterministic reasonable maximum exposure (RME) and the statistical Monte Carlo method. In both cases, the procedures to evaluate uncertainty on risk values are detailed. Uncertainties were evaluated by different methodologies to account for the peculiarity of information about the single variable. The GUM procedure enables the ranking of variables by their contribution to uncertainty; it provides a criterion for choosing variables for deeper analysis. The obtained results show that the application of GUM procedure is easy and straightforward to quantify uncertainty and variability of risk estimation. Health risk estimation is based on literature data on a water table contaminated by three volatile organic compounds. Daily intake was considered by either ingestion of water or inhalation during showering. The results indicate one of the substances as the main contaminant, and give a criterion to identify the key component on which the treatment selection may be performed and the treatment process may be designed in order to reduce risk.