Search results for: perceived costs
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 4070

Search results for: perceived costs

3140 Barriers for Sustainable Consumption of Antifouling Products in the Baltic Sea

Authors: Bianca Koroschetz, Emma Mäenpää

Abstract:

The purpose of this paper is to study consumer practices and meanings of different antifouling methods in order to identify the main barriers for sustainable consumption of antifouling products in the Baltic Sea. The Baltic Sea is considered to be an important tourism area. More than 3.5 million leisure boaters use the sea for recreational boating. Most leisure boat owners use toxic antifouling paint to keep barnacles from attaching to the hull. Attached barnacles limit maneuverability and add drag which in turn increases fuel costs. Antifouling paint used to combat barnacles causes particular problems, as the use of these products continuously adds to the distribution of biocides in the coastal ecosystem and leads to the death of marine organisms. To keep the Baltic Sea as an attractive tourism area measures need to be undertaken to stop the pollution coming from toxic antifouling paints. The antifouling market contains a wide range of environment-friendly alternative products such as a brush wash for boats, hand scrubbing devices, hull covers and boat lifts. Unfortunately, not a lot of boat owners use these environment-friendly alternatives and instead prefer the use of the traditional toxic copper paints. We ask “Why is the unsustainable consumption of toxic paints still predominant when there is a big range of environment-friendly alternatives available? What are the barriers for sustainable consumption?” Environmental psychology has concentrated on developing models of human behavior, including the main factors that influence pro-environmental behavior. The main focus of these models was directed to the individual’s attitudes, principals, and beliefs. However, social practice theory emphasizes the importance to study practices, as they have a stronger explanatory power than attitude-behavior to explain unsustainable consumer behavior. Thus, the study focuses on describing the material, meaning and competence of antifouling practice in order to understand the social and cultural embeddedness of the practice. Phenomenological interviews were conducted with boat owners using antifouling products such as paints and alternative methods. This data collection was supplemented with participant observations in marinas. Preliminary results indicate that different factors such as costs, traditions, advertising, frequency of use, marinas and application of method impact on the consumption of antifouling products. The findings have shown that marinas have a big influence on the consumption of antifouling goods. Some marinas are very active in supporting the sustainable consumption of antifouling products as for example in Stockholm area several marinas subsidize costs for using environmental friendly alternatives or even forbid toxic paints. Furthermore the study has revealed that environmental friendly methods are very effective and do not have to be more expensive than painting with toxic paints. This study contributes to a broader understanding why the unsustainable consumption of toxic paints is still predominant when a big range of environment-friendly alternatives exist. Answers to this phenomenon will be gained by studying practices instead of attitudes offering a new perspective on environmental issues.

Keywords: antifouling paint, Baltic Sea, boat tourism, sustainable consumption

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3139 An Inventory Management Model to Manage the Stock Level for Irregular Demand Items

Authors: Riccardo Patriarca, Giulio Di Gravio, Francesco Costantino, Massimo Tronci

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An accurate inventory management policy acquires a crucial role in the several high-availability sectors. In these sectors, due to the high-cost of spares and backorders, an (S-1, S) replenishment policy is necessary for high-availability items. The policy enables the shipment of a substitute efficient item anytime the inventory size decreases by one. This policy can be modelled following the Multi-Echelon Technique for Recoverable Item Control (METRIC). The METRIC is a system-based technique that allows defining the optimum stock level in a multi-echelon network, adopting measures in line with the decision-maker’s perspective. The METRIC defines an availability-cost function with inventory costs and required service levels, using as inputs data about the demand trend, the supplying and maintenance characteristics of the network and the budget/availability constraints. The traditional METRIC relies on the hypothesis that a Poisson distribution well represents the demand distribution in case of items with a low failure rate. However, in this research, we will explore the effects of using a Poisson distribution to model the demand of low failure rate items characterized by an irregular demand trend. This characteristic of a demand is not included in the traditional METRIC formulation leading to the need of revising its traditional formulation. Using the CV (Coefficient of Variation) and ADI (Average inter-Demand Interval) classification, we will define the inherent flaws of Poisson-based METRIC for irregular demand items, defining an innovative ad hoc distribution which can better fit the irregular demands. This distribution will allow defining proper stock levels to reduce stocking and backorder costs due to the high irregularities in the demand trend. A case study in the aviation domain will clarify the benefits of this innovative METRIC approach.

Keywords: METRIC, inventory management, irregular demand, spare parts

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3138 Optimizing AI Voice for Adolescent Health Education: Preferences and Trustworthiness Across Teens and Parent

Authors: Yu-Lin Chen, Kimberly Koester, Marissa Raymond-Flesh, Anika Thapar, Jay Thapar

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Purpose: Effectively communicating adolescent health topics to teens and their parents is crucial. This study emphasizes critically evaluating the optimal use of artificial intelligence tools (AI), which are increasingly prevalent in disseminating health information. By fostering a deeper understanding of AI voice preference in the context of health, the research aspires to have a ripple effect, enhancing the collective health literacy and decision-making capabilities of both teenagers and their parents. This study explores AI voices' potential within health learning modules for annual well-child visits. We aim to identify preferred voice characteristics and understand factors influencing perceived trustworthiness, ultimately aiming to improve health literacy and decision-making in both demographics. Methods: A cross-sectional study assessed preferences and trust perceptions of AI voices in learning modules among teens (11-18) and their parents/guardians in Northern California. The study involved the development of four distinct learning modules covering various adolescent health-related topics, including general communication, sexual and reproductive health communication, parental monitoring, and well-child check-ups. Participants were asked to evaluate eight AI voices across the modules, considering a set of six factors such as intelligibility, naturalness, prosody, social impression, trustworthiness, and overall appeal, using Likert scales ranging from 1 to 10 (the higher, the better). They were also asked to select their preferred choice of voice for each module. Descriptive statistics summarized participant demographics. Chi-square/t-tests explored differences in voice preferences between groups. Regression models identified factors impacting the perceived trustworthiness of the top-selected voice per module. Results: Data from 104 participants (teen=63; adult guardian = 41) were included in the analysis. The mean age is 14.9 for teens (54% male) and 41.9 for the parent/guardian (12% male). At the same time, similar voice quality ratings were observed across groups, and preferences varied by topic. For instance, in general communication, teens leaned towards young female voices, while parents preferred mature female tones. Interestingly, this trend reversed for parental monitoring, with teens favoring mature male voices and parents opting for mature female ones. Both groups, however, converged on mature female voices for sexual and reproductive health topics. Beyond preferences, the study delved into factors influencing perceived trustworthiness. Interestingly, social impression and sound appeal emerged as the most significant contributors across all modules, jointly explaining 71-75% of the variance in trustworthiness ratings. Conclusion: The study emphasizes the importance of catering AI voices to specific audiences and topics. Social impression and sound appeal emerged as critical factors influencing perceived trustworthiness across all modules. These findings highlight the need to tailor AI voices by age and the specific health information being delivered. Ensuring AI voices resonate with both teens and their parents can foster their engagement and trust, ultimately leading to improved health literacy and decision-making for both groups. Limitations and future research: This study lays the groundwork for understanding AI voice preferences for teenagers and their parents in healthcare settings. However, limitations exist. The sample represents a specific geographic location, and cultural variations might influence preferences. Additionally, the modules focused on topics related to well-child visits, and preferences might differ for more sensitive health topics. Future research should explore these limitations and investigate the long-term impact of AI voice on user engagement, health outcomes, and health behaviors.

Keywords: artificial intelligence, trustworthiness, voice, adolescent

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3137 Exploring Key Elements of Successful Distance Learning Programs: A Case Study in Palau

Authors: Maiya Smith, Tyler Thorne

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Background: The Pacific faces multiple healthcare crises, including high rates of noncommunicable diseases, infectious disease outbreaks, and susceptibility to natural disasters. These issues are expected to worsen in the coming decades, increasing the burden on an already understaffed healthcare system. Telehealth is not new to the Pacific, but improvements in technology and accessibility have increased its utility and have already proven to reduce costs and increase access to care in remote areas. Telehealth includes distance learning; a form of education that can help alleviate many healthcare issues by providing continuing education to healthcare professionals and upskilling staff, while decreasing costs. This study examined distance learning programs at the Ministry of Health in the Pacific nation of Palau and identified key elements to their successful distance learning programs. Methods: Staff at the Belau National Hospital in Koror, Palau as well as private practitioners were interviewed to assess distance learning programs utilized. This included physicians, IT personnel, public health members, and department managers of allied health. In total, 36 people were interviewed. Standardized questions and surveys were conducted in person throughout the month of July 2019. Results: Two examples of successful distance learning programs were identified. Looking at the factors that made these programs successful, as well as consulting with staff who undertook other distance learning programs, four factors for success were determined: having a cohort, having a facilitator, dedicated study time off from work, and motivation. Discussion: In countries as geographically isolated as the Pacific, with poor access to specialists and resources, telehealth has the potential to radically change how healthcare is delivered. Palau shares similar resources and issues as other countries in the Pacific and the lessons learned from their successful programs can be adapted to help other Pacific nations develop their own distance learning programs.

Keywords: distance learning, Pacific, Palau, telehealth

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3136 Patients' Out-Of-Pocket Expenses-Effectiveness Analysis of Presurgical Teledermatology

Authors: Felipa De Mello-Sampayo

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Background: The aim of this study is to undertake, from a patient perspective, an economic analysis of presurgical teledermatology, comparing it with a conventional referral system. Store-and-forward teledermatology allows surgical planning, saving both time and number of visits involving travel, thereby reducing patients’ out-of-pocket expenses, i.e., costs that patients incur when traveling to and from health providers for treatment, visits’ fees, and the opportunity cost of time spent in visits. Method: Patients’ out-of-pocket expenses-effectiveness of presurgical teledermatology were analyzed in the setting of a public hospital during two years. The mean delay in surgery was used to measure effectiveness. The teledermatology network covering the area served by the Hospital Garcia da Horta (HGO), Portugal, linked the primary care centers of 24 health districts with the hospital’s dermatology department. The patients’ opportunity cost of visits, travel costs, and visits’ fee of each presurgical modality (teledermatology and conventional referral), the cost ratio between the most and least expensive alternative, and the incremental cost-effectiveness ratio were calculated from initial primary care visit until surgical intervention. Two groups of patients: those with squamous cell carcinoma and those with basal cell carcinoma were distinguished in order to compare the effectiveness according to the dermatoses. Results: From a patient perspective, the conventional system was 2.15 times more expensive than presurgical teledermatology. Teledermatology had an incremental out-of-pocket expenses-effectiveness ratio of €1.22 per patient and per day of delay avoided. This saving was greater in patients with squamous cell carcinoma than in patients with basal cell carcinoma. Conclusion: From a patient economic perspective, teledermatology used for presurgical planning and preparation is the dominant strategy in terms of out-of-pocket expenses-effectiveness than the conventional referral system, especially for patients with severe dermatoses.

Keywords: economic analysis, out-of-pocket expenses, opportunity cost, teledermatology, waiting time

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3135 Design of an Active Compression System for Treating Vascular Disease Using a Series of Silicone Based Inflatable Mini Bladders

Authors: Gayani K. Nandasiri, Tilak Dias, William Hurley

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Venous disease of human lower limb could range from minor asymptomatic incompetence of venous valves to chronic venous ulceration. The sheer prevalence of varicose veins and its associated significant costs of treating late complications such as chronic ulcers contribute to a higher burden on health care resources. In most of western countries with developed health care systems, treatment costs associated with Venous disease accounts for a considerable portion of their total health care budget, and it has become a high-cost burden to National Health Service (NHS), UK. The established gold standard of treatment for the venous disease is the graduated compression, where the pressure at the ankle being highest and decreasing towards the knee and thigh. Currently, medical practitioners use two main methods to treat venous disease; i.e. compression bandaging and compression stockings. Both these systems have their own disadvantages which lead to the current programme of research. The aim of the present study is to revolutionize the compression therapy by using a novel active compression system to deliver a controllable and more accurate pressure profiles using a series of inflatable mini bladders. Two types of commercially available silicones were tested for the application. The mini bladders were designed with a special fabrication procedure to provide required pressure profiles, and a series of experiments were conducted to characterise the mini bladders. The inflation/deflation heights of these mini bladders were investigated experimentally and using a finite element model (FEM), and the experimental data were compared to the results obtained from FEM simulations, which showed 70-80% agreement. Finally, the mini bladders were tested for its pressure transmittance characteristics, and the results showed a 70-80% of inlet air pressure transmitted onto the treated surface.

Keywords: finite element analysis, graduated compression, inflatable bladders, venous disease

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3134 Heavy Oil Recovery with Chemical Viscosity-Reduction: An Innovative Low-Carbon and Low-Cost Technology

Authors: Lin Meng, Xi Lu, Haibo Wang, Yong Song, Lili Cao, Wenfang Song, Yong Hu

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China has abundant heavy oil resources, and thermal recovery is the main recovery method for heavy oil reservoirs. However, high energy consumption, high carbon emission and high production costs make heavy oil thermal recovery unsustainable. It is urgent to explore a replacement for developing technology. A low Carbon and cost technology of heavy oil recovery, chemical viscosity-reduction in layer (CVRL), is developed by the petroleum exploration and development research institute of Sinopec via investigated mechanisms, synthesized products, and improved oil production technologies, as follows: (1) Proposed a cascade viscous mechanism of heavy oil. Asphaltene and resin grow from free molecules to associative structures further to bulk aggregations by π - π stacking and hydrogen bonding, which causes the high viscosity of heavy oil. (2) Aimed at breaking the π - π stacking and hydrogen bond of heavy oil, the copolymer of N-(3,4-dihydroxyphenethyl) acryl amide and 2-Acrylamido-2-methylpropane sulfonic acid was synthesized as a viscosity reducer. It achieves a viscosity reduction rate of>80% without shearing for heavy oil (viscosity < 50000 mPa‧s), of which fluidity is evidently improved in the layer. (3) Synthesized hydroxymethyl acrylamide-maleic acid-decanol ternary copolymer self-assembly plugging agent. The particle size is 0.1 μm-2 mm adjustable, and the volume is 10-500 times controllable, which can achieve the efficient transportation of viscosity reducer to enriched oil areas. CVRL has applied 400 wells until now, increasing oil production by 470000 tons, saving 81000 tons of standard coal, reducing CO2 emissions by 174000 tons, and reducing production costs by 60%. It promotes the transformation of heavy oil towards low energy consumption, low carbon emissions, and low-cost development.

Keywords: heavy oil, chemical viscosity-reduction, low carbon, viscosity reducer, plugging agent

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3133 Contrasting Infrastructure Sharing and Resource Substitution Synergies Business Models

Authors: Robin Molinier

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Industrial symbiosis (I.S) rely on two modes of cooperation that are infrastructure sharing and resource substitution to obtain economic and environmental benefits. The former consists in the intensification of use of an asset while the latter is based on the use of waste, fatal energy (and utilities) as alternatives to standard inputs. Both modes, in fact, rely on the shift from a business-as-usual functioning towards an alternative production system structure so that in a business point of view the distinction is not clear. In order to investigate the way those cooperation modes can be distinguished, we consider the stakeholders' interplay in the business model structure regarding their resources and requirements. For infrastructure sharing (following economic engineering literature) the cost function of capacity induces economies of scale so that demand pooling reduces global expanses. Grassroot investment sizing decision and the ex-post pricing strongly depends on the design optimization phase for capacity sizing whereas ex-post operational cost sharing minimizing budgets are less dependent upon production rates. Value is then mainly design driven. For resource substitution, synergies value stems from availability and is at risk regarding both supplier and user load profiles and market prices of the standard input. Baseline input purchasing cost reduction is thus more driven by the operational phase of the symbiosis and must be analyzed within the whole sourcing policy (including diversification strategies and expensive back-up replacement). Moreover, while resource substitution involves a chain of intermediate processors to match quality requirements, the infrastructure model relies on a single operator whose competencies allow to produce non-rival goods. Transaction costs appear higher in resource substitution synergies due to the high level of customization which induces asset specificity, and non-homogeneity following transaction costs economics arguments.

Keywords: business model, capacity, sourcing, synergies

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3132 Evaluation of Age-Friendly Nursing Service System: KKU (AFNS:KKU) Model for the Excellence

Authors: Roongtiwa Chobchuen, Siriporn Mongkholthawornchai, Boonsong Hatawaikarn, Uriwan Chaichangreet, Kobkaew Thongtid, Pusda Pukdeekumjorn, Panita Limpawattana

Abstract:

Background: Age-friendly nursing service system in Srinagarind Hospital has been developed continuously based on the value and cultural background of Thailand which corporates with the modified WHO’s Age friendly Primary Care Service System. It consists of 3 issues; 1) development of staff training, 2) age-friendly service and 3) appropriate physical environment. Objective: To evaluate the efficacy of Age-friendly Nursing Service System: KKU (AFNS:KKU) model and to evaluate factors associated with nursing perception with AFN:KKU. Study design: Descriptive study Setting: 31 wards that served older patients in Srinagarind Hospital Populations: Nursing staff from 11 departments (31 wards) Instrument: Age-friendly nursing care scale as perceived by hospitalized older person Procedure and statistical analysis: All participants were asked questions using age-friendly nursing care scale as perceived by hospitalized older person questionnaires. Descriptive statistics and multiple logistic regression analyses were used to analyse the outcomes. Results: There were 337 participants recruited in this study. The majority of them were women (92%) with the mean ages of 29 years and 77.45% were nurse practitioners. They had average nursing experiences of 5 years. The average scores of age-friendly nursing care scale were high and highest in the area of attitude and communication. Age, sex, educational level, duration of work among, and having experience in aging training were not associated with nursing perception where type of department was an independent factor. Nurses from department of Surgery and Orthopedic, Eye and ENT, special ward and Obstetrics and Gynecological had significant greater perception than nurses from Internal Medicine Department (p < 0.05). Conclusion: Nurses had high scores in all dimensions of age-friendly concept. The result indicates that nurses have good attitude to aging care which can lead to improve quality of care. Organization should support other domains of ageing care to achieve greater effectiveness in geriatric care.

Keywords: age-friendly, nursing service system, excellence model, geriatric care

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3131 Explaining the Relationship between Religiosity and Resilience

Authors: Rita Phillips, Mark Burgess, Maga Berlinski

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Although the positive impact of religiosity on well-being, health, and life-coping abilities is well known, up to date research has failed to provide scientific evidence for the relationship reasons. Therefore the present study took a qualitative approach by examining how religiosity interacts in coping with emotionally distressful situations, for which wedding preparations are an example. Wedding preparations, related to the experience of ambiguous emotions, can be the reason for phases of high distress. Although being per-se religious ceremonies, they are also socially-scripted and characterized by people’s striving for personally meaningful celebrations. The negotiation of these many influences can evoke conflicts. To reveal components of religiosity which contribute to stress-resolution, eight biographic-narrative interviews with recently married spouses were conducted. Participants were from different nationalities and Catholic deep-belief communities in order to determine factors independent from national-culture and social-subgroup. The audio-tape recorded, transcribed and translated interviews were analyzed by Interpretative Phenomenological Analysis. Opposing previous research on wedding-related conflicts but in-line with the quantitative account on the relation between stress-resilience and religiosity, the present study found participants reporting very low levels of distress and ambiguity. Although similar areas of potential conflicts were revealed, deep-belief Christians seemed to handle them in a different way. Participants freed themselves from own and others’ rigor mundane expectations by their spiritual preparation and the focus on a divine instance. This evoked a feeling of perceived closeness to God and of unconditional love, resulting in acceptance of oneself and others. Through relativizing mundane goods, participants perceived absolute freedom. Thus belief did not supplement coping strategies, previously defined in the literature, but substituted them. The paper implies that in explaining the connection between stress-resilience and religiosity, one’s perception and experience of unconditional love might outweigh other social or personal factors. However, further qualitative investigations are needed to fully explain the phenomenon.

Keywords: deep-belief, religiosity, resilience, wedding

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3130 Cost Based Analysis of Risk Stratification Tool for Prediction and Management of High Risk Choledocholithiasis Patients

Authors: Shreya Saxena

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Background: Choledocholithiasis is a common complication of gallstone disease. Risk scoring systems exist to guide the need for further imaging or endoscopy in managing choledocholithiasis. We completed an audit to review the American Society for Gastrointestinal Endoscopy (ASGE) scoring system for prediction and management of choledocholithiasis against the current practice at a tertiary hospital to assess its utility in resource optimisation. We have now conducted a cost focused sub-analysis on patients categorized high-risk for choledocholithiasis according to the guidelines to determine any associated cost benefits. Method: Data collection from our prior audit was used to retrospectively identify thirteen patients considered high-risk for choledocholithiasis. Their ongoing management was mapped against the guidelines. Individual costs for the key investigations were obtained from our hospital financial data. Total cost for the different management pathways identified in clinical practice were calculated and compared against predicted costs associated with recommendations in the guidelines. We excluded the cost of laparoscopic cholecystectomy and considered a set figure for per day hospital admission related expenses. Results: Based on our previous audit data, we identified a77% positive predictive value for the ASGE risk stratification tool to determine patients at high-risk of choledocholithiasis. 47% (6/13) had an magnetic resonance cholangiopancreatography (MRCP) prior to endoscopic retrograde cholangiopancreatography (ERCP), whilst 53% (7/13) went straight for ERCP. The average length of stay in the hospital was 7 days, with an additional day and cost of £328.00 (£117 for ERCP) for patients awaiting an MRCP prior to ERCP. Per day hospital admission was valued at £838.69. When calculating total cost, we assumed all patients had admission bloods and ultrasound done as the gold standard. In doing an MRCP prior to ERCP, there was a 130% increase in cost incurred (£580.04 vs £252.04) per patient. When also considering hospital admission and the average length of stay, it was an additional £1166.69 per patient. We then calculated the exact costs incurred by the department, over a three-month period, for all patients, for key investigations or procedures done in the management of choledocholithiasis. This was compared to an estimate cost derived from the recommended pathways in the ASGE guidelines. Overall, 81% (£2048.45) saving was associated with following the guidelines compared to clinical practice. Conclusion: MRCP is the most expensive test associated with the diagnosis and management of choledocholithiasis. The ASGE guidelines recommend endoscopy without an MRCP in patients stratified as high-risk for choledocholithiasis. Our audit that focused on assessing the utility of the ASGE risk scoring system showed it to be relatively reliable for identifying high-risk patients. Our cost analysis has shown significant cost savings per patient and when considering the average length of stay associated with direct endoscopy rather than an additional MRCP. Part of this is also because of an increased average length of stay associated with waiting for an MRCP. The above data supports the ASGE guidelines for the management of high-risk for choledocholithiasis patients from a cost perspective. The only caveat is our small data set that may impact the validity of our average length of hospital stay figures and hence total cost calculations.

Keywords: cost-analysis, choledocholithiasis, risk stratification tool, general surgery

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3129 Effect of Lithium Bromide Concentration on the Structure and Performance of Polyvinylidene Fluoride (PVDF) Membrane for Wastewater Treatment

Authors: Poojan Kothari, Yash Madhani, Chayan Jani, Bharti Saini

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The requirements for quality drinking and industrial water are increasing and water resources are depleting. Moreover large amount of wastewater is being generated and dumped into water bodies without treatment. These have made improvement in water treatment efficiency and its reuse, an important agenda. Membrane technology for wastewater treatment is an advanced process and has become increasingly popular in past few decades. There are many traditional methods for tertiary treatment such as chemical coagulation, adsorption, etc. However recent developments in membrane technology field have led to manufacturing of better quality membranes at reduced costs. This along with the high costs of conventional treatment processes, high separation efficiency and relative simplicity of the membrane treatment process has made it an economically viable option for municipal and industrial purposes. Ultrafiltration polymeric membranes can be used for wastewater treatment and drinking water applications. The proposed work focuses on preparation of one such UF membrane - Polyvinylidene fluoride (PVDF) doped with LiBr for wastewater treatment. Majorly all polymeric membranes are hydrophobic in nature. This property leads to repulsion of water and hence solute particles occupy the pores, decreasing the lifetime of a membrane. Thus modification of membrane through addition of small amount of salt such as LiBr helped us attain certain characteristics of membrane, which can then be used for wastewater treatment. The membrane characteristics are investigated through measuring its various properties such as porosity, contact angle and wettability to find out the hydrophilic nature of the membrane and morphology (surface as well as structure). Pure water flux, solute rejection and permeability of membrane is determined by permeation experiments. A study of membrane characteristics with various concentration of LiBr helped us to compare its effectivity.

Keywords: Lithium bromide (LiBr), morphology, permeability, Polyvinylidene fluoride (PVDF), solute rejection, wastewater treatment

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3128 More Than Financial Wealth: An Empirical Study on the Impact of Family Involvement on the Dimensions of Exit Success

Authors: Tim Vollmer, Andrea Greven, Malte Brettel

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Family firms represent the predominant business structure worldwide, accounting for 90 percent of all operational businesses. These firms are essential to society and the economy. In the past decade, family firm exits increased by 72%; and in the next five years, 95,000 German family firms will be sold, acquired, or liquidated. For family firms, socioemotional wealth represents the frame of reference and value to preserve when making decisions. Family firm exits threaten the socioemotional wealth, as in extreme scenarios, economic logic may take over. So, a dilemma arises: Maintaining socioemotional wealth versus pursuing financial wealth. Family firm researchers agree that family involvement leads to specific goals, behaviors, and outcomes. For instance, the desire to protect socioemotional wealth when selling the firm and the focus on particular exit success dimensions, depending on the family's role inside the firm. However, despite the regularity of family firm exits, there is little research on the effect of family involvement on the family firm CEOs' perceived exit performance. We investigate the family firm CEOs' perceived exit performance, which we call exit success. Considering the deficiencies in the literature, we identify two research gaps. First, it remains unclear how family involvement affects the dimensions of exit success. Hence, we provide evidence of which success dimensions matter most depending on the family's involvement and how to differentiate successful from unsuccessful exits. Second, prior work has analyzed family involvement in the socioemotional wealth context but found contradictory findings. This work considers, for example, the family generation in control and identifies the tipping point of economic objectives becoming preferable over socioemotional wealth-related goals. This paper theorizes and empirically investigates, through the lens of socioemotional wealth and conflict theory, how socioemotional wealth mediates the relationship between family involvement and family firms' exit success. We analyze family firms' exit success dimensions of personal financial benefits, personal reputation, employee benefits, and firm mission persistence. Family involvement considers the family firms' heterogeneity in ownership, management, and generation. We use a quantitative approach in the form of an online survey by drawing on 116 responses from former family firm CEOs'. This study highlights that socioemotional wealth mediates the relationship between the dimensions of family involvement and exit success. The greater socioemotional wealth, the greater the family firm CEOs focus on the pro-organizational exit success dimensions of employee benefits and firm mission persistence. In contrast, the self-regarding dimension of personal financial benefits is significantly negatively affected. An important finding is that later generations and the number of family managers involved significantly negatively affect the two pro-organizational dimensions of exit success. Family ownership does not show any significant effect. Our work widens implications for research, theory, and practice by contributing in two meaningful ways. First, our results offer insights to differentiate successful from unsuccessful family firm exits and provide evidence of which success dimensions matter and which to focus on, most dependent on the family's role inside the firm. Second, our article advances research and empirical understanding of family firms and socioemotional wealth by clarifying contradictory findings.

Keywords: exit success, family firm exit, perceived exit performance, socioemotional wealth

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3127 Robotic Process Automation in Accounting and Finance Processes: An Impact Assessment of Benefits

Authors: Rafał Szmajser, Katarzyna Świetla, Mariusz Andrzejewski

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Robotic process automation (RPA) is a technology of repeatable business processes performed using computer programs, robots that simulate the work of a human being. This approach assumes replacing an existing employee with the use of dedicated software (software robots) to support activities, primarily repeated and uncomplicated, characterized by a low number of exceptions. RPA application is widespread in modern business services, particularly in the areas of Finance, Accounting and Human Resources Management. By utilizing this technology, the effectiveness of operations increases while reducing workload, minimizing possible errors in the process, and as a result, bringing measurable decrease in the cost of providing services. Regardless of how the use of modern information technology is assessed, there are also some doubts as to whether we should replace human activities in the implementation of the automation in business processes. After the initial awe for the new technological concept, a reflection arises: to what extent does the implementation of RPA increase the efficiency of operations or is there a Business Case for implementing it? If the business case is beneficial, in which business processes is the greatest potential for RPA? A closer look at these issues was provided by in this research during which the respondents’ view of the perceived advantages resulting from the use of robotization and automation in financial and accounting processes was verified. As a result of an online survey addressed to over 500 respondents from international companies, 162 complete answers were returned from the most important types of organizations in the modern business services industry, i.e. Business or IT Process Outsourcing (BPO/ITO), Shared Service Centers (SSC), Consulting/Advisory and their customers. Answers were provided by representatives of the positions in their organizations: Members of the Board, Directors, Managers and Experts/Specialists. The structure of the survey allowed the respondents to supplement the survey with additional comments and observations. The results formed the basis for the creation of a business case calculating tangible benefits associated with the implementation of automation in the selected financial processes. The results of the statistical analyses carried out with regard to revenue growth confirmed the correctness of the hypothesis that there is a correlation between job position and the perception of the impact of RPA implementation on individual benefits. Second hypothesis (H2) that: There is a relationship between the kind of company in the business services industry and the reception of the impact of RPA on individual benefits was thus not confirmed. Based results of survey authors performed simulation of business case for implementation of RPA in selected Finance and Accounting Processes. Calculated payback period was diametrically different ranging from 2 months for the Account Payables process with 75% savings and in the extreme case for the process Taxes implementation and maintenance costs exceed the savings resulting from the use of the robot.

Keywords: automation, outsourcing, business process automation, process automation, robotic process automation, RPA, RPA business case, RPA benefits

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3126 Factors Leading to Recividism

Authors: Maria Kralova, Michal Palecek

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We have detected factors leading to recidivism (the Czech Republic data). The employment during imprisonment turned out to be the most significant predictor with a positive effect on reduction of a rate of recidivism. Accordingly, we mainly focus on this predictor and its economic consequences. Smart public policy can cut government costs dramatically as more than a half of prisoners in the Czech Republic are recidivists. The operating cost cut of the Czech prison service could be CZK 127,680,000 (USD 5,889,623) in 2013 if a public policy had been set smarter.

Keywords: cost-cut, effective, optimal, public policy, reducing recidivism

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3125 The Mediation Impact of Demographic and Clinical Characteristics on the Relationship between Trunk Control and Quality of Life among the Sub-Acute Stroke Population: A Cross-Sectional Study

Authors: Kumar Gular, Viswanathan S., Mastour Saeed Alshahrani, Ravi Shankar Reddy, Jaya Shanker Tedla, Snehil Dixit, Ajay Prasad Gautam, Venkata Nagaraj Kakaraparthi, Devika Rani Sangadala

Abstract:

Background: Despite trunk control’s significant contribution to improving various functional activity components, the independent effect of trunk performance on quality of life is yet to be estimated in stroke survivors. Ascertaining the correlation between trunk control and self-reported quality of life while evaluating the effect of demographic and clinical characteristics on their relationship will guide concerned healthcare professionals in designing ideal rehabilitation protocols during the late sub-acute stroke stage of recovery. The aims of the present research were to (1) investigate the associations of trunk performance with self-rated quality of life and (2) evaluate if age, body mass index (BMI), and clinical characteristics mediate the relationship between trunk motor performance and perceived quality of life in the sub-acute stroke population. Methods: Trunk motor functions and quality of life among the late sub-acute stroke population aged 57.53 ± 6.42 years were evaluated through the trunk Impairment Scale (TIS) and Stroke specific quality of life (SSQOL) questionnaire, respectively. Pearson correlation coefficients and mediation analysis were performed to elucidate the relationship of trunk motor function with quality of life and determine the mediation impact of demographic and clinical characteristics on their association, respectively. Results: The current study observed significant correlations between trunk motor functions (TIS) and quality of life (SSQOL) with r=0.68 (p<0.001). Age, BMI, and type of stroke were detected as potential mediating factors in the association between trunk performance and quality of life. Conclusion: Validated associations between trunk motor functions and perceived quality of life among the late sub-acute stroke population emphasize the importance of comprehensive evaluation of trunk control. Rehabilitation specialists should focus on appropriate strategies to enhance trunk performance anticipating the potential effects of age, BMI, and type of stroke to improve health-related quality of life in stroke survivors.

Keywords: sub-acute stroke, quality of life, functional independence, trunk control

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3124 Maize Farmers’ Perception of Sharp Practices among Agro-Input Dealers in Ibadan/Ibarapa Agricultural Zone, Oyo State

Authors: Ademola A. Ladele, Peace I. Aburime

Abstract:

Fake and substandard agricultural inputs pose a serious stumbling block to farm productivity and subsequently improved livelihood. There is, therefore, a need to pave ways for sustainable agriculture and self-sufficiency in food production by proffering solutions to this challenge. Maize farmers' perception of sharp practices among agro-input dealers in Ibadan/Ibarapa agricultural zone in Oyo state was therefore investigated. A multi-stage random sampling technique was used to select registered maize farmers in the Ibadan/Ibarapa agricultural zone of the Oyo State Agricultural Development Programme (OYSADEP). A structured questionnaire was used to collect information on the perception of sharp practices and the effects of sharp practices. A total of seventy-five maize farmers were interviewed. A focus group discussion was organized to identify ways of curbing sharp practices to complement the survey. Data were analyzed using descriptive statistics, Chi-square, and Pearson Product Moment Correlation (PPMC). Forms of sharp practices indicated were sales of expired fertilizers, expired pesticides, expired herbicides, underweight fertilizers, adulterated fertilizers, adulterated herbicides, packs containing broken seeds, infested seeds, lack of truth in labeling/wrong labels, manipulation of measuring scales, and false declaration of hecterages covered by tractor operators. The majority had unfavorable perception of agro-input dealers on sharp practices. A significant relationship was observed between respondents’ level of education and their perception of sharp practices. There were no significant relationships between respondents’ sex, marital status and religion, and their perception of sharp practices. A significant correlation exists between the forms of sharp practices and the perceived effect on agricultural production. It is concluded that the perceived effect of sharp practices was critical and the endemic culture of sharp practices prevailed in agro-input in Ibadan/Ibarapa agricultural zone. A standard regulatory system that will certify and monitor the quality of inputs should be put in place.

Keywords: agricultural productivity, agro-input dealers, maize farmers, sharp practices

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3123 Health Advocacy in Medical School: An American Survey on Attitudes and Engagement in Clerkships

Authors: Rachel S. Chang, Samuel P. Massion, Alan Z. Grusky, Heather A. Ridinger

Abstract:

Introduction Health advocacy is defined as activities that improve access to care, utilize resources, address health disparities, and influence health policy. Advocacy is increasingly being recognized as a critical component of a physician’s role, as understanding social determinants of health and improving patient care are important aspects within the American Medical Association’s Health Systems Science framework. However, despite this growing prominence, educational interventions that address advocacy topics are limited and variable across medical school curricula. Furthermore, few recent studies have evaluated attitudes toward health advocacy among physicians-in-training in the United States. This study examines medical student attitudes towards health advocacy, along with perceived knowledge, ability, and current level of engagement with health advocacy during their clerkships. Methods This study employed a cross-sectional survey design using a single anonymous, self-report questionnaire to all second-year medical students at Vanderbilt University School of Medicine (n=96) in December 2020 during clerkship rotations. The survey had 27 items with 5-point Likert scale (15), multiple choice (11), and free response questions (1). Descriptive statistics and thematic analysis were utilized to analyze responses. The study was approved by the Vanderbilt University Institutional Review Board. Results There was an 88% response rate among second-year clerkship medical students. A majority (83%) agreed that formal training in health advocacy should be a mandatory part of the medical student curriculum Likewise, 83% of respondents felt that acting as a health advocate or patients should be part of their role as a clerkship student. However, a minority (25%) felt adequately prepared. While 72% of respondents felt able to identify a psychosocial need, 18% felt confident navigating the healthcare system and only 9% felt able to connect a patient to a psychosocial resource to fill that gap. 44% of respondents regularly contributed to conversations with their medical teams when discussing patients’ social needs, such as housing insecurity, financial insecurity, or legal needs. On average, respondents reported successfully connecting patients to psychosocial resources 1-2 times per 8-week clerkship block. Barriers to participating in health advocacy included perceived time constraints, lack of awareness of resources, lower emphasis among medical teams, and scarce involvement with social work teams. Conclusions In this single-institutional study, second-year medical students on clerkships recognize the importance of advocating for patients and support advocacy training within their medical school curriculum. However, their perceived lack of ability to navigate the healthcare system and connect patients to psychosocial resources, result in students feeling unprepared to advocate as effectively as they hoped during their clerkship rotations. Our results support the ongoing need to equip medical students with training and resources necessary for them to effectively act as advocates for patients.

Keywords: clerkships, medical students, patient advocacy, social medicine

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3122 Use of Analytic Hierarchy Process for Plant Site Selection

Authors: Muzaffar Shaikh, Shoaib Shaikh, Mark Moyou, Gaby Hawat

Abstract:

This paper presents the use of Analytic Hierarchy Process (AHP) in evaluating the site selection of a new plant by a corporation. Due to intense competition at a global level, multinational corporations are continuously striving to minimize production and shipping costs of their products. One key factor that plays significant role in cost minimization is where the production plant is located. In the U.S. for example, labor and land costs continue to be very high while they are much cheaper in countries such as India, China, Indonesia, etc. This is why many multinational U.S. corporations (e.g. General Electric, Caterpillar Inc., Ford, General Motors, etc.), have shifted their manufacturing plants outside. The continued expansion of the Internet and its availability along with technological advances in computer hardware and software all around the globe have facilitated U.S. corporations to expand abroad as they seek to reduce production cost. In particular, management of multinational corporations is constantly engaged in concentrating on countries at a broad level, or cities within specific countries where certain or all parts of their end products or the end products themselves can be manufactured cheaper than in the U.S. AHP is based on preference ratings of a specific decision maker who can be the Chief Operating Officer of a company or his/her designated data analytics engineer. It serves as a tool to first evaluate the plant site selection criteria and second, alternate plant sites themselves against these criteria in a systematic manner. Examples of site selection criteria are: Transportation Modes, Taxes, Energy Modes, Labor Force Availability, Labor Rates, Raw Material Availability, Political Stability, Land Costs, etc. As a necessary first step under AHP, evaluation criteria and alternate plant site countries are identified. Depending upon the fidelity of analysis, specific cities within a country can also be chosen as alternative facility locations. AHP experience in this type of analysis indicates that the initial analysis can be performed at the Country-level. Once a specific country is chosen via AHP, secondary analyses can be performed by selecting specific cities or counties within a country. AHP analysis is usually based on preferred ratings of a decision-maker (e.g., 1 to 5, 1 to 7, or 1 to 9, etc., where 1 means least preferred and a 5 means most preferred). The decision-maker assigns preferred ratings first, criterion vs. criterion and creates a Criteria Matrix. Next, he/she assigns preference ratings by alternative vs. alternative against each criterion. Once this data is collected, AHP is applied to first get the rank-ordering of criteria. Next, rank-ordering of alternatives is done against each criterion resulting in an Alternative Matrix. Finally, overall rank ordering of alternative facility locations is obtained by matrix multiplication of Alternative Matrix and Criteria Matrix. The most practical aspect of AHP is the ‘what if’ analysis that the decision-maker can conduct after the initial results to provide valuable sensitivity information of specific criteria to other criteria and alternatives.

Keywords: analytic hierarchy process, multinational corporations, plant site selection, preference ratings

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3121 Payment Subsidies for Environmentally-Friendly Agriculture on Rice Production in Japan

Authors: Danielle Katrina Santos, Koji Shimada

Abstract:

Environmentally-friendly agriculture has been promoted for over two decades as a response to the environmental challenges brought by climate change and biological loss. Located above the equator, it is possible that Japan may benefit from future climate change, yet Japan is also a rarely developed country located in the Asian Monsoon climate region, making it vulnerable to the impacts of climate change. In this regard, the Japanese government has initiated policies to adapt to the adverse effects of climate change through the promotion and popularization of environmentally-friendly farming practices. This study aims to determine profit efficiency among environmentally-friendly rice farmers in Shiga Prefecture using the Stochastic Frontier Approach. A cross-sectional survey was conducted among 66 farmers from top rice-producing cities through a structured questionnaire. Results showed that the gross farm income of environmentally-friendly rice farmers was higher by JPY 316,223.00/ha. Production costs were also found to be higher among environmentally-friendly rice farmers, especially on labor costs, which accounted for 32% of the total rice production cost. The resulting net farm income of environmentally-friendly rice farmers was only higher by JPY 18,044/ha. Results from the stochastic frontier analysis further showed that the profit efficiency of conventional farmers was only 69% as compared to environmentally-friendly rice farmers who had a profit efficiency of 76%. Furthermore, environmentally-friendly agriculture participation, other types of subsidy, educational level, and farm size were significant factors positively influencing profit efficiency. The study concluded that substitution of environmentally-friendly agriculture for conventional rice farming would result in an increased profit efficiency due to the direct payment subsidy and price premium received. The direct government policies that would strengthen the popularization of environmentally-friendly agriculture to increase the production of environmentally-friendly products and reduce pollution load to the Lake Biwa ecosystem.

Keywords: profit efficiency, environmentally-friendly agriculture, rice farmers, direct payment subsidies

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3120 Autonomy Supportive Coaching to Achieve Health Literacy

Authors: E. Knisel, H. Rupprich, A. Heissel

Abstract:

Health Literacy is defined as the degree to which people have the capacity to obtain and understand information to make health decisions. Illustrated are three levels of health literacy: (1) Functional literacy refers to the transmission of information about e. g. physical activity and nutrition; (2) interactive literacy implies the development of personal and social skills to adopt health-related behaviour and (3) critical health literacy indicates advanced cognitive skills connected with personal empowerment to critically analyse health information, to define self-determined goals and taking action in various situations accordingly. The achievement of the third level refers to self-determination and autonomy which should be outcomes of exercise programs for overweight children as health-related behaviour change will occur and persist if it is autonomously motivated. Method: We adopted a quasi-experimental design with group (autonomy supportive coaching, control) and session (pre-test, intervention, post-test, and follow-up-test). Overweight and obese children and adolescents at the age of 8-14 years (N=40) received a 6-month (20 sessions) exercise program with autonomy supportive coaching implemented by the coaches and sandwiched between pre-test and post-test. All participants (N=92) completed the German version of the Basic Needs Satisfaction Scale Sport and Exercise. Additionally, we assessed the engagement in the exercise program by the MVPA (Moderate-to-Vigorous Physical Activity) and by the adherence and drop-out-rate. Results: Participants in the intervention group perceived their autonomy as moderate in the post-test and the follow-up-test. However, the psychological intervention failed to develop a high autonomy, as both groups show moderate perceived autonomy from the pre-test to the post-test. Participants in the intervention group were higher engaged in MVPA in the exercise program and they attend the program more regularly. Discussion: Young overweight and obese children and adolescents can acquire autonomy using autonomy supporting coaching. However, research identifying the extent they achieve critical health literacy is required to implement an autonomy-supportive coaching style into exercise programs for this target group.

Keywords: autonomy support, coaching, health literacy, health promotion

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3119 Intellectual Property Rights and Health Rights: A Feasible Reform Proposal to Facilitate Access to Drugs in Developing Countries

Authors: M. G. Cattaneo

Abstract:

The non-effectiveness of certain codified human rights is particularly apparent with reference to the lack of access to essential drugs in developing countries, which represents a breach of the human right to receive adequate health assistance. This paper underlines the conflict and the legal contradictions between human rights, namely health rights, international Intellectual Property Rights, in particular patent law, as well as international trade law. The paper discusses the crucial links between R&D costs for innovation, patents and new medical drugs, with the goal of reformulating the hierarchies of priorities and of interests at stake in the international intellectual property (IP) law system. Different from what happens today, International patent law should be a legal instrument apt at rebalancing an axiological asymmetry between the (conflicting) needs at stake The core argument in the paper is the proposal of an alternative pathway, namely a feasible proposal for a patent law reform. IP laws tend to balance the benefits deriving from innovation with the costs of the provided monopoly, but since developing countries and industrialized countries are in completely different political and economic situations, it is necessary to (re)modulate such exchange according to the different needs. Based on this critical analysis, the paper puts forward a proposal, called Trading Time for Space (TTS), whereby a longer time for patent exclusive life in western countries (Time) is offered to the patent holder company, in exchange for the latter selling the medical drug at cost price in developing countries (Space). Accordingly, pharmaceutical companies should sell drugs in developing countries at the cost price, or alternatively grant a free license for the sale in such countries, without any royalties or fees. However, such social service shall be duly compensated. Therefore, the consideration for such a service shall be an extension of the temporal duration of the patent’s exclusive in the country of origin that will compensate the reduced profits caused by the supply at the price cost in developing countries.

Keywords: global health, global justice, patent law reform, access to drugs

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3118 Change through Stillness: Mindfulness Meditation as an Intervention for Men with Self-Perceived Problematic Pornography Use

Authors: Luke Sniewski, Pante Farvid, Phil Carter, Rita Csako

Abstract:

Background and Aims: Self-Perceived Problematic Porn Use (SPPPU) refers to individuals who identify as or perceive themselves to be addicted to porn. These individuals feel they are unable to regulate their porn consumption and experience adverse consequences as a result of their use in everyday life. To the author’s best knowledge, this research represents the first study to intervene with pornography use with mindfulness meditation, and aims to investigate the experiences and challenges of men with SPPPU as they engage in a mindfulness meditation intervention. As meditation is commonly characterized by sitting and observing one’s internal experience with non-reaction and acceptance, the study’s principal hypothesis was that consistent practice of meditation would develop the participant’s capacity to respond to cravings, urges, and unwanted thoughts in less reactive, more productive ways. Method: This 12-mixed method research utilised Single Case Experimental Design (SCED) methodology, with a standard AB design. Each participant was randomly assigned to an initial baseline time period between 2 to 5 weeks before learning the meditation technique and practicing it for the remainder of the 12-week study. The pilot study included 3 participants, while the intervention study included 12. The meditation technique used for the study involved a 15-minute guided breathing exercise in the morning, along with a 15-minute guided concentration meditation in the evening. Results: At the time of submission, only pilot study results were available. Results from the pilot study indicate an improved capacity for self-awareness of the uncomfortable mental and emotional states that drove their participants’ pornography use. Statistically significant reductions were also observed in daily porn use, total weekly time spent viewing porn, as well as lowered Pornography Craving Questionnaire (PCQ) and Problematic Pornography Use Scale (PPUS) scores. Conclusion: Pilot study results suggest that meditation could serve as a complementary tool for health professionals to provide clients in conjunction with therapeutic interventions. Study limitations, directions for future research, and clinical implications to be discussed as well.

Keywords: meditation, behavioural change, pornography, mindfulness

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3117 Multi-Objective Optimization of Run-of-River Small-Hydropower Plants Considering Both Investment Cost and Annual Energy Generation

Authors: Amèdédjihundé H. J. Hounnou, Frédéric Dubas, François-Xavier Fifatin, Didier Chamagne, Antoine Vianou

Abstract:

This paper presents the techno-economic evaluation of run-of-river small-hydropower plants. In this regard, a multi-objective optimization procedure is proposed for the optimal sizing of the hydropower plants, and NSGAII is employed as the optimization algorithm. Annual generated energy and investment cost are considered as the objective functions, and number of generator units (n) and nominal turbine flow rate (QT) constitute the decision variables. Site of Yeripao in Benin is considered as the case study. We have categorized the river of this site using its environmental characteristics: gross head, and first quartile, median, third quartile and mean of flow. Effects of each decision variable on the objective functions are analysed. The results gave Pareto Front which represents the trade-offs between annual energy generation and the investment cost of hydropower plants, as well as the recommended optimal solutions. We noted that with the increase of the annual energy generation, the investment cost rises. Thus, maximizing energy generation is contradictory with minimizing the investment cost. Moreover, we have noted that the solutions of Pareto Front are grouped according to the number of generator units (n). The results also illustrate that the costs per kWh are grouped according to the n and rise with the increase of the nominal turbine flow rate. The lowest investment costs per kWh are obtained for n equal to one and are between 0.065 and 0.180 €/kWh. Following the values of n (equal to 1, 2, 3 or 4), the investment cost and investment cost per kWh increase almost linearly with increasing the nominal turbine flowrate while annual generated. Energy increases logarithmically with increasing of the nominal turbine flowrate. This study made for the Yeripao river can be applied to other rivers with their own characteristics.

Keywords: hydropower plant, investment cost, multi-objective optimization, number of generator units

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3116 A Simulation-Based Method for Evaluation of Energy System Cooperation between Pulp and Paper Mills and a District Heating System: A Case Study

Authors: Alexander Hedlund, Anna-Karin Stengard, Olof Björkqvist

Abstract:

A step towards reducing greenhouse gases and energy consumption is to collaborate with the energy system between several industries. This work is based on a case study on integration of pulp and paper mills with a district heating system in Sundsvall, Sweden. Present research shows that it is possible to make a significant reduction in the electricity demand in the mechanical pulping process. However, the profitability of the efficiency measures could be an issue, as the excess steam recovered from the refiners decreases with the electricity consumption. A consequence will be that the fuel demand for steam production will increase. If the fuel price is similar to the electricity price it would reduce the profit of such a project. If the paper mill can be integrated with a district heating system, it is possible to upgrade excess heat from a nearby kraft pulp mill to process steam via the district heating system in order to avoid the additional fuel need. The concept is investigated by using a simulation model describing both the mass and energy balance as well as the operating margin. Three scenarios were analyzed: reference, electricity reduction and energy substitution. The simulation show that the total input to the system is lowest in the Energy substitution scenario. Additionally, in the Energy substitution scenario the steam from the incineration boiler covers not only the steam shortage but also a part of the steam produced using the biofuel boiler, the cooling tower connected to the incineration boiler is no longer needed and the excess heat can cover the whole district heating load during the whole year. The study shows a substantial economic advantage if all stakeholders act together as one system. However, costs and benefits are unequally shared between the actors. This means that there is a need for new business models in order to share the system costs and benefits.

Keywords: energy system, cooperation, simulation method, excess heat, district heating

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3115 The Effect of a Multidisciplinary Spine Clinic on Treatment Rates and Lead Times to Care

Authors: Ishan Naidu, Jessica Ryvlin, Devin Videlefsky

Abstract:

Introduction: Back pain is a leading cause of years lived with disability and economic burden, exceeding over $20 billion in healthcare costs not including indirect costs such as absence from work and caregiving. The multifactorial nature of back pain leads to treatment modalities administered by a variety of specialists, which are often disjointed. Multiple studies have found that patients receiving delayed physical therapy for lower back pain had higher medical-related costs from increased health service utilization as well as a reduced improvement in pain severity compared to early management. Uncoordinated health care delivery can exacerbate the physical and economic toll of the chronic condition, thus improvements in interdisciplinary, shared decision-making may improve outcomes. Objective: To assess whether a multidisciplinary spine clinic (MSC), consisting of orthopedic surgery, neurosurgery, pain medicine, and physiatry, alters interventional and non-interventional planning and treatment compared to a traditional unidisciplinary spine clinic (USC) including only orthopedic surgery. Methods: We conducted a retrospective cohort study with patients initially presenting for spine care to orthopedic surgeons between July 1, 2018 to June 30, 2019. Time to treatment recommendation, time to treatment and rates of treatment recommendations were assessed, including physical therapy, injections and surgery. Treatment rates were compared between MSC and USC using Pearson’s chi-square test logistic regression. Time to treatment recommendation and time to treatment were compared using log-rank test and Cox proportional hazard regression. All analyses were repeated for the propensity score (PS) matched subsample. Results: This study included 1,764 patients, with 692 at MSC and 1,072 at USC. Patients in MSC were more likely to be recommended injection when compared to USC (8.5% vs. 5.4%, p=0.01). When adjusted for confounders, the likelihood of injection recommendation remained greater in MSC than USC (Odds ratio [OR]=2.22, 95% CI: (1.39, 3.53), p=0.001). MSC was also associated with a shorter time to receiving injection recommendation versus USC (median: 21 vs. 32 days, log-rank: p<0.001; hazard ratio [HR]=1.90, 95% CI: (1.25, 2.90), p=0.003). MSC was associated with a higher likelihood of injection treatment (OR=2.27, 95% CI: (1.39, 3.73), p=0.001) and shorter lead time (HR=1.98, 95% CI: (1.27, 3.09), p=0.003). PS-matched analyses yielded similar conclusions. Conclusions: Care delivered at a multidisciplinary spine clinic was associated with a higher likelihood of recommending injection and a shorter lead time to injection administration when compared to a traditional unidisciplinary spine surgery clinic. Multidisciplinary clinics may facilitate coordinated care amongst different specialties resulting in increased utilization of less invasive treatment modalities while also improving care efficiency. The multidisciplinary clinic model is an important advancement in care delivery and communication, which can be used as a powerful method of improving patient outcomes as treatment guidelines evolve.

Keywords: coordinated care, epidural steroid injection, multi-disciplinary, non-invasive

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3114 Voluntary Work Monetary Value and Cost-Benefit Analysis with 'Value Audit and Voluntary Investment' Technique: Case Study of Yazd Red Crescent Society Youth Members Voluntary Work in Health and Safety Plan for New Year's Passengers

Authors: Hamed Seddighi Khavidak

Abstract:

Voluntary work has a lot of economic and social benefits for a country, but the economic value is ignored because it is voluntary. The aim of this study is reviewing Monetary Value of Voluntary Work methods and comparing opportunity cost method and replacement cost method both in theory and in practice. Beside monetary value, in this study, we discuss cost-benefit analysis of health and safety plan in the New Year that conducted by young volunteers of Red Crescent society of Iran. Method: We discussed eight methods for monetary value of voluntary work including: Alternative-Employment Wage Approach, Leisure-Adjusted OCA, Volunteer Judgment OCA, Replacement Wage Approach, Volunteer Judgment RWA, Supervisor Judgment RWA, Cost of Counterpart Goods and Services and Beneficiary Judgment. Also, for cost benefit analysis we drew on 'value audit and volunteer investment' (VIVA) technique that is used widely in voluntary organizations like international federation of Red Cross and Red Crescent societies. Findings: In this study, using replacement cost approach, voluntary work by 1034 youth volunteers was valued 938000000 Riyals and using Replacement Wage Approach it was valued 2268713232 Riyals. Moreover, Yazd Red Crescent Society spent 212800000 Riyals on food and other costs for these volunteers. Discussion and conclusion: In this study, using cost benefit analysis method that is Volunteer Investment and Value Audit (VIVA), VIVA rate showed that for every Riyal that the Red Crescent Society invested in the health and safety of New Year's travelers in its volunteer project, four Riyals returned, and using the wage replacement approach, 11 Riyals returned. Therefore, New Year's travelers health and safety project were successful and economically, it was worthwhile for the Red Crescent Society because the output was much bigger than the input costs.

Keywords: voluntary work, monetary value, youth, red crescent society

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3113 The Optimal Order Policy for the Newsvendor Model under Worker Learning

Authors: Sunantha Teyarachakul

Abstract:

We consider the worker-learning Newsvendor Model, under the case of lost-sales for unmet demand, with the research objective of proposing the cost-minimization order policy and lot size, scheduled to arrive at the beginning of the selling-period. In general, the New Vendor Model is used to find the optimal order quantity for the perishable items such as fashionable products or those with seasonal demand or short-life cycles. Technically, it is used when the product demand is stochastic and available for the single selling-season, and when there is only a one time opportunity for the vendor to purchase, with possibly of long ordering lead-times. Our work differs from the classical Newsvendor Model in that we incorporate the human factor (specifically worker learning) and its influence over the costs of processing units into the model. We describe this by using the well-known Wright’s Learning Curve. Most of the assumptions of the classical New Vendor Model are still maintained in our work, such as the constant per-unit cost of leftover and shortage, the zero initial inventory, as well as the continuous time. Our problem is challenging in the way that the best order quantity in the classical model, which is balancing the over-stocking and under-stocking costs, is no longer optimal. Specifically, when adding the cost-saving from worker learning to such expected total cost, the convexity of the cost function will likely not be maintained. This has called for a new way in determining the optimal order policy. In response to such challenges, we found a number of characteristics related to the expected cost function and its derivatives, which we then used in formulating the optimal ordering policy. Examples of such characteristics are; the optimal order quantity exists and is unique if the demand follows a Uniform Distribution; if the demand follows the Beta Distribution with some specific properties of its parameters, the second derivative of the expected cost function has at most two roots; and there exists the specific level of lot size that satisfies the first order condition. Our research results could be helpful for analysis of supply chain coordination and of the periodic review system for similar problems.

Keywords: inventory management, Newsvendor model, order policy, worker learning

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3112 Development of Vapor Absorption Refrigeration System for Mini-Bus Car’s Air Conditioning: A Two-Fluid Model

Authors: Yoftahe Nigussie

Abstract:

This research explores the implementation of a vapor absorption refrigeration system (VARS) in mini-bus cars to enhance air conditioning efficiency. The conventional vapor compression refrigeration system (VCRS) in vehicles relies on mechanical work from the engine, leading to increased fuel consumption. The proposed VARS aims to utilize waste heat and exhaust gas from the internal combustion engine to cool the mini-bus cabin, thereby reducing fuel consumption and atmospheric pollution. The project involves two models: Model 1, a two-fluid vapor absorption system (VAS), and Model 2, a three-fluid VAS. Model 1 uses ammonia (NH₃) and water (H₂O) as refrigerants, where water absorbs ammonia rapidly, producing a cooling effect. The absorption cycle operates on the principle that absorbing ammonia in water decreases vapor pressure. The ammonia-water solution undergoes cycles of desorption, condensation, expansion, and absorption, facilitated by a generator, condenser, expansion valve, and absorber. The objectives of this research include reducing atmospheric pollution, minimizing air conditioning maintenance costs, lowering capital costs, enhancing fuel economy, and eliminating the need for a compressor. The comparison between vapor absorption and compression systems reveals advantages such as smoother operation, fewer moving parts, and the ability to work at lower evaporator pressures without affecting the Coefficient of Performance (COP). The proposed VARS demonstrates potential benefits for mini-bus air conditioning systems, providing a sustainable and energy-efficient alternative. By utilizing waste heat and exhaust gas, this system contributes to environmental preservation while addressing economic considerations for vehicle owners. Further research and development in this area could lead to the widespread adoption of vapor absorption technology in automotive air conditioning systems.

Keywords: room, zone, space, thermal resistance

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3111 Fabrication of All-Cellulose Composites from End-of-Life Textiles

Authors: Behnaz Baghaei, Mikael Skrifvars

Abstract:

Sustainability is today a trend that is seen everywhere, with no exception for the textiles 31 industry. However, there is a rather significant downside regarding how the textile industry currently operates, namely the huge amount of end-of-life textiles coming along with it. Approximately 73% of the 53 million tonnes of fibres used annually for textile production is landfilled or incinerated, while only 12% is recycled as secondary products. Mechanical recycling of end-of-life textile fabrics into yarns and fabrics was before very common, but due to the low costs for virgin man-made fibres, the current textile material composition diversity, the fibre material quality variations and the high recycling costs this route is not feasible. Another way to decrease the ever-growing pile of textile waste is to repurpose the textile. If a feasible methodology can be found to reuse end-of life textiles as secondary market products including a manufacturing process that requires rather low investment costs, then this can be highly beneficial to counteract the increasing textile waste volumes. In structural composites, glass fibre textiles are used as reinforcements, but today there is a growing interest in biocomposites where the reinforcement and/or the resin are from a biomass resource. All-cellulose composites (ACCs) are monocomponent or single polymer composites, and they are entirely made from cellulose, ideally leading to a homogeneous biocomposite. Since the matrix and the reinforcement are both made from cellulose, and therefore chemically identical, they are fully compatible with each other which allow efficient stress transfer and adhesion at their interface. Apart from improving the mechanical performance of the final products, the recycling of the composites will be facilitated. This paper reports the recycling of end-of-life cellulose containing textiles by fabrication of all-cellulose composites (ACCs). Composite laminates were prepared by using an ionic liquid (IL) in a hot process, involving a partial dissolving of the cellulose fibres. Discharged denim fabrics were used as the reinforcement while dissolved cellulose from two different cellulose resources was used as the matrix phase. Virgin cotton staple fibres and recovered cotton from polyester/cotton (polycotton) waste fabrics were used to form the matrix phase. The process comprises the dissolving 6 wt.% cellulose solution in the ionic liquid 1-butyl-3-methyl imidazolium acetate ([BMIM][Ac]), this solution acted as a precursor for the matrix component. The denim fabrics were embedded in the cellulose/IL solution after which laminates were formed, which also involved removal of the IL by washing. The effect of reuse of the recovered IL was also investigated. The mechanical properties of the obtained ACCs were determined regarding tensile, impact and flexural properties. Mechanical testing revealed that there are no clear differences between the values measured for mechanical strength and modulus of the manufactured ACCs from denim/cotton-fresh IL, denim/recovered cotton-fresh IL and denim/cotton-recycled IL. This could be due to the low weight fraction of the cellulose matrix in the final ACC laminates and presumably the denim as cellulose reinforcement strongly influences and dominates the mechanical properties. Fabricated ACC composite laminates were further characterized regarding scanning electron microscopy.

Keywords: all-cellulose composites, denim fabrics, ionic liquid, mechanical properties

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