Measuring and evaluating efficiency of hospitals through total quality management: A multi-criteria data envelopment analysis model

The purpose of this study is to measure and evaluate the efficiency of 12 hospitals in Turkey using a multi-criteria Data Envelopment Analysis (DEA) methodology. Number of beds, number of physicians and the critical factors of total quality management in the health care sector were used as inputs of the model. The outputs used in this analysis incorporated financial and non-financial performance of hospitals, number of outpatients and number of patient days. Performance of the hospitals was measured using subjective measures based on executive's perception of how their organization performed relative to the competition. Results provide management with information regarding the relatively best practice hospitals in the observation sets and locate the relatively inefficient hospitals by comparison with the best practice ones. At last some suggestions are made for the least efficient hospital. © 2007 by The Haworth Press. All rights reserved

Fingering and strain localization in porous media during imbibition processes

Fingered infiltration of a wetting fluid through a porous network is a widely studied subject in the field of fluid mechanics. However, the effect of this heterogeneous percolation on the response of granular materials, in particular fine-grained soils, is a poorly investigated and badly understood topic which deserves deep analysis, considering, among others, possible applications in soil remediation and underground energy storage. This paper presents a first application of a new formulation of unsaturated poromechanics based on a phase field approach that allows to characterize on the one hand the occurrence of fingering hydraulic instabilities and on the other one to capture their effects on the irreversible, and possible unstable, deformation of the solid skeleton. The envisaged application concerns the behavior of fine-grained soils whose dilatant/contractant behavior is more and more attracting the interest of the scientific community both in the fields of experimental research and numerical modeling

How do supply chain management and information systems practices influence operational performance?:Evidence from emerging country SMEs

This study first provides a comparative analysis of the impact of supply chain management (SCM) and information systems (IS) practices on operational performance (OPER) of small- and medium-sized enterprises (SMEs) operating in two neighbouring emerging country markets of Turkey and Bulgaria. Then, we investigate moderating effects of both SCM–IS-linked enablers and inhibitors on the links between SCM and IS practices and OPER of SMEs. To this end, we first empirically identify the underlying dimensions of SCM and IS practices, and SCM–IS-related enabling and inhibiting factors. Second, a series of regression analyses are undertaken to estimate the impact of the study's constructs on OPER of SMEs. The results are discussed comparatively within the contexts of both Turkish and Bulgarian SMEs and beyond. The study makes a significant contribution to the extant literature through obtaining and analysing cross-national survey data of SCM and IS practices in emerging country markets

Fistule et kyste nasofrontaux : a propos d’un cas

Introduction : Les fistules nasofrontales correspondent à la persistance d’une communication anormale d’origine embryologique entre la couche profonde de la peau et le système nerveux. Ils peuvent être associés à un kyste dermoïde ou épidermoïde.Ils peuvent être révélés par une infection loco-régionale et surtout neuro-méningée qui fait toute la gravité de cette malformation congénitale. Notre objectif est d’insister sur les caractéristiques de cette pathologie pour un diagnostic précoce.Observation : Il s’agit d’un enfant âgé de 2 ans, qui présente depuis sa naissance une fistule cutanée au niveau du dos du nez laissant sourdre du pus de façon intermittente. L’imagerie a objectivée une formation kystique basi-frontale médiane, associée à une déhiscence de l’os frontal gauche avec défaut de développement de l’apophyse crista galli. Le diagnostic de fistule associée à un kyste nasofrontal a été retenu. Le patient a été opéré par voie bicoronale. En per-opératoire, nous avons découvert un kyste extra-dural mais adhérant au feuillet externe de la dure-mère. La paroi kystique a été disséquée puis enlevée en totalité. Le défect osseux de l’os frontal gauche a été colmaté par de la poudre d’os et du surgicel. Les suites opératoires étaient simples et l’examen anatomopathologique a confirmé qu’il s’agit d’un kyste dermoïde nasofrontal. Une fistulectomie a été réalisée 6 mois plus tard avec bonne évolution.Conclusion : L’apport de l’imagerie est indispensable pour le diagnostic positif et topographique desfistules et kystes nasofrontaux. Le risque de complications infectieuses impose un traitement chirurgical. Le but de la chirurgie doit être une résection totale, seule garante de l’absence de récidive à long terme.Mots-clés : fistule nasofrontale, kyste nasofrontal, tomodensitométrie, imagerie par résonance magnétique, craniotomie frontaleIntroduction : Naso frontal fistula correspond to the persistence of an abnormal communication of embryological origin between the deep layer of the skin and the nervous system. They can be associated with dermoid or epidermoid cyst. They can be revealed by a locoregional and especially neuro-meningeal infection, wich makes all the severity of this malformation.Case-report : A 2 year-old child presents since birth cutaneous fistula at the nasal dorsum with intermittent purulent effuse. Imaging showed medial basi-frontal cyst, associated with dehiscence of the left frontal bone and defective development of the crista galli. The diagnosis of fistula associated with nasofrontal cyst was retained. The patient was operated by bicoronal approach. Intraoperatively, we found an extradural cyst but adhering to the outer layer of the dura mater. The cyst wall was dissected and removed totally. The bone defect of the left frontal bone was clogged with bone powder and surgicel. The postoperative course was uneventful and pathologic examination confirmed that this is a nasofrontal dermoid cyst. Fistulectomy was performed 6 months later with good evolution.Conclusion : Contribution of imaging is essential for positive and topographic diagnosis of nasofrontal fistulas and cysts. The risk of infectious complications requires surgical treatment. The goal of surgery should be a total resection, the only guarantee of the absence of long-term recurrence.Keywords : nasofrontal fistula, nasofrontal cyst, computed tomography, magnetic resonance imaging, frontal craniotom

A Performance Comparison According to Number of Wavelengths and Topologies on PCSA Reservation Mechanism for OBS

Abstract A performance comparison according to different number of wavelengths and topologies on OBS has been studied in this paper. Preemptive Channel Scheduling Algorithm (PCSA) has been used as reservation mechanism in OBS. In terms of performance criteria, loss rate in bytes, access delay and end-to-end delay are considered. A 2-state MMPP (Markov Modulated Poisson Process) traffic generator is used. Four different types of Mesh and Ring topologies are used. NS2 Network Simulation tool is used for our tests. In OBS algorithms, bursts are created using a hybrid model that takes into account both timeout and maximum length threshold mechanisms. In nodes, in order to satisfy QoS requirements, priority based queuing and Regulative Wavelength Grouping (RWG) are used. In priority based queuing, packets (bursts) are sent according to their priority order. In this study, the effects of generated traffic according to the topologies and the effects of increased number of wavelengths are shown by access delays. According to the simulation studies, the success of byte drop rate increases while the number of wavelengths increases. The results that obtained on mesh topologies are better than the results of ring topologies according to our simulation results

Global Trends in the Use of Insecticides to Control Vector-Borne Diseases

Background: Data on insecticide use for vector control are essential for guiding pesticide management systems on judicious and appropriate use, resistance management, and reduction of risks to human health and the environment

Drug excipient interaction study with polymorphic forms of tibolone.

Powder mixtures (1:1) of tibolone polymorphic forms I (monoclinic) and II (triclinic) and excipients have been prepared and compacted. The samples were stored at 50 °C and 90% RH for one month and subsequently were evaluated using differential scanning calorimetry (DSC) and high-performance liquid chromatography (HPLC). The results indicate that during the compaction, the applied pressure reduced the chemical stability of tibolone in both polymorph forms. The triclinic form was more chemically unstable, both pure and in contact with excipients, than the monoclinic form. Lactose monohydrate was shown to reduce chemical degradation for both forms. Ascorbyl palmitate was shown to affect the tibolone stability differently depending on the polymorphic form used.Colegio de Farmacéuticos de la Provincia de Buenos Aire