Journal articles: 'Expected interruption cost' – Grafiati (2024)

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It is becoming increasingly important to implement projects with care on environmental conditions. Some projects can be carried out only during the allowable season and interrupted during other seasons. Such a project interruption is expected to affect the quality of the project’s outcome through the decision-making of the stakeholders. This paper investigates the impact of interruption on the decision-making of the project owner and the contractor. We consider a project with some work after the interruption period (two-year project), the owner can select another option (one-year project) where all work is completed before the interruption period. If the fixed cost is higher relative to the benefit, our results show that the contractor prefers the one-year project, even when the owner selects the two-year project. We also represent the two threshold values of the interruption length that determine the owner’s selection and relative quality of outcomes, respectively. It was found that a range of interruption length where the selected project does not provide the higher quality outcome.

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Abstract In this investigation, we establish a steady-state solution of an infinite-space single-server Markovian queueing system with working vacation (WV), Bernoulli schedule vacation interruption, and impatient customers. Once the system becomes empty, the server leaves the system and takes a vacation with probability p or a working vacation with probability 1 − p, where 0 ≤ p ≤ 1. The working vacation period is interrupted if the system is non empty at a service completion epoch and the server resumes its regular service period with probability 1 − q or carries on with the working vacation with probability q. During vacation and working vacation periods, the customers may be impatient and leave the system. We use a probability generating function technique to obtain the expected number of customers and other system characteristics. Stochastic decomposition of the queueing model is given. Then, a cost function is constructed by considering different cost elements of the system states, in order to determine the optimal values of the service rate during regular busy period, simultaneously, to minimize the total expected cost per unit time by using a quadratic fit search method (QFSM). Further, by taking illustration, numerical experiment is performed to validate the analytical results and to examine the impact of different parameters on the system characteristics.

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Power system faults can cause voltage sags that, if they are less than voltage sensitivity threshold of equipment, can lead to interruption of supply and lead to incurring of financial losses. The impact of distributed generation (DG) on these financial losses is investigated in this work. Using the method of fault positions, a stochastic approach to determine voltage sag performance, profiles of magnitudes of remaining voltages at a monitoring point for faults occurring along lines in the network is developed. It follows that an expected number of critical voltage sags at a monitoring point is calculated and the expected cost of these sags is derived for various voltage sensitivity threshold limits. An illustrative study is carried out comparing the expected costs of voltage sags for a network without DG with a DG case, for various mixes of customers. It is shown that in the presence of DG, the expected costs of voltage sags are lesser for all voltage sensitivity criteria assumed and for all customer mixes. The study demonstrates that the impact of incorporating DG sources results in a reduction in the expected cost of voltage sags.

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Cross-border e-commerce of the Internet of Things is affected by international situations and political factors. Supply chain interruption and returns will cause violent fluctuations in commodity inventory, making the inventory control of cross-border e-commerce very difficult. The TRIZ principle is utilized to solve the problem of the difficulty to evaluate the suppliers comprehensively in e-commerce warehouse management. The Markov algorithm is used to describe the change of inventory level. The cyclic expected time and cost function are constructed by the horizontal crossing method, updating the process and Martingale theory. The effect of the correlation between the demand and supply interruption on the optimal inventory control strategy is studied by simulation. The change of the optimal control strategy under the different interrupt and return types is analyzed, and the validity of the management system is verified.

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<abstract> <p>Over the last decade, automated distribution networks have grown in importance since traditional distribution networks are insufficiently intelligent to meet the growing need for reliable electricity supplies. Because the distribution network is the least reliable and the sole link between the utility and its customers, it is critical to improve its reliability. The remote-controlled switch (RCS) is a viable choice for boosting system reliability. It shortens the interruption period, which also minimizes the expected interruption cost and the amount of energy not served. Using the greedy search algorithm, this research expands the current reliability evaluation technique to include RCSs in distribution networks. The optimal location and numbers of RCSs have been evaluated with compromised cost. This study simultaneously takes into account the effects of load growth on system reliability indices, the impact of age on equipment failure rates and the hidden failure rate of fuses. The Roy Billinton test system's distribution network connected at bus 2 and bus 5 has been used to test the effectiveness of the suggested approach. The outcomes demonstrate that effective RCS deployment improves the radial distribution network's reliability indices significantly.</p> </abstract>

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Aiming at the problem that the current dynamic economic dispatch (DED) fails to consider the response risk of spinning reserve caused by the fluctuation and uncertainty of wind power, we work out a DED problem considering time-coupling spinning reserve response risk while the stochasticity and variability arising from RESs are taken into consideration. The developed framwork unified the response risk of reserve caused by forced shutdown of the unit into the response risk caused by time coupling. The expected customer interruption cost (ECOST) and the expected abandoned wind cost considering this reserve response risk are added to the objective function. While seeking the minimum objective function, the system is automatically configured with suitable reserve to ensure the consistency of the system’s response risk in each period. An improved multi-universe parallel quantum genetic algorithm was used to solve the model. Numerical examples and analysis prove the effectiveness and feasibility of the proposed method.

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This paper presents a case study life cycle analysis of a conventional and base isolated steel braced frame office building. The case study focuses particularly on the effects of moat wall pounding and business interruption using the FEMA P-58 methodology. Analytical results suggest that the overall performance of the base isolated building is far superior to the conventional building but that expected financial losses in the isolated building become significant if structural pounding occurs. The cost-effectiveness of the isolation is found to be particularly sensitive to the ability of businesses to relocate quickly and effectively after a large earthquake.

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In this paper we consider a single server queueing model with working vacation and multiple working breakdowns. When on vacation, the server works at a different pace. Disturbances occur in the server due to multiple breakdowns. In working breakdowns server works at a different rate. During the time of interruption caused by working vacation and working breakdowns, the main server can find many implementations in operation. Both the server's lifespan and the time it takes to repair it are considered to be exponentially dispersed. Also, we have considered balking and reneging behaviours of customers. The stationary queue length distribution is computed using a matrix-analytic technique. Using Genetic Algorithm (GA) we optimize the cost function. The predicted length of a busy period, the expected length of a working vacation period, the expected length of a working breakdown period, the mean waiting time, and the average delay are all established. We compute numerical results to verify the analytical point of view. The effect of individual parameters is investigated using sensitivity analysis.

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Mobile edge computing (MEC) is an emerging technology that provides cloud services at the edge of network to enable latency-critical and resource-intensive E-healthcare applications. User mobility is common in MEC. User mobility can result in an interruption of ongoing edge services and a dramatic drop in quality of service. Service migration has a great potential to address the issues and brings inevitable cost for the system. In this paper, we propose a service migration solution based on migration zone and formulate service migration cost with a comprehensive model that captures the key challenges. Then, we formulate service migration problem into Markov decision process to obtain optimal service migration policies that decide where to migrate in a limited area. We propose three algorithms to resolve the optimization problem given by the formulated model. Finally, we demonstrate the performance of our proposed algorithms by carrying out extensive experiments. We show that the proposed service migration approach reduces the total cost by up to 3 times compared to no migration and outperforms the general solution in terms of the total expected reward.

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HIV cure studies require patients to enter an analytical treatment interruption (ATI). Here, we describe previously unanalyzed data that sheds light on ATI dynamics in PLHIV (People Living with HIV). We present drug resistance mutation dynamics on the pol gene among individuals with antiretroviral virological failure who underwent ATI. The study involved a 12-week interruption in antiretroviral therapy (ART), monitoring of viral load, CD4+/CD8+ T cell counts, and sequencing of the pol gene from 38 individuals experiencing virological failure and harboring 3-class resistant HIV strains: nucleoside reverse transcriptase inhibitors (NRTI) non-nucleoside inhibitors (NNRTI), and protease inhibitors (PI). Protease and reverse transcriptase regions of the pol gene were sequenced at baseline before ATI and every four weeks thereafter from PBMCs and at baseline and after 12 weeks from plasma HIV RNA using population-based Sanger sequencing. Average viral load increased 0.559 log10 copies per milliliter. CD4+ T cell count decreased as soon as ART was withdrawn, an average loss of 99.0 cells/mL. Forty-three percent of the mutations associated with antiretroviral resistance in PBMCs disappeared and fifty-seven percent of the mutations in plasma reverted to wild type, which was less than the 100% reversion expected. In PBMC, the PI mutations reverted more slowly than reverse transcriptase mutations. The patients were projected to need an average of 33.7 weeks for PI to revert compared with 20.9 weeks for NRTI and 19.8 weeks for NNRTI. Mutations in the pol gene can cause virological failure and difficulty in re-establishing effective virological suppression.

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Objective: To assess, from an epidemiological and economic point of view, the consequences of the reduction in the supply of antiretroviral drugs due to the COVID-19 pandemic. Method: The analysis was conducted by adapting a Markov model previously published in literature. The simulations were conducted considering the possibility of continuous treatment for patients already diagnosed (no therapeutic interruptions are expected) and an immediate start of patients with new diagnosis during 2021. This analysis was compared with a scenario involving a therapeutic interruption or diagnostic delay caused by COVID-19. Results: The analysis showed that the scenario characterized by a treatment delay, compared to the scenario of early resumption of therapy, could generate an increase in the number of patients with CD4 < 200 equal to 1,719 subjects (+16%) and a reduction in the number of patients with CD4 500 equal to 6,751 (−9%). A timely resumption of treatment for HIV+ patients could prevent 296, 454 and 687 deaths in the third, fifth and tenth years of analysis respectively with a potential cost reduction equal to 78,9 million at a 10 year time horizon. Conclusions: These findings show that it is essential, especially in a pandemic situation such as the present one, to introduce technological, digital and organizational solutions, aimed at promoting timely diagnosis and at accelerating the therapeutic switch for patients who are no longer targeted.

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The paper intends to select the most economical and reliable expansion alternative of a composite power system to meet the expected future load growth. In order to reduce time computational quantity, a heuristic algorithm is adopted for composite power system reliability evaluation is proposed. The proposed algorithm is based on Monte-Carlo simulation method. The reliability indices are estimated for system base case and for the case of adding peaking generation units. The least cost reserve margin for the addition of five 20MW generating units sequentially is determined. Using the proposed algorithm an increment comparison approach used to illustrate the effect of the added units on the interruption and on the annual net gain costs. A flow chart introduced to explain the basic methodology to have an adequate assessment of a power system using Monte Carlo Simulation. The IEEE RTS (24-bus, 38-line) and The Jordanian Electrical Power System (46-bus and 92-line) were examined to illustrate how to make decisions in power system planning and expansions.

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Reliability is an important index which determines the power service and quality provided to customers. As the demand increases continuously and the system changes in accordance with the environmental regulation, the reliability assessment in the distribution system becomes crucial. In this paper, we propose methods for improving the reliability of the distribution system using electric vehicles (EVs) in the system. In this paper, EVs are used as power supplying devices, such as a transportable energy storage system (ESS) which supplies power when fault occurs in the system, and by using a time–space network (TSN) in particular, EV capacity in accordance with the load arrival time was calculated. Unlike other existing reliability assessments, we did not use the average load of customers. Instead, by taking into account the load pattern by times, we considered the priority for load supply in accordance with the failure scenarios and failure times. Based on the priority calculated for each time of failure and failure scenario, plans for EV operation to minimize expected customer interruption cost (ECOST), the reliability index in the distribution system, were established. Finally, a case study was performed using the IEEE RBTS (Roy Billinton Test System) 2 Bus and the performance of the model proposed in this paper was verified based on the result.

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We address the problem of finding shortest paths in graphs where some edges have a prior probability of existence, and their existence can be verified during planning with time- consuming operations. Our work is motivated by real-world robot motion planning, where edge existence is often expensive to verify (typically involves time-consuming collision-checking between the robot and world models), but edge existence probabilities are readily available. The goal then, is to develop an anytime algorithm that can return good solutions quickly by somehow leveraging the existence probabilities, and continue to return better-quality solutions or provide tighter suboptimality bounds with more time. While our motivation is fast and high-quality motion planning for robots, this work presents two fundamental contributions applicable to generic graphs with probabilistic edges. They are: a) an algorithm for efficiently computing all relevant shortest paths in a graph with probabilistic edges, and as a by-product the expected shortest path cost, and b) an anytime algorithm for evaluating (verifying existence of) edges in a collection of paths, which is optimal in expectation under a chosen distribution of the algorithm interruption time. Finally, we provide a practical approach to integrate a) and b) in the context of robot motion planning and demonstrate significant improvements in success rate and planning time for a 11 degree-of-freedom mobile manipulation planning problem. We also conduct additional evaluations on a 2D grid navigation domain to study our algorithm’s behavior.

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Abstract OBJECTIVES: With a greater focus on costs in today’s health care markets, it is important to evaluate overall costs and quality of care associated with new therapies in cost-effectiveness analyses. Adverse events (AEs) associated with cancer therapies often result in substantial economic costs and negative impacts on patient quality of life. AEs may also affect adherence to therapy and result in suboptimal treatment outcomes. Important AEs of dasatinib in chronic myelogenous leukemia (CML) patients who are resistant to imatinib include neutropenia, thrombocytopenia, anemia, gastrointestinal hemorrhage, central nervous system hemorrhage, and fluid retention leading to effusions and heart dysfunction. This study evaluated the total cost of treatment with dasatinib in patients with chronic, accelerated, and myeloid blast phase CML, taking into account both drug and AE-associated costs. METHODS: A literature-based economic model was developed to examine the short-term potential impact of AEs in patients with CML treated with dasatinib. The incidence rates of Grade 3/4 AEs were obtained from the SPRYCEL™ (dasatinib) package insert. The AEs were assumed to occur within the first 6 months of treatment. The costs associated with the AEs were obtained from published medical literature and the 2003 Healthcare Cost and Utilization Project database of mean hospital charges by principal diagnosis, converting to costs using a Medicare cost-to-charge ratio of 0.55. Dasatinib dosing assumptions were based on the FDA briefing documents of the SPRYCEL™ filing submission presented at the June 2, 2006 Oncology Drug Advisory Committee meeting. The initial dose for dasatinib was 70 mg twice daily based on the package insert. Patients were assumed to remain on treatment for 6 months. However, dose interruption of 7–14 days during the first 3 months of treatment and dose reduction to 50 mg twice daily in the second 3 months of treatment were assumed in 46–55% and 9–10% of patients, respectively. Drug costs were based on wholesale acquisition cost. Univariate and multivariate sensitivity analyses were conducted. All costs were adjusted to 2006 U.S. dollars using the medical care component of the consumer price index. RESULTS: In the base case analysis, the expected 6-month per-patient cost of treatment for dasatinib was $31,528 for chronic phase, $44,340 for accelerated phase, and $48,666 for myeloid blast phase. Six-month drug cost alone was $22,284 per patient in each phase. Grade 3/4 AEs accounted for approximately 29%, 50%, and 54% of the total cost of care for chronic, accelerated, and myeloid blast phases, respectively. Sensitivity analysis showed that the 6-month cost of Grade 3/4 AEs may range from $5,235–$10,696 for chronic, $16,109–$23,723 for accelerated, and $12,971–$27,551 for myeloid blast phases. Primary cost drivers were the hematologic AEs. CONCLUSIONS: This study provides an estimate for the total cost of treatment with dasatinib that considers treatment costs for severe AEs associated with therapy. These results highlight the importance of including treatment-related AEs in addition to drug costs when assessing the economic value of treatment options for CML. Future studies should expand the time horizon of the analysis and include recurring AEs to more comprehensively evaluate the overall economic impact of AEs with dasatinib.

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Bougnères P. Efficacy of intermittent therapy in growth hormone-deficient children. Eur J Endocrinol 1994;130:459–62. ISSN 0804–4643 Eighty-six growth hormone-deficient children treated with extractive growth hormone were transferred to recombinant growth hormone (rGH): 57 children were transferred directly to rGH, but 29 experienced a 9.7 ± 1-month pause in growth hormone administration. The retrospective analysis of growth from 1 year before to 1 year after initiation of rGH showed that the interruption of growth hormone administration did not modify the final height gain. During the 2 years, children with continuous therapy gained 12.2 ± 0.5 cm with a cumulative growth hormone dose of 43 ± 3 U/kg, while those who paused gained 12.1 ±0.3 cm with a cumulative growth hormone dose of only 24 ± 2 U/kg (p < 0.0005). As expected, during the year preceding the onset of rGH, the children who paused gained less height than those treated continuously, but grew more rapidly during the first year of rGH administration. This was due to an important re-acceleration of growth rate at re-initiation of therapy after the pause. Our observation suggests that regimens of discontinuous rGH administration could be as efficient as continuous treatment. If confirmed in prospective randomized trials, this could have important consequences for improving the clinical efficiency of a given dose of rGH, as well as for the patient's comfort, secondary effects and cost of therapy. Pierre Bougnères, Service d'Endocrinologie Pédiatrique, Hôpital Saint Vincent de Paul, 82 avenue DenfertRochereau, 75014 Paris, France

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Earthquake Engineering is facing an extraordinarily challenging era, the ultimate target being set at increasingly higher levels by the demanding expectations of our modern society. The renewed challenge is to be able to provide low-cost, thus more widely affordable, high-seismic-performance structures capable of sustaining a design level earthquake with limited or negligible damage, minimum disruption of business (downtime) or, in more general terms, controllable socio-economical losses. The Canterbury earthquakes sequence in 2010-2011 has represented a tough reality check, confirming the current mismatch between societal expectations over the reality of seismic performance of modern buildings. In general, albeit with some unfortunate exceptions, modern multi-storey buildings performed as expected from a technical point of view, in particular when considering the intensity of the shaking (higher than new code design) they were subjected to. As per capacity design principles, plastic hinges formed in discrete regions, allowing the buildings to sway and stand and people to evacuate. Nevertheless, in many cases, these buildings were deemed too expensive to be repaired and were consequently demolished. Targeting life-safety is arguably not enough for our modern society, at least when dealing with new building construction. A paradigm shift towards damage-control design philosophy and technologies is urgently required. This paper and the associated presentation will discuss motivations, issues and, more importantly, cost-effective engineering solutions to design buildings capable of sustaining low-level of damage and thus limited business interruption after a design level earthquake. Focus will be given to the extensive research and developments in jointed ductile connections based upon controlled rocking & dissipating mechanisms for either reinforced concrete and, more recently, laminated timber structures. An overview of recent on-site applications of such systems, featuring some of the latest technical solutions developed in the laboratory and including proposals for the rebuild of Christchurch, will be provided as successful examples of practical implementation of performance-based seismic design theory and technology.

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BackgroundAccurate time-energy budgets summarise an animal’s energy expenditure in a given environment, and are potentially a sensitive indicator of how an animal responds to changing resources. Deriving accurate time-energy budgets requires an estimate of time spent in different activities and of the energetic cost of that activity. Bio-loggers (e.g., accelerometers) may provide a solution for monitoring animals such as fur seals that make long-duration foraging trips. Using low resolution to record behaviour may aid in the transmission of data, negating the need to recover the device.MethodsThis study used controlled captive experiments and previous energetic research to derive time-energy budgets of juvenile Australian fur seals (Arctocephalus pusillus)equipped with tri-axial accelerometers. First, captive fur seals and sea lions were equipped with accelerometers recording at high (20 Hz) and low (1 Hz) resolutions, and their behaviour recorded. Using this data, machine learning models were trained to recognise four states—foraging, grooming, travelling and resting. Next, the energetic cost of each behaviour, as a function of location (land or water), season and digestive state (pre- or post-prandial) was estimated. Then, diving and movement data were collected from nine wild juvenile fur seals wearing accelerometers recording at high- and low- resolutions. Models developed from captive seals were applied to accelerometry data from wild juvenile Australian fur seals and, finally, their time-energy budgets were reconstructed.ResultsBehaviour classification models built with low resolution (1 Hz) data correctly classified captive seal behaviours with very high accuracy (up to 90%) and recorded without interruption. Therefore, time-energy budgets of wild fur seals were constructed with these data. The reconstructed time-energy budgets revealed that juvenile fur seals expended the same amount of energy as adults of similar species. No significant differences in daily energy expenditure (DEE) were found across sex or season (winter or summer), but fur seals rested more when their energy expenditure was expected to be higher. Juvenile fur seals used behavioural compensatory techniques to conserve energy during activities that were expected to have high energetic outputs (such as diving).DiscussionAs low resolution accelerometry (1 Hz) was able to classify behaviour with very high accuracy, future studies may be able to transmit more data at a lower rate, reducing the need for tag recovery. Reconstructed time-energy budgets demonstrated that juvenile fur seals appear to expend the same amount of energy as their adult counterparts. Through pairing estimates of energy expenditure with behaviour this study demonstrates the potential to understand how fur seals expend energy, and where and how behavioural compensations are made to retain constant energy expenditure over a short (dive) and long (season) period.

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BackgroundMedullary thyroid cancer (MTC) is a rare form of cancer that affects patients’ health-related quality of life (HRQoL) and survival. Cabozantinib (Cometriq®; Ipsen, Paris, France) and vandetanib (Caprelsa®; Sanofi Genzyme, Cambridge, MA, USA) are currently the treatment modality of choice for treating unresectable progressive and symptomatic MTC.Objectives(1) To evaluate the clinical effectiveness and safety of cabozantinib and vandetanib. (2) To estimate the incremental cost-effectiveness of cabozantinib and vandetanib versus each other and best supportive care. (3) To identify key areas for primary research. (4) To estimate the overall cost of these treatments in England.Data sourcesPeer-reviewed publications (searched from inception to November 2016), European Public Assessment Reports and manufacturers’ submissions.Review methodsA systematic review [including a network meta-analysis (NMA)] was conducted to evaluate the clinical effectiveness and safety of cabozantinib and vandetanib. The economic analysis included a review of existing analyses and the development of a de novo model.ResultsThe systematic review identified two placebo-controlled trials. The Efficacy of XL184 (Cabozantinib) in Advanced Medullary Thyroid Cancer (EXAM) trial evaluated the efficacy and safety of cabozantinib in patients with unresectable locally advanced, metastatic and progressive MTC. The ZETA trial evaluated the efficacy and safety of vandetanib in patients with unresectable locally advanced or metastatic MTC. Both drugs significantly improved progression-free survival (PFS) more than the placebo (p < 0.001). The NMA suggested that, within the symptomatic and progressive MTC population, the effects on PFS were similar (vandetanib vs. cabozantinib: hazard ratio 1.14, 95% credible interval 0.41 to 3.09). Neither trial demonstrated a significant overall survival benefit for cabozantinib or vandetanib versus placebo, although data from ZETA were subject to potential confounding. Both cabozantinib and vandetanib demonstrated significantly better objective response rates and calcitonin (CTN) and carcinoembryonic antigen (CEA) response rates than placebo. Both cabozantinib and vandetanib produced frequent adverse events, often leading to dose interruption or reduction. The assessment group model indicates that, within the EU-label population (symptomatic and progressive MTC), the incremental cost-effectiveness ratios (ICERs) for cabozantinib and vandetanib are > £138,000 per quality-adjusted life-year (QALY) gained. Within the restricted EU-label population (symptomatic and progressive MTC with CEA/CTN doubling times of ≤ 24 months), the ICER for vandetanib is expected to be > £66,000 per QALY gained. The maximum annual budget impact within the symptomatic and progressive population is estimated to be ≈£2.35M for cabozantinib and ≈£5.53M for vandetanib. The costs of vandetanib in the restricted EU-label population are expected to be lower.LimitationsThe intention-to-treat populations of the EXAM and ZETA trials are notably different. The analyses of ZETA subgroups may be subject to confounding as a result of differences in baseline characteristics and open-label vandetanib use. Attempts to statistically adjust for treatment switching were unsuccessful. No HRQoL evidence was identified for the MTC population.ConclusionsThe identified trials suggest that cabozantinib and vandetanib improve PFS more than the placebo; however, significant OS benefits were not demonstrated. The economic analyses indicate that within the EU-label population, the ICERs for cabozantinib and vandetanib are > £138,000 per QALY gained. Within the restricted EU-label population, the ICER for vandetanib is expected to be > £66,000 per QALY gained.Future research priorities(1) Primary research assessing the long-term effectiveness of cabozantinib and vandetanib within relevant subgroups. (2) Reanalyses of the ZETA trial to investigate the impact of adjusting for open-label vandetanib use using appropriate statistical methods. (3) Studies assessing the impact of MTC on HRQoL.Study registrationThis study is registered as PROSPERO CRD42016050403.FundingThe National Institute for Health Research Health Technology Assessment programme.

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The past four decades have been years of phenomenal progress in all of medicine, yet in terms of numbers of lives saved or in years of productive lives spared, nothing has equaled the record of preventative pediatrics, specifically, our national immunization program. In the past several years, however, this immunization program has almost fallen into shambles. The sources of this reversal would have been from vaccine liability leading to exorbitant costs or loss of supply of vaccines. In the 1970s and 1980s, a series of crises that were only narrowly averted threatened interruption of the national immunization program. It is now worthwhile to trace the events of the past several years so that we can review the continuity of the course of events through those years to understand the necessity for the specific resolution of these problems in the form of the National Childhood Vaccine Injury Compensation Act. The American Academy of Pediatrics played a leading and pivotal role in the long struggle to enact this legislation. It is expected that the act should be the means of avoiding any future threats to our national immunization program through loss of supply. Furthermore, and of equal importance, after time for stabilization and experience with its administration, the act should reduce the cost of vaccines. The courts have dealt with the matter of vaccine injury in an irregular and sometimes unpredictable manner. This legislation should provide a more predictable and just outcome for those few who suffer vaccine injuries. Because this is the first major legislation the Academy has undertaken, the membership should be informed of the time involved in promoting passage of this legislation: the costs in hours by the members, officers, and staff, as well as the monetary costs to the Academy.

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AimTo improve patient experience, patient safety and streamline the patient journey when obtaining Methicillin-resistant well as unsafe due to interruption of healthcare professionals on the ward. To determine if this patient journey was a fair representation, questionnaires were distributed to parents/carers attending the pre-assessment clinic regarding the time taken at stages throughout the process and their satisfaction. These were distributed to every cardiac patient attending the clinic over a 4 week period (age 0–16 years). From the results it was concluded that the time could be reduced by patients obtaining MRSA decolonisation within the clinic; either by having a prescriber present or producing a Patient Group Directive (PGD). A PGD was preferred due to cost and workforce availability. A PGD was written, approved and implemented within clinic. To assess the reduction in time and change in patient experience, revised questionnaires are in the process of being distributed, again to every cardiac patient attending clinic over a 4 week period.ResultsThe initial patient journey took 130 minutes from beginning to end, with the time taken to obtain MRSA decolonisation being 80 minutes. 15 questionnaires were distributed, 9 patients responded (aged 6 months-14 years) with the mean time to obtain MRSA decolonisation being 59 minutes (40–85 minutes). From the 9 that responded, 5 of the comments sections regarding patient experience were left blank. 4 contained dissatisfied comments such as ‘very long afternoon with lots of walking’ and ‘seems silly to interrupt the very busy nurses and doctors for a prescription’. Post PGD 5 questionnaires have been distributed and 3 returned. Journey time has now been considerably reduced with an average time to obtain MRSA decolonisation being 5 minutes; a reduction of 54 minutes. Further responses are expected to support this.ConclusionThe patient experience when obtaining MRSA decolonisation prior to cardiac surgery was far from ideal. The implementation of a PGD has improved this experience and considerably reduced the time the process takes. This applies to all age ranges. A limitation is that only 3 questionnaires have been received post PGD implementation. The aim is that at least 9 questionnaires will be returned in order to compare the time pre and post PGD. It is apparent that interruptions to healthcare professionals on the ward by patients from pre-assessment clinic have stopped, resulting in a safer clinical environment. Further work needs to be undertaken in order to demonstrate this.ReferencesDepartment of Health. 2016. The NHS Outcomes Framework 2016/17 [online] (accessed 17 Nov 2017). Available from: https://www.gov.uk/government/publications/nhs-outcomes-framework-2016-to-2017Denton M, Hodgson G. Meticillin Resistant Staphylococcus Aureus (MRSA) Guideline. 2010. Leeds Teaching Hospitals. [online] (accessed 17 Nov 2017]. Available from: http://nww.lhp.leedsth.nhs.uk/common/guidelines/detail.aspx?ID=684

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A set of field trials were carried out aboard a Canadian Coast Guard fast rescue Rigid Hull Inflatable Boat. The vessel was outfitted with a data acquisition system to collect vessel and engine performance data and trialled in three wave conditions (approx. Beaufort 2 to 7). This paper focusses on the methodologies and results for calculating and investigating Motion-Induced Interruptions (MIIs). MIIs due to lateral and longitudinal overbalancing and sliding were investigated using the counting of motion events which are expected to cause an interruption, supported by a statistical analysis and examination of the distribution of the MII data. We conclude that MII assessments of small, light, high-speed craft such as the one studied should include longitudinal acceleration and pitch angle, typically assumed to be non-influential in MII assessments. Statistical treatments have promise for analysis of field-acquired MII data.

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Abstract Background: Immune thrombocytopenia (ITP) is a heterogeneous disorder of immune dysregulation of T and autoreactive B cells leading to immune mediated destruction of platelets due to eventual loss of immune tolerance against platelet epitopes. Whether intensification regimens like Rituximab improve sustained platelet response (SR) across different lines is unclear. Methods: A retrospective review of three hundred sixty-two patients of thrombocytopenia seen between Jan 1990 to June 2016 across three rural community practices across southeastern NM was performed. Eighty-eight patients with chronic liver disease and or drug related thrombocytopenia were excluded from the statistical analysis. Fisher's exact test was used to test the association of treatment and response in both primary and secondary ITP. International working group (IWG-2009) classification was used to assess response criteria. (SR) was defined as a platelet count of >50,000 per cubic millimeter six months after treatment. Results: Two hundred thirty-three patients (64%) had primary ITP 41 (11%) had secondary ITP. Median age of diagnosis was 61 and median platelet on diagnosis was 90 (0-148). Of the 274 patients included in this analysis, 143 ITP patients (52%) were followed by observation alone and 131 (48%) received treatment. Sixty-six (24%) patients received second line treatment and further 41 (15%) patients received third line treatment. Complete remission (CR) was achieved in 68% in first line. Sixty-one percent patients had a CR with Prednisone in first line as compared to 84% with dexamethasone (p=0.15). Forty-seven (17%) of all ITP patients received Rituximab (across multiple lines of treatment). Twenty percent of patients who achieved CR/PR in first line had received IVIg. Rituximab was used in 9%,39% and 34% of first, second and third lines of treatment respectively. Across all lines of treatment Rituximab was not associated with a higher CR (p=0.47) or SR (p=0.35) (Table 1). Fifteen percent of patients had toxicity requiring interruption of Rituximab including 1 patient with sepsis. Hyperglycemia, insomnia were the three most common toxicities seen in 19%, 11% patients overall (Table 2). Conclusion: Rituximab use across all lines of treatment was not associated with a higher CR or SR rate in our dataset. The higher than expected Response rates may be due to inclusion of other intensification treatments like IVIg. The use of Rituximab however is limited in real world rural practices especially in the first line setting possibly partly due to insurance denials and cost. Its use seems more common in subsequent lines of treatment. Other ways to intensifying therapy in first line should be evaluated in prospective clinical trials like use of IVIg with or without the use of Rituximab and whether upfront intensive treatment avoids earlier recurrence need to be studied. Table 1 Table 1. Disclosures No relevant conflicts of interest to declare.

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A two-level optimization method is presented to find the optimal number and location of conventional protective devices to be upgraded to remote-controlled switches (RCSs) for an existing distribution network (DN). The effect of distributed generation (DG) on this problem is considered. In the first level, a nonlinear binary program is proposed to maximize the restored customers subject to technical and topological constraints. All feasible interchanges between protective devices and ties involved in the restoration, when a fault occurs at all possible locations are found considering switching dependencies. In the second level, a nonlinear cost function, combining the expected cost of interruptions (ECOST) and the switch cost, is minimized with respect to the location of RCSs. The expected cost function is computed based on the optimum restoration policies obtained from the first level. The optimum placement of RCSs using the proposed algorithm is tested on a 4-feeder 1069-node test system and compared to the solution obtained with a genetic algorithm (GA) on the same system.

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This article develops economic models for a cow-calf ranching operation and an alfalfa hay operation in the Humboldt River Region (HRR) that use surface water for irrigation. The models were built and parameterized through consultation with ranchers and farmers in the HRR in order to represent typical agricultural operations in the region. The models were used to calculate the economic value to an operation of an acre-foot of water not received due to an unanticipated supply reduction. This analysis was conducted to support the conjunctive management of surface and groundwater in the HRR by providing estimates of the economic value of the water that surface water users expect but do not receive due to interference from upstream groundwater pumping. For the cow-calf ranch model, reduced water deliveries impact ranch profits by reducing the amount of low-cost feed grown on the ranch. The increase in average feed costs forces the ranch to reduce its herd size, which lowers the number of new calf births and, as a result, lowers future profits from livestock sales. The cow-calf ranching model predicts an economic value of an acre-foot of water for the cow-calf ranch in the range of $215 per acre-foot for unanticipated supply interruptions that occur in normal water years, and upwards of $290 per acre-foot for supply interruptions that occur during drought. Model results do not provide evidence that the economic value of an acre-foot of water increases with the length of the unanticipated supply reduction. For the alfalfa hay farm model, results indicate that unanticipated reduced water deliveries impact farm profits by first preventing the farm from planting a cover crop during fallow years and then, for more significant interruptions, reducing its acreage of alfalfa hay. The alfalfa hay model predicts that the economic value of an acre-foot of water increases with both the volume of water not received and the length of the unanticipated supply reduction. The economic value of water per-acre-foot predicted by the alfalfa hay model ranges from less than $10 per acre-foot for unanticipated supply interruptions that occur in normal water years, in the range of $100-$200 per acre-foot for single-year supply interruptions that occur during a below average water year, and over $300 per-acre-foot for supply interruptions that occur in successive below average water years.

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This article presents a perishable inventory system under continuous review at a service facility in which a waiting area for customers is of finite size . The authors assume that the replenishment of inventory is instantaneous. The items of inventory have exponential life times. It is assumed that demand for the commodity is of unit size. The service starts only when the customer level reaches a prefixed level , starting from the epoch at which no customer is left behind in the system. The arrivals of customers to the service station form a Poisson process. The server goes for a vacation of an exponentially distributed duration whenever the waiting area is zero. If the server finds the customer level is less than when he returns to the system, he immediately takes another vacation. The individual customer is issued a demanded item after a random service time, which is distributed as negative exponential. The service process is subject to interruptions, which occurs according to a Poisson process. The interrupted server is repaired at an exponential rate. Also the waiting customer independently reneges the system after an exponentially distributed amount of time. The joint probability distribution of the number customers in the system and the inventory levels is obtained in steady state case. Some measures of system performance in the steady state are derived and the total expected cost is also considered. The results are illustrated with numerical examples.

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The Australian urban water industry has been substantially reformed over the past 20 years. Critical amongst these reforms has been the separation of operational and regulatory responsibilities. Under these arrangements the performance standards expected of water companies are specified by independent regulatory bodies or governments, and codified. Both regulators and water service providers have an interest in ensuring that regulatory standards are efficient and meet customer expectations, particularly as such standards can greatly affect the industry’s capital expenditure. A project has therefore been initiated to develop a framework for setting standards that are economically efficient, taking into account customer preferences. The project included development of methods to: identify customer preferences and means by which they would be measured;identify and evaluate the whole life cost of meeting standards for water continuity;value customers’ preferences, measure social costs associated with water interruptions and construct the overall cost benefit framework. Water system continuity was the service chosen for testing the methodologies developed. We conclude that a viable methodological framework for setting customer service standards can be developed.

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Statins reduce the incidence of cardiovascular events, one of the most important public health problems and among the main leading causes of death. Their use has been increasing in the last decade and today they represent the first drug class in terms of public expenditure. In view of the introduction of generic simvastatin in the Italian market, this paper outlines a pharmacological and economic profile of this compound. Despite two decades of life, simvastatin remains competitive with other HMG-CoA inhibitors, inducing a dose-dependent, up to 43% cLDL reduction. In clinical trials evaluating hard endpoints, simvastatin treatment achieved a strong reduction of cardiovascular events, revascularization procedures and mortality. Review of the main published pharmacoeconomic studies on simvastatin consistently indicated good cost/effectiveness ratios in most geographic contexts; convenience of this therapy increases along with baseline cardiovascular risk. Among available statins inducing equivalent cholesterol reductions, generic simvastatin has the lowest daily costs. Assuming stable market volume, an estimated cost saving for the Italian National Health Service of about 1 million Euro per year is expected from the introduction of the generic drug. Further cost savings may accrue for a potential switch from more expensive statins to simvastatin. Albeit individual responses to statins are unpredictable, the choice to start with lower cost molecules can limit initial drug investment and dampen the negative financial impact of treatment interruptions and switches.

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Abstract Sewer pipe networks are expected to operate with minimal or no interruptions. The complex nature of randomly occurring failures in sewer networks arising from blockages significantly adds to the cost of operation and maintenance. Blockages are significant due to sewage backup or basem*nts flooding, resulting from their occurrence. Therefore, continuous performance assessment of sewer pipe networks is necessary to ensure required levels of service at an acceptable cost. This study provides insight into the performance of the sewer pipe networks by assessing the proneness of the network to blockages. Furthermore it draws inferences at a holistic strategic level of influential explanatory factors of blockage proneness, using data available in the Swedish Water and Wastewater Association's benchmarking system. Results indicate that medium sized municipalities are prone to at least 30% more blockages per km per year compared to other municipalities. A hypothesis of explanatory factors includes reduced flow volumes and flow depth. Flow velocities below self-cleaning velocity in sewer pipe networks, encouraged by sluggishness of flow are responsible for increased possibility for sediment deposition and accumulation in sewers leading to blockages. This is also exacerbated by the deposition of non-disposables (wet wipes, baby diapers, hard paper, etc.), accumulation of fats, oils and grease in sewers and increased water conservation measures.

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Extraction of resources in remote locations can require temporary haul roads to transport extremely large, slow-moving, indivisible loads (e.g., plant, oil–gas production modules, and reactors, weighing in excess of 1000 t) without interruptions. Poor subgrade soils may experience larger cyclic strains and greater cyclic degradation under these conditions than under conventional roads, yet the short engineering life precludes many foundation-strengthening options due to cost. As there is little research into this unique situation, this paper synthesizes research from a broad range of applications to discuss implications on expected soil response. Reference is made to critical state theory and discrete element method (DEM) modelling to develop fundamental concepts considering particle-scale interactions. Cyclic failure is proposed to be a kinematically unstable process, triggered by shear banding on the Hvorslev surface, tensile liquefaction or fabric-governed meta-stable liquefaction; the latter is particularly influenced by stress history and anisotropy. This paper finds pore-water pressure accumulation under load and dissipation between loads are key to cyclic degradation and furthermore to be dependent upon load duration, principal stress rotation, and repetition frequency. For meta-stable, liquefiable soils in particular, inclination of principal stresses is at least as important in assessing failure risk as magnitude of stresses.

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Performance is typically reduced for dual-versus single-tasks, and potential interference between tasks can often be predicted by resource theories such as Multiple Resource Theory (MRT). MRT suggests that performance of two tasks drawing from the same set of cognitive resources is reduced in comparison to performance of two drawing on separate resource pools (e.g., visual-visual compared to visual-auditory). One drawback of MRT is the effect of auditory preemption on an ongoing visual task: whereas MRT expects no interference between auditory and visual tasks, auditory preemption theory posits a cost of attentional switching which may reduce performance. We investigated the effect of auditory preemption by administering an ongoing visual detection task and an interrupting auditory processing task. Results support the theory of auditory preemption as shown by a decline of response criterion ( C), but not perceptual sensitivity ( d’). MRT is also partially supported by an increase in perceived workload.

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Efficient business organizations must balance quality, cost, and time constraints in competitive environments. Reflecting the complexity of this task, we consider manufacturing systems including several stages of production chains requiring time measurement. When production scheduling is not prioritized in such enterprises, several negative effects may occur. A corporation may suffer financial penalties as well as negative brand exposure, and thus may find its credibility challenged. Therefore, in this study, we propose constructive methods to minimize a total tardiness criterion, considering preventative maintenance constraints to reflect the reality of industrial practice, focusing on a no-wait flowshop environment in which jobs are successively processed without operational interruptions. In addition to proposing constructive methods to solve the no-wait flowshop production scheduling problem, a metaheuristic is presented as an approach to improve results obtained by constructive methods. Computational experiments were designed and performed to compare several production scheduling algorithms. Among various constructive heuristics considered, an algorithm called HENLL using an insertion logic showed the best performance. The proposed metaheuristic is based on the iterated greedy (IG) search method, and the results obtained demonstrated significant improvement compared to the heuristics alone. It is expected that this study may be used by production planning and control (PPC) professionals to apply the proposed method to schedule production more efficiently. We show that the proposed method successfully presented a better solution in relation to total tardiness, considering the above mentioned environment.

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Jeddah, Saudi Arabia’s largest coastal city, is positioned between two prominent natural features: the mountain range on its eastern side and the Red Sea on its west. The city faces many challenges central to which is storm water drainage. The natural drainage of the city through its pre-existing wadis, bringing down the rain water from the steep mountain ranges through the low inclining coastal plane and into the sea, has been interrupted in the last few decades by massive road infrastructural projects cutting through the city and interrupting the natural flow. The outcome of these interventions has been excessive flooding calamities, of which the ones in 2009 and 2011 were the most extreme, causing severe damage to infrastructure, property and lives.In light of climate change the intensity of flash floods is expected to increase, placing enormous stress on the city. To control the floods the city has pushed forward heavily engineered solutions, canalizing the rich network of wadis, almost 80 in number, into 4 major concrete channels that discharge the rain water accumulated in the mountains directly into the sea. This solution, which has been prohibitive in cost, has robbed the city of any potential of utilizing the precious supply of rain water. This paper explores the potential of recovering Jeddah’s wadis and creating green corridors across the city. As opposed to engineered solutions which address singular problematics, green infrastructures could provide numerous benefits to the city and the region as a whole.

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Introduction An expected future increase in older adults will demand changes in health care delivery, making development, implementation and evaluation of new health care models essential. The rationale for political decision-making concerning the implementation and application of interventions in health care should include cost estimations, specifically those involving clinical interventions. To provide such data knowledge of time spent on the intervention is imperative. Time and motion methodology is suitable to quantify health care personnel’s time distribution. Aim To investigate the time distribution for pharmacists conducting a randomized controlled trial (RCT) implementing a clinical intervention. Materials and methods The setting was an RCT with a 5-step pharmacist-intervention in collaboration with the interdisciplinary team in a geriatric ward. Two pharmacists were involved in the trial during the observation period. Pharmacist activities, classified as RCT-tasks (intervention or administrative), non-RCT tasks and social/breaks, were recorded applying the Work Observation Method By Activity Timing methodology, enabling recording of predefined work tasks as well as interruptions and multitasking. One observer collected data over eight weeks. Results In total, 109.1 hours were observed resulting in 110.2 hours total task time, including multitasking. RCT tasks comprised 85.4% of the total observed time, and nearly 60% of the RCT time was spent on intervention tasks. Medication reviews was the most time consuming task, accounting for 32% of the observed time. The clinical pharmacists spent 14% of the intervention time communicating verbally, mainly with patients and healthcare professionals. Conclusion During the RCT, the clinical pharmacists spent about half their time performing the actual intervention. Consequently, costs for providing such a clinical pharmacist service should reflect actual time spent; otherwise, we may risk overestimating theoretical costs.

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The purpose of the paper is to diagnose the state of a power transformer by determining its equivalent circuit parameters by means of synchronized vector measurements of currents and voltages in the transformer normal operation mode without shutdowns, which makes it possible to increase the reliability of relay protection operation. A cost - effective method for proactive diagnostics of power transformers is proposed. Through monitoring of additional parameters (short circuit resistance, active and inductive resistance of the positive sequence, active and inductive resistance of the negative sequence) it can increase the speed and accuracy of detecting possible internal short circuits arising due to winding damage or high-voltage transformer bushings without diagnosed transformer disconnection from the network. The method allows to estimate the transformer health index and serviceability by the difference between the calculated parameters of the equivalent circuit and the passport values of the parameters. Having conducted the damage causedependent analysis of the number of power transformer damages, the authors determined total economic losses that include the losses caused by equipment damage and losses caused by the interruptions in consumer power supply. The total economic losses for a power transformer with a rated power of 63 MVA amounted to 10687402 rubles. It is shown that the diagnostic system expands the possibilities of analyzing the transformer state in operating modes, allows to pr event the approaching of the damage moment and occurrence of sudden accidents as well as minimizes the expected damage from shutdowns and equipment failure. A hardware and software complex is proposed for the diagnostics of power transformer internal damage. The given main characteristics of the proposed hardware and software complex include the number of measuring channels, accuracy class, sampling frequency, and others. The results of the work expand the possibilities of analyzing the transformer state in the operating mode and can be used in the world practice of creating various monitoring systems designed to identify the defects developing in transformers caused by winding deformation.

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<span style="font-family: OptimaLTStd; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;">Power transformer failures have a significant impact on electrical systems reliability, as they compromise the electricity delivery. Failures <span style="font-family: OptimaLTStd; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;">impact the operational cost of electric utilities as they endanger the accomplishment of power commitments. Power transformer <span style="font-family: OptimaLTStd; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;">failure rate can be modeled from its health condition, which is determined from different condition parameters. This paper is aimed <span style="font-family: OptimaLTStd; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;">to compare different maintenance schemes that allow the asset to be available the longest possible time. The power transformer <span style="font-family: OptimaLTStd; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;">operation is represented considering actual electric load profiles and temperature. Electrical and thermal transformer parameters are <span style="font-family: OptimaLTStd; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;">taken from manufacturer tests and technical standards. An electrical-thermal model is employed to estimate the life span reduction <span style="font-family: OptimaLTStd; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;">and temperature changes. From life span and loading, the health condition is determined, so as the effects of different maintenance <span style="font-family: OptimaLTStd; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;">schemes. The failure rates are calculated for unmaintained conditions and different maintained schemes, allowing to determine their <span style="font-family: OptimaLTStd; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;">effects on transformer reliability. Optimal maintenance schemes are determined and the expected benefits in failure rate reduction, <span style="font-family: OptimaLTStd; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;">asset reliability and life span extension are presented. As a result, it was found that certain time-based maintenance schemes provide <span style="font-family: OptimaLTStd; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;">better transformer reliability performance in comparison to condition based schemes, allowing to reduce the interruptions and<br /><span style="font-family: OptimaLTStd; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;">extending the life of the transformer.</span></span></span></span></span></span></span></span></span></span></span><br style="font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px;" /><br class="Apple-interchange-newline" /></span>

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Abstract Background: Heparin-induced thrombocytopenia (HIT) is a rare disorder with potential to cause significant morbidity and mortality. Early identification and initiation of non-heparin anticoagulation can prevent devastating thrombotic events. However, over-testing is common and can lead to result misinterpretation, unnecessary heparin avoidance, and increased cost. When there is concern for HIT, guidelines from the American Society of Hematology recommend calculation of the 4Ts score to determine the need for laboratory testing. The Choosing Wisely® initiative recommends against laboratory testing in patients with a low probability score of ≤3. In patients with an intermediate or high probability score (≥4), screening with enzyme-linked immunosorbent assay (ELISA) is performed first. If positive, the diagnosis of HIT is confirmed with a functional assay, commonly the serotonin release assay (SRA). Methods: In an effort to increase recognition of HIT, providers at a large academic medical center received a non-interruptive alert in the electronic medical record (EMR) on all patients in whom the platelet count declined by ≥50% starting in Aug 2017. We performed a retrospective evaluation of 1) the number of alerts and 2) all ELISA results obtained with or without an alert, over a 90-day period (Dec 2019 to March 2020). A 4Ts score was calculated by chart review by the first author in real-time as the alert was sent (blinded to ELISA and SRA results). Among those patients with multiple alerts or test orders, the first instance was used for analysis. Demographic and clinical characteristics were reported using frequencies and percentages, means (standard deviation, SD), and medians (interquartile range, IQR). Patients with alerts and ELISA testing ordered were compared with 2 groups: 1) patients with alerts but no ELISA ordered; 2) patients with no alerts but ELISA ordered. Comparisons were performed using chi squared tests, Fisher's exact tests, t-tests and Wilcoxon rank-sum tests as appropriate. Results: In the 90-day observation period, 302 alerts were fired in 270 patients (Figure 1). Thirty alerts (28 patients, 10%) were generated for patients admitted for organ donation or post-stem cell transplantation, for whom platelet count decline was expected. Excluding these patients, there were 272 alerts in 242 patients (approximately 3 alerts per day in a 1,157-bed hospital). Of patients with alerts, 22 (8%) had a platelet count inaccuracy (i.e. platelets clump or another reason) and 18 (7%) did not receive heparin prior to platelet decline, for a cumulative total of 40 (15%) inappropriate alerts. In patients with an alert, the ELISA was ordered more frequently for those with a lower platelet nadir (77x10 9/L vs. 115x10 9/L, p&lt;0.0001) or in those with a thrombotic event (11 patients (17%) vs. 6 patients (4%), p=0.0021) (Table 1). Those without an ELISA ordered were more likely to have a low 4Ts score (23 patients (36%) vs. 81 patients (58%), p&lt;0.0001). In addition to 71 patients with an alert, an ELISA was also ordered for 67 patients without an alert (n=138) (Figure 1). Close to half of ELISA-tested patients had a low 4Ts score (n=51, 46%) (Figure 2). In patients with an alert and ELISA not ordered, 18 (27%) had an intermediate or high 4Ts score. Seven patients were diagnosed with HIT based on a positive SRA, 6 with an alert and 1 without. The alert demonstrated a sensitivity of 86% (95% CI, 59.8-100%) and specificity of 50% (95% CI, 41.8-58.9%) with a positive predictive value of 0.0845 (95% CI, 0.0198-0.1492) and negative predictive value of 0.9851 (95% CI, 0.9560-1.0000). Conclusion: An EMR alert based on platelet count decline had multiple shortcomings including frequent inappropriate firings and a lack of guidance on appropriate indications for testing. This evaluation of institutional testing practices indicates frequent use and misinterpretation of ELISA discordant with evidence-based guidelines. Although prompt diagnosis of HIT is important, alternative strategies for identification of at-risk patients and communication of recommended actions to providers should be considered. Because the 4Ts score includes variables difficult to automate in the EMR, our institution is exploring electronic consultation and real-time expert provider access to overcome these limitations. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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We’ll have trouble now!The Archaeological Society of Jutland was founded on Sunday, 11 March 1951. As with most projects with which P.V Glob was involved, this did not pass off without drama. Museum people and amateur archaeologists in large numbers appeared at the Museum of Natural History in Aarhus, which had placed rooms at our disposal. The notable dentist Holger Friis, the uncrowned king of Hjørring, was present, as was Dr Balslev from Aidt, Mr and Mrs Overgaard from Holstebro Museum, and the temperamental leader of Aalborg Historical Museum, Peter Riismøller, with a number of his disciples. The staff of the newly-founded Prehistoric Museum functioned as the hosts, except that one of them was missing: the instigator of the whole enterprise, Mr Glob. As the time for the meeting approached, a cold sweat broke out on the foreheads of the people present. Finally, just one minute before the meeting was to start, he arrived and mounted the platform. Everything then went as expected. An executive committee was elected after some discussion, laws were passed, and then suddenly Glob vanished again, only to materialise later in the museum, where he confided to us that his family, which included four children, had been enlarged by a daughter.That’s how the society was founded, and there is not much to add about this. However, a few words concerning the background of the society and its place in a larger context may be appropriate. A small piece of museum history is about to be unfolded.The story begins at the National Museum in the years immediately after World War II, at a time when the German occupation and its incidents were still terribly fresh in everyone’s memory. Therkel Mathiassen was managing what was then called the First Department, which covered the prehistoric periods.Although not sparkling with humour, he was a reliable and benevolent person. Number two in the order of precedence was Hans Christian Broholm, a more colourful personality – awesome as he walked down the corridors, with his massive proportions and a voice that sounded like thunder when nothing seemed to be going his way, as quite often seemed to be the case. Glob, a relatively new museum keeper, was also quite loud at times – his hot-blooded artist’s nature manifested itself in peculiar ways, but his straight forward appearance made him popular with both the older and the younger generations. His somewhat younger colleague C.J. Becker was a scholar to his fingertips, and he sometimes acted as a welcome counterbalance to Glob. At the bottom of the hierarchy was the student group, to which I belonged. The older students handled various tasks, including periodic excavations. This was paid work, and although the salary was by no means princely, it did keep us alive. Student grants were non-existent at the time. Four of us made up a team: Olfert Voss, Mogens Ørsnes, Georg Kunwald and myself. Like young people in general, we were highly discontented with the way our profession was being run by its ”ruling” members, and we were full of ideas for improvement, some of which have later been – or are being – introduced.At the top of our wish list was a central register, of which Voss was the strongest advocate. During the well over one hundred years that archaeology had existed as a professional discipline, the number of artefacts had grown to enormous amounts. The picture was even worse if the collections of the provincial museums were taken into consideration. We imagined how it all could be registered in a card index and categorised according to groups to facilitate access to references in any particular situation. Electronic data processing was still unheard of in those days, but since the introduction of computers, such a comprehensive record has become more feasible.We were also sceptical of the excavation techniques used at the time – they were basically adequate, but they badly needed tightening up. As I mentioned before, we were often working in the field, and not just doing minor jobs but also more important tasks, so we had every opportunity to try out our ideas. Kunwald was the driving force in this respect, working with details, using sections – then a novelty – and proceeding as he did with a thoroughness that even his fellow students found a bit exaggerated at times, although we agreed with his principles. Therkel Mathiassen moaned that we youngsters were too expensive, but he put up with our excesses and so must have found us somewhat valuable. Very valuable indeed to everyon e was Ejnar Dyggve’s excavation of the Jelling mounds in the early 1940s. From a Danish point of view, it was way ahead of its time.Therkel Mathiassen justly complained about the economic situation of the National Museum. Following the German occupation, the country was impoverished and very little money was available for archaeological research: the total sum available for the year 1949 was 20,000 DKK, which corresponded to the annual income of a wealthy man, and was of course absolutely inadequate. Of course our small debating society wanted this sum to be increased, and for once we didn’t leave it at the theoretical level.Voss was lucky enough to know a member of the Folketing (parliament), and a party leader at that. He was brought into the picture, and between us we came up with a plan. An article was written – ”Preserve your heritage” (a quotation from Johannes V. Jensen’s Denmark Song) – which was sent to the newspaper Information. It was published, and with a little help on our part the rest of the media, including radio, picked up the story.We informed our superiors only at the last minute, when everything was arranged. They were taken by surprise but played their parts well, as expected, and everything went according to plan. The result was a considerable increase in excavation funds the following year.It should be added that our reform plans included the conduct of exhibitions. We found the traditional way of presenting the artefacts lined up in rows and series dull and outdated. However, we were not able to experiment within this field.Our visions expressed the natural collision with the established ways that comes with every new generation – almost as a law of nature, but most strongly when the time is ripe. And this was just after the war, when communication with foreign colleagues, having been discontinued for some years, was slowly picking up again. The Archaeological Society of Jutland was also a part of all this, so let us turn to what Hans Christian Andersen somewhat provocatively calls the ”main country”.Until 1949, only the University of Copenhagen provided a degree in prehistoric archaeology. However, in this year, the University of Aarhus founded a chair of archaeology, mainly at the instigation of the Lord Mayor, Svend Unmack Larsen, who was very in terested in archaeology. Glob applied for the position and obtained it, which encompassed responsibility for the old Aarhus Museum or, as it was to be renamed, the Prehistoric Museum (now Moesgaard Museum).These were landmark events to Glob – and to me, as it turned out. We had been working together for a number of years on the excavation of Galgebakken (”Callows Hill”) near Slots Bjergby, Glob as the excavation leader, and I as his assistant. He now offered me the job of museum curator at his new institution. This was somewhat surprising as I had not yet finished my education. The idea was that I was to finish my studies in remote Jutland – a plan that had to be given up rather quickly, though, for reasons which I will describe in the following. At the same time, Gunner Lange-Kornbak – also hand-picked from the National Museum – took up his office as a conservation officer.The three of us made up the permanent museum staff, quickly supplemented by Geoffrey Bibby, who turned out to be an invaluable colleague. He was English and had been stationed in the Faeroe Islands during the war, where he learned to speak Danish. After 1945 he worked for some years for an oil company in the Gulf of Persia, but after marrying Vibeke, he settled in her home town of Aarhus. As his academic background had involved prehistoric cultures he wanted to collaborate with the museum, which Glob readily permitted.This small initial flock governed by Glob was not permitted to indulge inidleness. Glob was a dynamic character, full of good and not so good ideas, but also possessing a good grasp of what was actually practicable. The boring but necessary daily work on the home front was not very interesting to him, so he willingly handed it over to others. He hardly noticed the lack of administrative machinery, a prerequisite for any scholarly museum. It was not easy to follow him on his flights of fancy and still build up the necessary support base. However, the fact that he in no way spared himself had an appeasing effect.Provincial museums at that time were of a mixed nature. A few had trained management, and the rest were run by interested locals. This was often excellently done, as in Esbjerg, where the master joiner Niels Thomsen and a staff of volunteers carried out excavations that were as good as professional investigations, and published them in well-written articles. Regrettably, there were also examples of the opposite. A museum curator in Jutland informed me that his predecessor had been an eager excavator but very rarely left any written documentation of his actions. The excavated items were left without labels in the museum store, often wrapped in newspapers. However, these gave a clue as to the time of unearthing, and with a bit of luck a look in the newspaper archive would then reveal where the excavation had taken place. Although somewhat exceptional, this is not the only such case.The Museum of Aarhus definitely belonged among the better ones in this respect. Founded in 1861, it was at first located at the then town hall, together with the local art collection. The rooms here soon became too cramped, and both collections were moved to a new building in the ”Mølleparken” park. There were skilful people here working as managers and assistants, such as Vilhelm Boye, who had received his archaeological training at the National Museum, and later the partners A. Reeh, a barrister, and G.V. Smith, a captain, who shared the honour of a number of skilfully performed excavations. Glob’s predecessor as curator was the librarian Ejler Haugsted, also a competent man of fine achievements. We did not, thus, take over a museum on its last legs. On the other hand, it did not meet the requirements of a modern scholarly museum. We were given the task of turning it into such a museum, as implied by the name change.The goal was to create a museum similar to the National Museum, but without the faults and shortcomings that that museum had developed over a period of time. In this respect our nightly conversations during our years in Copenhagen turned out to be useful, as our talk had focused on these imperfections and how to eradicate them.We now had the opportunity to put our theories into practice. We may not have succeeded in doing so, but two areas were essentially improved:The numerous independent numbering systems, which were familiar to us from the National Museum, were permeating archaeological excavation s not only in the field but also during later work at the museum. As far as possible this was boiled down to a single system, and a new type of report was born. (In this context, a ”report” is the paper following a field investigation, comprising drawings, photos etc. and describing the progress of the work and the observations made.) The instructions then followed by the National Museum staff regarding the conduct of excavations and report writing went back to a 19th-century protocol by the employee G.V. Blom. Although clear and rational – and a vast improvement at the time – this had become outdated. For instance, the excavation of a burial mound now involved not only the middle of the mound, containing the central grave and its surrounding artefacts, but the complete structure. A large number of details that no one had previously paid attention to thus had to be included in the report. It had become a comprehensive and time-consuming work to sum up the desultory notebook records in a clear and understandable description.The instructions resulting from the new approach determined a special records system that made it possible to transcribe the notebook almost directly into a report following the excavation. The transcription thus contained all the relevant information concerning the in vestigation, and included both relics and soil layers, the excavation method and practical matters, although in a random order. The report proper could then bereduced to a short account containing references to the numbers in the transcribed notebook, which gave more detailed information.As can be imagined, the work of reform was not a continuous process. On the contrary, it had to be done in our spare hours, which were few and far between with an employer like Glob. The assignments crowded in, and the large Jutland map that we had purchased was as studded with pins as a hedge hog’s spines. Each pin represented an inuninent survey, and many of these grew into small or large excavations. Glob himself had his lecture duties to perform, and although he by no means exaggerated his concern for the students, he rarely made it further than to the surveys. Bibby and I had to deal with the hard fieldwork. And the society, once it was established, did not make our lives any easier. Kuml demanded articles written at lightning speed. A perusal of my then diary has given me a vivid recollection of this hectic period, in which I had to make use of the evening and night hours, when the museum was quiet and I had a chance to collect my thoughts. Sometimes our faithful supporter, the Lord Mayor, popped in after an evening meeting. He was extremely interested in our problems, which were then solved according to our abilities over a cup of instant coffee.A large archaeological association already existed in Denmark. How ever, Glob found it necessary to establish another one which would be less oppressed by tradition. Det kongelige nordiske Oldsskriftselskab had been funded in 1825 and was still influenced by different peculiarities from back then. Membership was not open to everyone, as applications were subject to recommendation from two existing members and approval by a vote at one of the monthly lecture meetings. Most candidates were of course accepted, but unpopular persons were sometimes rejected. In addition, only men were admitted – women were banned – but after the war a proposal was brought forward to change this absurdity. It was rejected at first, so there was a considerable excitement at the January meeting in 1951, when the proposal was once again placed on the agenda. The poor lecturer (myself) did his best, although he was aware of the fact that just this once it was the present and not the past which was the focus of attention. The result of the voting was not very courteous as there were still many opponents, but the ladies were allowed in, even if they didn’t get the warmest welcome.In Glob’s society there were no such restrictions – everyone was welcome regardless of sex or age. If there was a model for the society, it was the younger and more progressive Norwegian Archaeological Society rather than the Danish one. The main purpose of both societies was to produce an annual publication, and from the start Glob’s Kuml had a closer resemblance to the Norwegian Viking than to the Danish Aarbøger for nordisk Oldkyndighed og Historie. The name of the publication caused careful consideration. For a long time I kept a slip of paper with different proposals, one of which was Kuml, which won after having been approved by the linguist Peter Skautrup.The name alone, however, was not enough, so now the task became to find so mething to fill Kuml with. To this end the finds came in handy, and as for those, Glob must have allied him self with the higher powers, since fortune smiled at him to a considerable extent. Just after entering upon his duties in Aarhus, an archaeological sensation landed at his feet. This happened in May 1950 when I was still living in the capital. A few of us had planned a trip to Aarhus, partly to look at the relics of th e past, and partly to visit our friend, the professor. He greeted us warmly and told us the exciting news that ten iron swords had been found during drainage work in the valley of lllerup Aadal north of the nearby town of Skanderborg. We took the news calmly as Glob rarely understated his affairs, but our scepticism was misplaced. When we visited the meadow the following day and carefully examined the dug-up soil, another sword appeared, as well as several spear and lance heads, and other iron artefacts. What the drainage trench diggers had found was nothing less than a place of sacrifice for war booty, like the four large finds from the 1800s. When I took up my post in Aarhus in September of that year I was granted responsibility for the lllerup excavation, which I worked on during the autumn and the following six summers. Some of my best memories are associated with this job – an interesting and happy time, with cheerful comradeship with a mixed bunch of helpers, who were mainly archaeology students. When we finished in 1956, it was not because the site had been fully investigated, but because the new owner of the bog plot had an aversion to archaeologists and their activities. Nineteen years later, in 1975, the work was resumed, this time under the leadership of Jørgen Ilkjær, and a large amount of weaponry was uncovered. The report from the find is presently being published.At short intervals, the year 1952 brought two finds of great importance: in Februar y the huge vessel from Braa near Horsens, and in April the Grauballe Man. The large Celtic bronze bowl with the bulls’ heads was found disassembled, buried in a hill and covered by a couple of large stones. Thanks to the finder, the farmer Søren Paaske, work was stopped early enough to leave areas untouched for the subsequent examination.The saga of the Grauballe Man, or the part of it that we know, began as a rumour on the 26th of April: a skeleton had been found in a bog near Silkeborg. On the following day, which happened to be a Sunday, Glob went off to have a look at the find. I had other business, but I arrived at the museum in the evening with an acquaintance. In my diary I wrote: ”When we came in we had a slight shock. On the floor was a peat block with a corpse – a proper, well-preserved bog body. Glob brought it. ”We’ll be in trouble now.” And so we were, and Glob was in high spirits. The find created a sensation, which was also thanks to the quick presentation that we mounted. I had purchased a tape recorder, which cost me a packet – not a small handy one like the ones you get nowadays, but a large monstrosity with a steel tape (it was, after all, early days for this device) – and assisted by several experts, we taped a number of short lectures for the benefit of the visitors. People flocked in; the queue meandered from the exhibition room, through the museum halls, and a long way down the street. It took a long wait to get there, but the visitors seemed to enjoy the experience. The bog man lay in his hastily – procured exhibition case, which people circled around while the talking machine repeatedly expressed its words of wisdom – unfortunately with quite a few interruptions as the tape broke and had to be assembled by hand. Luckily, the tape recorders now often used for exhibitions are more dependable than mine.When the waves had died down and the exhibition ended, the experts examined the bog man. He was x-rayed at several points, cut open, given a tooth inspection, even had his fingerprints taken. During the autopsy there was a small mishap, which we kept to ourselves. However, after almost fifty years I must be able to reveal it: Among the organs removed for investigation was the liver, which was supposedly suitable for a C-14 dating – which at the time was a new dating method, introduced to Denmark after the war. The liver was sent to the laboratory in Copenhagen, and from here we received a telephone call a few days later. What had been sent in for examination was not the liver, but the stomach. The unfortunate (and in all other respects highly competent) Aarhus doctor who had performed the dissection was cal1ed in again. During another visit to the bogman’s inner parts he brought out what he believed to be the real liver. None of us were capable of deciding th is question. It was sent to Copenhagen at great speed, and a while later the dating arrived: Roman Iron Age. This result was later revised as the dating method was improved. The Grauballe Man is now thought to have lived before the birth of Christ.The preservation of the Grauballe Man was to be conservation officer Kornbak’s masterpiece. There were no earlier cases available for reference, so he invented a new method, which was very successful. In the first volumes of Kuml, society members read about the exiting history of the bog body and of the glimpses of prehistoric sacrificial customs that this find gave. They also read about the Bahrain expeditions, which Glob initiated and which became the apple of his eye. Bibby played a central role in this, as it was he who – at an evening gathering at Glob’s and Harriet’s home in Risskov – described his stay on the Persian Gulf island and the numerous burial mounds there. Glob made a quick decision (one of his special abilities was to see possibilities that noone else did, and to carry them out successfully to everyone’s surprise) and in December 1952 he and Bibby left for the Gulf, unaware of the fact that they were thereby beginning a series of expeditions which would continue for decades. Again it was Glob’s special genius that was the decisive factor. He very quickly got on friendly terms with the rulers of the small sheikhdoms and interested them in their past. As everyone knows, oil is flowing plentifully in those parts. The rulers were thus financially powerful and some of this wealth was quickly diverted to the expeditions, which probably would not have survived for so long without this assistance. To those of us who took part in them from time to time, the Gulf expeditions were an unforgettable experience, not just because of the interesting work, but even more because of the contact with the local population, which gave us an insight into local manners and customs that helped to explain parts of our own country’s past which might otherwise be difficult to understand. For Glob and the rest of us did not just get close to the elite: in spite of language problems, our Arab workers became our good friends. Things livened up when we occasionally turned up in their palm huts.Still, co-operating with Glob was not always an easy task – the sparks sometimes flew. His talent of initiating things is of course undisputed, as are the lasting results. He was, however, most attractive when he was in luck. Attention normally focused on this magnificent person whose anecdotes were not taken too seriously, but if something went wrong or failed to work out, he could be grossly unreasonable and a little too willing to abdicate responsibility, even when it was in fact his. This might lead to violent arguments, but peace was always restored. In 1954, another museum curator was attached to the museum: Poul Kjærum, who was immediately given the important task of investigating the dolmen settlement near Tustrup on Northern Djursland. This gave important results, such as the discovery of a cult house, which was a new and hitherto unknown Stone Age feature.A task which had long been on our mind s was finally carried out in 1955: constructing a new display of the museum collections. The old exhibitio n type consisted of numerous artefacts lined up in cases, accompaied ony by a brief note of the place where it was found and the type – which was the standard then. This type of exhibition did not give much idea of life in prehistoric times.We wanted to allow the finds to speak for themselves via the way that they were arranged, and with the aid of models, photos and drawings. We couldn’t do without texts, but these could be short, as people would understand more by just looking at the exhibits. Glob was in the Gulf at the time, so Kjærum and I performed the task with little money but with competent practical help from conservator Kornbak. We shared the work, but in fairness I must add that my part, which included the new lllerup find, was more suitable for an untraditional display. In order to illustrate the confusion of the sacrificial site, the numerous bent swords and other weapons were scattered a.long the back wall of the exhibition hall, above a bog land scape painted by Emil Gregersen. A peat column with inlaid slides illustrated the gradual change from prehistoric lake to bog, while a free-standing exhibition case held a horse’s skeleton with a broken skull, accompanied by sacrificial offerings. A model of the Nydam boat with all its oars sticking out hung from the ceiling, as did the fine copy of the Gundestrup vessel, as the Braa vessel had not yet been preserved. The rich pictorial decoration of the vessel’s inner plates was exhibited in its own case underneath. This was an exhibition form that differed considerably from all other Danish exhibitions of the time, and it quickly set a fashion. We awaited Glob’s homecoming with anticipation – if it wasn’t his exhibition it was still made in his spirit. We hoped that he would be surprised – and he was.The museum was thus taking shape. Its few employees included Jytte Ræbild, who held a key position as a secretary, and a growing number of archaeology students who took part in the work in various ways during these first years. Later, the number of employees grew to include the aforementioned excavation pioneer Georg Kunwald, and Hellmuth Andersen and Hans Jørgen Madsen, whose research into the past of Aarhus, and later into Danevirke is known to many, and also the ethnographer Klaus Ferdinand. And now Moesgaard appeared on the horizon. It was of course Glob’s idea to move everything to a manor near Aarhus – he had been fantasising about this from his first Aarhus days, and no one had raised any objections. Now there was a chance of fulfilling the dream, although the actual realisation was still a difficult task.During all this, the Jutland Archaeological Society thrived and attracted more members than expected. Local branches were founded in several towns, summer trips were arranged and a ”Worsaae Medal” was occasionally donated to persons who had deserved it from an archaeological perspective. Kuml came out regularly with contributions from museum people and the like-minded. The publication had a form that appealed to an inner circle of people interested in archaeology. This was the intention, and this is how it should be. But in my opinion this was not quite enough. We also needed a publication that would cater to a wider public and that followed the same basic ideas as the new exhibition.I imagined a booklet, which – without over-popularsing – would address not only the professional and amateur archaeologist but also anyone else interested in the past. The result was Skalk, which (being a branch of the society) published its fir t issue in the spring of 1957. It was a somewhat daring venture, as the financial base was weak and I had no knowledge of how to run a magazine. However, both finances and experience grew with the number of subscribers – and faster than expected, too. Skalk must have met an unsatisfied need, and this we exploited to the best of our ability with various cheap advertisem*nts. The original idea was to deal only with prehistoric and medieval archaeology, but the historians also wanted to contribute, and not just the digging kind. They were given permission, and so the topic of the magazine ended up being Denmark’s past from the time of its first inhabitant s until the times remembered by the oldest of us – with the odd sideways leap to other subjects. It would be impossible to claim that Skalk was at the top of Glob’s wish list, but he liked it and supported the idea in every way. The keeper of national antiquities, Johannes Brøndsted, did the same, and no doubt his unreserved approval of the magazine contributed to its quick growth. Not all authors found it easy to give up technical language and express themselves in everyday Danish, but the new style was quickly accepted. Ofcourse the obligations of the magazine work were also sometimes annoying. One example from the diary: ”S. had promised to write an article, but it was overdue. We agreed to a final deadline and when that was overdue I phoned again and was told that the author had gone to Switzerland. My hair turned grey overnight.” These things happened, but in this particular case there was a happy ending. Another academic promised me three pages about an excavation, but delivered ten. As it happened, I only shortened his production by a third.The 1960s brought great changes. After careful consideration, Glob left us to become the keeper of national antiquities. One important reason for his hesitation was of course Moesgaard, which he missed out on – the transfer was almost settled. This was a great loss to the Aarhus museum and perhaps to Glob, too, as life granted him much greater opportunities for development.” I am not the type to regret things,” he later stated, and hopefully this was true. And I had to choose between the museum and Skalk – the work with the magazine had become too timeconsuming for the two jobs to be combined. Skalk won, and I can truthfully say that I have never looked back. The magazine grew quickly, and happy years followed. My resignation from the museum also meant that Skalk was disengaged from the Jutland Archaeological Society, but a close connection remained with both the museum and the society.What has been described here all happened when the museum world was at the parting of the ways. It was a time of innovation, and it is my opinion that we at the Prehistoric Museum contributed to that change in various ways.The new Museum Act of 1958 gave impetus to the study of the past. The number of archaeology students in creased tremendously, and new techniques brought new possibilities that the discussion club of the 1940s had not even dreamt of, but which have helped to make some of the visions from back then come true. Public in terest in archaeology and history is still avid, although to my regret, the ahistorical 1960s and 1970s did put a damper on it.Glob is greatly missed; not many of his kind are born nowadays. He had, so to say, great virtues and great fault s, but could we have done without either? It is due to him that we have the Jutland Archaeological Society, which has no w existed for half a century. Congr tulat ion s to the Society, from your offspring Skalk.Harald AndersenSkalk MagazineTranslated by Annette Lerche Trolle

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Objective The market entry of biosimilars is expected to bring budgetary relief. Our objective was to determine how the introduction of biosimilars influences medication cost in patients with rheumatoid arthritis and which patients gain access to biologicals due to the availability of biosimilars. Methods Using hospital data of patients with rheumatoid arthritis between 2014 and 2018, an interrupted time series was performed. The interruption in the time series was placed at June 2016, i.e., the introduction of the etanercept biosimilar. The changes in trends for rheumatic medication cost before and after the interruption were measured. Secondary analyses focused on explaining these trends. Results In the first quarter after the interruption, there was a decrease in total cost for biologic users of €-63020 (CI=[€-96487;-€-29553]; P=0.001). The post-interruption trend did not differ from the pre-interruption trend (CI=[-€6695;€6715]; P=0.998) and after three quarters the medication cost were back at the interruption level. After the interruption, the average cost per biologic user decreased by €-370 (CI=[€-602;€-138]; P=0.005), followed by a quarterly decrease (relative to the pre-interruption trend) (CI=[€-86;€-14] P=0.010), bending the average cost curve. The percentage of patients being treated with biologics increased in post-interruption by 0.50 percentage points quarterly (CI=[0.38-0.62]; P<0.001). Also the average age at the start of the first biologic increased after the interruption (p=0.057). Conclusion The average cost per patient treated with biologicals decreased after the introduction of biosimilars with a persistent trend. However, the budgetary relief due to market entry of biosimilars vanished quickly due to an increase in patients treated with biologics.

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PurposeThe purpose of this paper is to construct a fuzzy logic model that acts as a decision support system to minimize inventory-related costs in the field of industrial maintenance. Achieving a balance between the unavailability and over-storage of spare parts is a problem with potentially significant consequences. That significance increases proportionally with the ever-increasing challenge of reducing overall cost. Either scenario can result in substantial financial losses because of the interruption of production or the costs of tied-up capital, also called the “solidification of capital.” Moreover, there is that additional problem of the expiry of parts on the shelf.Design/methodology/approachThe proposed approach relies on inputs from experts with consideration for incompleteness and inaccuracy. Two levels of decision are considered simultaneously. The first is whether a part should be stored or ordered when needed. The second involves comparing suppliers with their batch-size offers based on user-determined criteria. A mathematical model is developed in parallel for validation.FindingsThe results indicate that the fuzzy logic approach is accurate and satisfactory for this application and that it is advantageous because of its limited sensitivity to the inaccuracy and/or incompleteness of data. In addition, the approach is practical because it requires minimal user effort.Originality/valueTo the best of the authors’ knowledge, the exploitation of fuzzy-logic altogether with limited sensitivity experts' inputs were never combined for the solution of this particular problem; however, this approach's positive impact is expected to be highly significant in solving a chronic problem in industry.

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The necessity for dependability and safety in power system is rising at an alarming rate as the power system designs are getting more & more complex. In order to ensure maximum reliability, the numerical protection relays must receive accurate measurements. One of the most important input measurements desired by the relay is current. Nevertheless, the current measurements expected from current transformers (CTs) can be inaccurate due to occurrence of a phenomenon called as CT saturation. CT saturation causes distortion in the secondary current, which is not linearly proportional to the primary current, leading to mal-operation of protection devices. Therefore it becomes extremely vital that the numerical protection relay, also known as intelligent electronic device (IED) senses the CT saturation condition and blocks its operation so as to avoid mal-operation of the IED which may lead to supply interruption, further resulting in production losses and undesirable switching of the sensitive equipments affecting system reliability and customer satisfaction. This paper includes a review of the background about CTs & proposes a novel methodology to exclusively sense the CT saturation using the numerical protection relays reliably and cost effectively.

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In this paper, interruption risk in construction activities of bridge projects is assessed in order to identify the main causes of its occurrence and also to determine the potential outcomes resulted from the risk occurrence. To do this, fault tree and event tree analysis (ETA) methods are applied. As the application of the traditional approach of these two methods is difficult in many cases due to limited access to information, fuzzy arithmetic can be considered as a useful tool. In this research, first, fault tree structure is created according to consequences resulted from the Delphi method. Then, the probability of risk occurrence is calculated by applying fault tree analysis (FTA) based on fuzzy logic. By establishing the structure of fault tree related to the failure risk of mitigation strategies, the main causes relating to failure of strategies are identified. The structure of the event tree is created using the obtained results; moreover, the expected monetary value (EMV) of risk event is computed. Finally, to validate the results obtained, a model is created by Monte Carlo simulation and then the results obtained by applying the two methods are compared. The EMV of the risk event evaluated in this paper is determined to be 9.93% of the project baseline cost.

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ObjectiveTo provide surveillance tools to support policymakers andpractitioners to identify epidemiological situations and inform theprogressive implementation of rabies elimination programmes.IntroductionGlobal targets for elimination of human rabies mediated by dogshave been set for 2030. In the Americas countries are progressingtowards interruption of transmission and declaration of rabiesfreedom1. Guidance for managing elimination programmes toensure continued progress during the endgame is critical, yet oftenlimited and lacking in specific recommendations. Characteristicspatiotemporal incidence patterns are indicative of progress, andthrough their identification, tailored guidance can be provided.MethodsUsing SIRVERA, a surveillance database for rabies in theAmericas2, we developed a classification framework for identificationof epidemiological situations at subnational level. Each situationexhibits a characteristic pattern identified via a set of objective criteriaincluding trends in case detection, assessment of virus variants, caselocations and measures of incursion risk.We refined our framework through application to Mexico inconsultation with stakeholders. To understand factors predictingincursions we analysed state-level data on vaccination campaigns,populations and socioeconomic indicators employing multivariateregression models.ResultsWe were able to classify all states in Mexico and providecorrespondingly tailored guidance. Control efforts have resultedin progress towards elimination; however rabies still circulatesendemically in one state Chiapas, putting its neighbours at risk ofre-emergence.Epidemiological and socioeconomic factors associated withincursions were primarily geographic proximity to endemic and high-prevalence states, and inconsistent vaccination campaigns associatedwith a low human development index.ConclusionsOur management tool can support rabies programme managersat subnational levels to identify their epidemiological situation,develop tailored plans to meet targets, and sustainably maintainrabies freedom, as demonstrated for Mexico. Effective surveillanceis critical for disease elimination. Control options differ dependingon whether disease circulates intermittently through reintroductionsor persists focally, but with poor detection these situations mightbe indistinguishable. Our analysis enables identification of at-riskareas and methods to reduce risk. Investment in remaining endemicareas, through improved implementation and monitoring of mass dogvaccinations, is expected to provide the most cost-effective approachto elimination whilst preventing re-emergence elsewhere.Decision-tree framework.Rabies incursions in Mexico, 2005-2015. Blue circles indicate incursionlocations, and resulting outbreak sizes, with darker shading for more recentincursions. Red shading indicates the duration of endemic circulation over theten-year period.

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Manufacturing companies sometimes suffer from unexpected production disruptions/interruptions events (DIEs), affecting the production performance and cost. Since DIEs vary in type and cause, predicting the characteristics of their corresponding production downtimes is a challenging task. Although efforts have been devoted to forecast/prevent specific types of DIEs, such as machine-related events, it is still difficult to deal with the uncertainty caused by a combination of production DIEs of various types. Moreover, the absence of a realistic scenario generator incorporating DIEs has been a challenge in production scheduling under uncertainty. This study investigates the potential use of a hybrid data-driven approach in incorporating the uncertainties of a wide range of DIEs. In this approach, a random forest (RF) method and probability distributions are integrated to forecast the DIEs. The study was carried out based on the recorded DIEs in a Canadian company producing assembly parts for automotive industry. The performance of the proposed methodology for forecasting the production DIEs is evaluated by determining the predicted total downtime (TD) in percent of the expected processing time. The proposed hybrid model yields an overall accuracy of 92.82% in predicting the TD, compared to an overall accuracy of 75.64% when a single RF is used for prediction.

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The continuing rapid expansion of 99mTc diagnostic agents always calls for scaling up 99mTc production to cover increasing clinical demand. Nevertheless, 99mTc availability depends mainly on the fission-produced 99Mo supply. This supply is seriously influenced during renewed emergency periods, such as the past 99Mo production crisis or the current COVID-19 pandemic. Consequently, these interruptions have promoted the need for 99mTc production through alternative strategies capable of providing clinical-grade 99mTc with high purity. In the light of this context, this review illustrates diverse production routes that either have commercially been used or new strategies that offer potential solutions to promote a rapid production growth of 99mTc. These techniques have been selected, highlighted, and evaluated to imply their impact on developing 99mTc production. Furthermore, their advantages and limitations, current situation, and long-term perspective were also discussed. It appears that, on the one hand, careful attention needs to be devoted to enhancing the 99Mo economy. It can be achieved by utilizing 98Mo neutron activation in commercial nuclear power reactors and using accelerator-based 99Mo production, especially the photonuclear transmutation strategy. On the other hand, more research efforts should be devoted to widening the utility of 99Mo/99mTc generators, which incorporate nanomaterial-based sorbents and promote their development, validation, and full automization in the near future. These strategies are expected to play a vital role in providing sufficient clinical-grade 99mTc, resulting in a reasonable cost per patient dose.

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Abstract This paper compares spatial configuration, built form and uses at Tambauzinho and Tambaú areas, in João Pessoa, Brazil. Although it is located between the old city centre and its expansion towards the coast, Tambauzinho presents little urban vitality, different from the expected in a central location, and to what happens in Tambaú. Understanding cities as problems in organized complexity, and that space configures fields of potential movement and encounters, physical attributes work together to facilitate urban vitality. The potential movement to and through places at various scales (according to space syntax framework) were analysed for the city and the areas and compared with built form and uses. Both areas' urban grid present high potential movement; however at Tambauzinho, local physical attributes and a highway crossing the neighbourhood hinder more legibility and walkability, interrupting local flows and visual and physical connections at street level, with poor qualities of sidewalks. Limited urban vitality in Tambauzinho is underlined by non-residential uses mostly concentrating at the areas’ northern periphery, whereas at Tambaú, they spread more throughout the area. Problems at Tambauzinho express a mainly vehicular oriented urban planning; understanding negative consequences aims to build knowledge, alleviating problems and re-directing future interventions.

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Aims: This study aimed to design and model an off-grid SPV power plant with a storage system to meet the load required in Rwisirabo village. Study Design: PV modules, inverter, charge controller, and Batteries have been designed, reproduced/simulated, and optimized for the rural area of Rwisirabo village in Kayonza district, Eastern Province, Rwanda. Place and Duration of Study: The experiment has been done in the University of Rwanda/ African Centre of Excellence in Energy Studies for Sustainable Development (UR/ACE-ESD) High E-Tech Smart Grid Laboratory, Kigali, Rwanda between October 2020 and February 2021. Methodology: Different methodologies have been applied to address the objective of this work. The site was identified, problems of the community were clearly stated, data required for the work was collected through various data collection mechanisms, and different literature was reviewed to identify the way to do this work. The data were collected from different sources and were analysed using a software tool (HOMER software) and simulated for getting a solution for the problems and challenged accordingly. An Off-grid Solar Photovoltaic Power Plant was established in Rwisirabo village in Kayonza District, Rwanda. This site has been chosen because, in the Mwiri sector, Kageyo cellule in Rwisirabo (Rwisirabo II) village is listed by National Electrification Plan (NEP) as the site to construct an off-grid solar PV Power Plant. Results: Based on the load assessment and the design of the SPV system, the primary AC load of the village was 551,718 kWh/day with a peak load of 85.10 kW, the deferrable load was about 9.99 kWh/day and a deferrable peak load of 2.00 kW with the cost of energy (COE) $0.200/kWh were involved during optimization of the power plant. It also found that the peak demand of the community occurs from 18:00 to 20:00 hours because most of the household members would expect to be at their homes. The system items such as PV module, batteries, and inverter size have been found as an optimum system with 220 kW, 860 BAE PVS 210 batteries, and 110 kW respectively with a lifespan of 25 years of the project. The total net present cost (NPC), initial capital, operating cost, and Levelized COE for this off-grid SPV system were $903,829, $517,000, $17,522, and $0.200/kWh respectively. The monthly results of power generation in kW obtained after stimulation with software showed that the solar radiation is high in March, July, August, and September which brings more electric power generation. However, all months the power electricity remain generated. Results from simulation showed that this system generated mean power output of 220 kW and total production of 297,291 kWh/year. It approved that the system converter contributed the lowest NPC with $52,888.25 (6%), followed by PV modules that cost $244,284.28 (27%) and battery bank the first for this SPV system with a cost of $606,656.60 (67%). This optimal system uses 100% renewable energy. Conclusion: It found that the implementation of an SPV system with battery storage in residential, commercial, and institutions in the area where the solar irradiance is concentrated across a country will reduce the cost of electricity and power interruption on the national grid. Therefore, further work is needed to optimize this system for rural electrification as well by integrating with other renewable sources available in the country and also extend the electrification to another area that is detached from the national grid.

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DiSSCo, the Distributed System of Scientific Collections, is a pan-European Research Infrastructure (RI) mobilising, unifying bio- and geo-diversity information connected to the specimens held in natural science collections and delivering it to scientific communities and beyond. Bringing together 120 institutions across 21 countries and combining earlier investments in data interoperability practices with technological advancements in digitisation, cloud services and semantic linking, DiSSCo makes the data from natural science collections available as one virtual data cloud, connected with data emerging from new techniques and not already linked to specimens. These new data include DNA barcodes, whole genome sequences, proteomics and metabolomics data, chemical data, trait data, and imaging data (Computer-assisted Tomography (CT), Synchrotron, etc.), to name but a few; and will lead to a wide range of end-user services that begins with finding, accessing, using and improving data. DiSSCo will deliver the diagnostic information required for novel approaches and new services that will transform the landscape of what is possible in ways that are hard to imagine today. With approximately 1.5 billion objects to be digitised, bringing natural science collections to the information age is expected to result in many tens of petabytes of new data over the next decades, used on average by 5,000 – 15,000 unique users every day. This requires new skills, clear policies and robust procedures and new technologies to create, work with and manage large digital datasets over their entire research data lifecycle, including their long-term storage and preservation and open access. Such processes and procedures must match and be derived from the latest thinking in open science and data management, realising the core principles of 'findable, accessible, interoperable and reusable' (FAIR). Synthesised from results of the ICEDIG project ("Innovation and Consolidation for Large Scale Digitisation of Natural Heritage", EU Horizon 2020 grant agreement No. 777483) the DiSSCo Conceptual Design Blueprint covers the organisational arrangements, processes and practices, the architecture, tools and technologies, culture, skills and capacity building and governance and business model proposals for constructing the digitisation infrastructure of DiSSCo. In this context, the digitisation infrastructure of DiSSCo must be interpreted as that infrastructure (machinery, processing, procedures, personnel, organisation) offering Europe-wide capabilities for mass digitisation and digitisation-on-demand, and for the subsequent management (i.e., curation, publication, processing) and use of the resulting data. The blueprint constitutes the essential background needed to continue work to raise the overall maturity of the DiSSCo Programme across multiple dimensions (organisational, technical, scientific, data, financial) to achieve readiness to begin construction. Today, collection digitisation efforts have reached most collection-holding institutions across Europe. Much of the leadership and many of the people involved in digitisation and working with digital collections wish to take steps forward and expand the efforts to benefit further from the already noticeable positive effects. The collective results of examining technical, financial, policy and governance aspects show the way forward to operating a large distributed initiative i.e., the Distributed System of Scientific Collections (DiSSCo) for natural science collections across Europe. Ample examples, opportunities and need for innovation and consolidation for large scale digitisation of natural heritage have been described. The blueprint makes one hundred and four (104) recommendations to be considered by other elements of the DiSSCo Programme of linked projects (i.e., SYNTHESYS+, COST MOBILISE, DiSSCo Prepare, and others to follow) and the DiSSCo Programme leadership as the journey towards organisational, technical, scientific, data and financial readiness continues. Nevertheless, significant obstacles must be overcome as a matter of priority if DiSSCo is to move beyond its Design and Preparatory Phases during 2024. Specifically, these include: Organisational: Strengthen common purpose by adopting a common framework for policy harmonisation and capacity enhancement across broad areas, especially in respect of digitisation strategy and prioritisation, digitisation processes and techniques, data and digital media publication and open access, protection of and access to sensitive data, and administration of access and benefit sharing. Pursue the joint ventures and other relationships necessary to the successful delivery of the DiSSCo mission, especially ventures with GBIF and other international and regional digitisation and data aggregation organisations, in the context of infrastructure policy frameworks, such as EOSC. Proceed with the explicit aim of avoiding divergences of approach in global natural science collections data management and research. Strengthen common purpose by adopting a common framework for policy harmonisation and capacity enhancement across broad areas, especially in respect of digitisation strategy and prioritisation, digitisation processes and techniques, data and digital media publication and open access, protection of and access to sensitive data, and administration of access and benefit sharing. Pursue the joint ventures and other relationships necessary to the successful delivery of the DiSSCo mission, especially ventures with GBIF and other international and regional digitisation and data aggregation organisations, in the context of infrastructure policy frameworks, such as EOSC. Proceed with the explicit aim of avoiding divergences of approach in global natural science collections data management and research. Technical: Adopt and enhance the DiSSCo Digital Specimen Architecture and, specifically as a matter of urgency, establish the persistent identifier scheme to be used by DiSSCo and (ideally) other comparable regional initiatives. Establish (software) engineering development and (infrastructure) operations team and direction essential to the delivery of services and functionalities expected from DiSSCo such that earnest engineering can lead to an early start of DiSSCo operations. Adopt and enhance the DiSSCo Digital Specimen Architecture and, specifically as a matter of urgency, establish the persistent identifier scheme to be used by DiSSCo and (ideally) other comparable regional initiatives. Establish (software) engineering development and (infrastructure) operations team and direction essential to the delivery of services and functionalities expected from DiSSCo such that earnest engineering can lead to an early start of DiSSCo operations. Scientific: Establish a common digital research agenda leveraging Digital (extended) Specimens as anchoring points for all specimen-associated and -derived information, demonstrating to research institutions and policy/decision-makers the new possibilities, opportunities and value of participating in the DiSSCo research infrastructure. Establish a common digital research agenda leveraging Digital (extended) Specimens as anchoring points for all specimen-associated and -derived information, demonstrating to research institutions and policy/decision-makers the new possibilities, opportunities and value of participating in the DiSSCo research infrastructure. Data: Adopt the FAIR Digital Object Framework and the International Image Interoperability Framework as the low entropy means to achieving uniform access to rich data (image and non-image) that is findable, accessible, interoperable and reusable (FAIR). Develop and promote best practice approaches towards achieving the best digitisation results in terms of quality (best, according to agreed minimum information and other specifications), time (highest throughput, fast), and cost (lowest, minimal per specimen). Adopt the FAIR Digital Object Framework and the International Image Interoperability Framework as the low entropy means to achieving uniform access to rich data (image and non-image) that is findable, accessible, interoperable and reusable (FAIR). Develop and promote best practice approaches towards achieving the best digitisation results in terms of quality (best, according to agreed minimum information and other specifications), time (highest throughput, fast), and cost (lowest, minimal per specimen). Financial Broaden attractiveness (i.e., improve bankability) of DiSSCo as an infrastructure to invest in. Plan for finding ways to bridge the funding gap to avoid disruptions in the critical funding path that risks interrupting core operations; especially when the gap opens between the end of preparations and beginning of implementation due to unsolved political difficulties. Broaden attractiveness (i.e., improve bankability) of DiSSCo as an infrastructure to invest in. Plan for finding ways to bridge the funding gap to avoid disruptions in the critical funding path that risks interrupting core operations; especially when the gap opens between the end of preparations and beginning of implementation due to unsolved political difficulties. Strategically, it is vital to balance the multiple factors addressed by the blueprint against one another to achieve the desired goals of the DiSSCo programme. Decisions cannot be taken on one aspect alone without considering other aspects, and here the various governance structures of DiSSCo (General Assembly, advisory boards, and stakeholder forums) play a critical role over the coming years.

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For those seeking a diversion from the drudgery of work there are a number of websites offering to take you away. Consider the case of wasteaminute.com. On the site there is everything from flash video games, soft-core p*rnography and animated nudity, to puzzles and parlour games like poker. In addition, the site offers links to video clips grouped in categories such as “funny,” “accidents,” or “strange.” With its bright yellow bubble letters and elementary design, wasteaminute will never win any Webby awards. It is also unlikely to be part of a lucrative initial public offering for its owner, a web marketing company based in Lexington, Kentucky. The internet ratings company Alexa gives wasteaminute a ranking of 5,880,401 when it comes to the most popular sites online over the last three months, quite some way behind sites like Wikipedia, Facebook, and Windows Live.Wasteaminute is not unique. There exists a group of websites, a micro-genre of sorts, that go out of their way to offer momentary escape from the more serious work at hand, with a similar menu of offerings. These include sites with names such as ishouldbeworking.com, i-am-bored.com, boredatwork.com, and drivenbyboredom.com. These web destinations represent only the most overtly named time-wasting opportunities. Video sharing sites like YouTube or France’s DailyMotion, personalised home pages like iGoogle, and the range of applications available on mobile devices offer similar opportunities for escape. Wasteaminute inspired me to think about the relationship between digital media technologies and waste. In one sense, the site’s offerings remind us of the Internet’s capacity to re-purpose old media forms from earlier phases in the digital revolution, like the retro video game PacMan, or from aspects of print culture, like crosswords (Bolter and Grusin; Straw). For my purposes, though, wasteaminute permits the opportunity to meditate, albeit briefly, on the ways media facilitate wasting time at work, particularly for those working in white- and no-collar work environments. In contemporary work environments work activity and wasteful activity exist on the same platform. With a click of a mouse or a keyboard shortcut, work and diversion can be easily interchanged on the screen, an experience of computing I know intimately from first-hand experience. The blurring of lines between work and waste has accompanied the extension of the ‘working day,’ a concept once tethered to the standardised work-week associated with modernity. Now people working in a range of professions take work out of the office and find themselves working in cafes, on public transportation, and at times once reserved for leisure, like weekends (Basso). In response to the indeterminate nature of when and where we are at work, the mainstream media routinely report about the wasteful use of computer technology for non-work purposes. Stories such as a recent one in the Washington Post which claimed that increased employee use of social media sites like Facebook and Twitter led to decreased productivity at work have become quite common in traditional media outlets (Casciato). Media technologies have always offered the prospect of making office work more efficient or the means for management to exercise control over employees. However, those same technologies have also served as the platforms on which one can engage in dilatory acts, stealing time from behind the boss’s back. I suggest stealing time at work may well be a “tactic,” in the sense used by Michel de Certeau, as a means to resist the rules and regulations that structure work and the working life. However, I also consider it to be a tactic in a different sense: websites and other digital applications offer users the means to take time back, in the form of ‘quick hits,’ providing immediate visual or narrative pleasures, or through interfaces which make the time-wasting look like work (Wagman). Reading sites like wasteaminute as examples of ‘office entertainment,’ reminds us of the importance of workers as audiences for web content. An analysis of a few case studies also reveals how the forms of address of these sites themselves recognise and capitalise on an understanding of the rhythms of the working day, as well as those elements of contemporary office culture characterised by interruption, monotony and surveillance. Work, Media, Waste A mass of literature documents the transformations of work brought on by industrialisation and urbanisation. A recent biography of Franz Kafka outlines the rigors imposed upon the writer while working as an insurance agent: his first contract stipulated that “no employee has the right to keep any objects other than those belonging to the office under lock in the desk and files assigned for its use” (Murray 66). Siegfried Kracauer’s collection of writings on salaried workers in Germany in the 1930s argues that mass entertainment offers distractions that inhibit social change. Such restrictions and inducements are exemplary of the attempts to make work succumb to managerial regimes which are intended to maximise productivity and minimise waste, and to establish a division between ‘company time’ and ‘free time’. One does not have to be an industrial sociologist to know the efforts of Frederick W. Taylor, and the disciplines of “scientific management” in the early twentieth century which were based on the idea of making work more efficient, or of the workplace sociology scholarship from the 1950s that drew attention to the ways that office work can be monotonous or de-personalising (Friedmann; Mills; Whyte). Historian JoAnne Yates has documented the ways those transformations, and what she calls an accompanying “philosophy of system and efficiency,” have been made possible through information and communication technologies, from the typewriter to carbon paper (107). Yates evokes the work of James Carey in identifying these developments, for example, the locating of workers in orderly locations such as offices, as spatial in nature. The changing meaning of work, particularly white-collar or bureaucratic labour in an age of precarious employment and neo-liberal economic regimes, and aggressive administrative “auditing technologies,” has subjected employees to more strenuous regimes of surveillance to ensure employee compliance and to protect against waste of company resources (Power). As Andrew Ross notes, after a deep period of self-criticism over the drudgery of work in North American settings in the 1960s, the subsequent years saw a re-thinking of the meaning of work, one that gradually traded greater work flexibility and self-management for more assertive forms of workplace control (9). As Ross notes, this too has changed, an after-effect of “the shareholder revolution,” which forced companies to deliver short-term profitability to its investors at any social cost. With so much at stake, Ross explains, the freedom of employees assumed a lower priority within corporate cultures, and “the introduction of information technologies in the workplace of the new capitalism resulted in the intensified surveillance of employees” (12). Others, like Dale Bradley, have drawn attention to the ways that the design of the office itself has always concerned itself with the bureaucratic and disciplinary control of bodies in space (77). The move away from physical workspaces such as ‘the pen’ to the cubicle and now from the cubicle to the virtual office is for Bradley a move from “construction” to “connection.” This spatial shift in the way in which control over employees is exercised is symbolic of the liquid forms in which bodies are now “integrated with flows of money, culture, knowledge, and power” in the post-industrial global economies of the twenty-first century. As Christena Nippert-Eng points out, receiving office space was seen as a marker of trust, since it provided employees with a sense of privacy to carry out affairs—both of a professional or of a personal matter—out of earshot of others. Privacy means a lot of things, she points out, including “a relative lack of accountability for our immediate whereabouts and actions” (163). Yet those same modalities of control which characterise communication technologies in workspaces may also serve as the platforms for people to waste time while working. In other words, wasteful practices utilize the same technology that is used to regulate and manage time spent in the workplace. The telephone has permitted efficient communication between units in an office building or between the office and outside, but ‘personal business’ can also be conducted on the same line. Radio stations offer ‘easy listening’ formats, providing unobtrusive music so as not to disturb work settings. However, they can easily be tuned to other stations for breaking news, live sports events, or other matters having to do with the outside world. Photocopiers and fax machines facilitate the reproduction and dissemination of communication regardless of whether it is it work or non-work related. The same, of course, is true for computerised applications. Companies may encourage their employees to use Facebook or Twitter to reach out to potential clients or customers, but those same applications may be used for personal social networking as well. Since the activities of work and play can now be found on the same platform, employers routinely remind their employees that their surfing activities, along with their e-mails and company documents, will be recorded on the company server, itself subject to auditing and review whenever the company sees fit. Employees must be careful to practice image management, in order to ensure that contradictory evidence does not appear online when they call in sick to the office. Over time the dynamics of e-mail and Internet etiquette have changed in response to such developments. Those most aware of the distractive and professionally destructive features of downloading a funny or comedic e-mail attachment have come to adopt the acronym “NSFW” (Not Safe for Work). Even those of us who don’t worry about those things are well aware that the cache and “history” function of web browsers threaten to reveal the extent to which our time online is spent in unproductive ways. Many companies and public institutions, for example libraries, have taken things one step further by filtering out access to websites that may be peripheral to the primary work at hand.At the same time contemporary workplace settings have sought to mix both work and play, or better yet to use play in the service of work, to make “work” more enjoyable for its workers. Professional development seminars, team-building exercises, company softball games, or group outings are examples intended to build morale and loyalty to the company among workers. Some companies offer their employees access to gyms, to game rooms, and to big screen TVs, in return for long and arduous—indeed, punishing—hours of time at the office (Dyer-Witheford and Sherman; Ross). In this manner, acts of not working are reconfigured as a form of work, or at least as a productive experience for the company at large. Such perks are offered with an assumption of personal self-discipline, a feature of what Nippert-Eng characterises as the “discretionary workplace” (154). Of course, this also comes with an expectation that workers will stay close to the office, and to their work. As Sarah Sharma recently argued in this journal, such thinking is part of the way that late capitalism constructs “innovative ways to control people’s time and regulate their movement in space.” At the same time, however, there are plenty of moments of gentle resistance, in which the same machines of control and depersonalisation can be customised, and where individual expressions find their own platforms. A photo essay by Anna McCarthy in the Journal of Visual Culture records the inspirational messages and other personalised objects with which workers adorn their computers and work stations. McCarthy’s photographs represent the way people express themselves in relation to their work, making it a “place where workplace politics and power relations play out, often quite visibly” (McCarthy 214). Screen SecretsIf McCarthy’s photo essay illustrates the overt ways in which people bring personal expression or gentle resistance to anodyne workplaces, there are also a series of other ‘screen acts’ that create opportunities to waste time in ways that are disguised as work. During the Olympics and US college basketball playoffs, both American broadcast networks CBS and NBC offered a “boss button,” a graphic link that a user could immediately click “if the boss was coming by” that transformed the screen to something was associated with the culture of work, such as a spreadsheet. Other purveyors of networked time-wasting make use of the spreadsheet to mask distraction. The website cantyouseeimbored turns a spreadsheet into a game of “Breakout!” while other sites, like Spreadtweet, convert your Twitter updates into the form of a spreadsheet. Such boss buttons and screen interfaces that mimic work are the presentday avatars of the “panic button,” a graphic image found at the bottom of websites back in the days of Web 1.0. A click of the panic button transported users away from an offending website and towards something more legitimate, like Yahoo! Even if it is unlikely that boss keys actually convince one’s superiors that one is really working—clicking to a spreadsheet only makes sense for a worker who might be expected to be working on those kinds of documents—they are an index of how notions of personal space and privacy play out in the digitalised workplace. David Kiely, an employee at an Australian investment bank, experienced this first hand when he opened an e-mail attachment sent to him by his co-workers featuring a scantily-clad model (Cuneo and Barrett). Unfortunately for Kiely, at the time he opened the attachment his computer screen was visible in the background of a network television interview with another of the bank’s employees. Kiely’s inauspicious click (which made his the subject of an investigation by his employees) continues to circulate on the Internet, and it spawned a number of articles highlighting the precarious nature of work in a digitalised environment where what might seem to be private can suddenly become very public, and thus able to be disseminated without restraint. At the same time, the public appetite for Kiely’s story indicates that not working at work, and using the Internet to do it, represents a mode of media consumption that is familiar to many of us, even if it is only the servers on the company computer that can account for how much time we spend doing it. Community attitudes towards time spent unproductively online reminds us that waste carries with it a range of negative signifiers. We talk about wasting time in terms of theft, “stealing time,” or even more dramatically as “killing time.” The popular construction of television as the “boob tube” distinguishes it from more ‘productive’ activities, like spending time with family, or exercise, or involvement in one’s community. The message is simple: life is too short to be “wasted” on such ephemera. If this kind of language is less familiar in the digital age, the discourse of ‘distraction’ is more prevalent. Yet, instead of judging distraction a negative symptom of the digital age, perhaps we should reinterpret wasting time as the worker’s attempt to assert some agency in an increasingly controlled workplace. ReferencesBasso, Pietro. Modern Times, Ancient Hours: Working Lives in the Twenty-First Century. London: Verso, 2003. Bolter, Jay David, and Richard Grusin. Remediation: Understanding New Media. Cambridge: MIT Press, 2000.Bradley, Dale. “Dimensions Vary: Technology, Space, and Power in the 20th Century Office”. Topia 11 (2004): 67-82.Casciato, Paul. “Facebook and Other Social Media Cost UK Billions”. Washington Post, 5 Aug. 2010. 11 Aug. 2010 ‹http://www.washingtonpost.com/wp-dyn/content/article/2010/08/05/AR2010080503951.html›.Cuneo, Clementine, and David Barrett. “Was Banker Set Up Over Saucy Miranda”. The Daily Telegraph 4 Feb. 2010. 21 May 2010 ‹http://www.dailytelegraph.com.au/entertainment/sydney-confidential/was-banker-set-up-over-saucy-miranda/story-e6frewz0-1225826576571›.De Certeau, Michel. The Practice of Everyday Life. Vol. 1. Berkeley: U of California P. 1988.Dyer-Witheford, Nick, and Zena Sharman. "The Political Economy of Canada's Video and Computer Game Industry”. Canadian Journal of Communication 30.2 (2005). 1 May 2010 ‹http://www.cjc-online.ca/index.php/journal/article/view/1575/1728›.Friedmann, Georges. Industrial Society. Glencoe, Ill.: Free Press, 1955.Kracauer, Siegfried. The Salaried Masses. London: Verso, 1998.McCarthy, Anna. Ambient Television. Durham: Duke UP, 2001. ———. “Geekospheres: Visual Culture and Material Culture at Work”. Journal of Visual Culture 3 (2004): 213-21.Mills, C. Wright. White Collar. Oxford: Oxford UP, 1951. Murray, Nicholas. Kafka: A Biography. New Haven: Yale UP, 2004.Newman, Michael. “Ze Frank and the Poetics of Web Video”. 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Athabasca: Athabasca UP 2009. 55-77. ‹http://www2.carleton.ca/jc/ccms/wp-content/ccms-files/02_Beaty_et_al-How_Canadians_Communicate.pdf›Yates, JoAnne. “Business Use of Information Technology during the Industrial Age”. A Nation Transformed by Information. Eds. Alfred D. Chandler & James W. Cortada. Oxford: Oxford UP., 2000. 107-36.