Yarra Valley Water (Australia)

Purpose This study aims to examine how hybrid medical managers in a public hospital reconcile their identities and involvement in management-introduced top-down interventions to improve operational performance. In our study, Lean serves as an example of a management intervention through which we examine how hybrids shape the implementation of managerial interventions in a public hospital. Design/methodology/approach We gathered our data from a longitudinal qualitative study of a Lean initiative implemented in an Australian public hospital. The current analysis is part of a larger case study which involved 87 in-depth semi-structured interviews over three years in a major Australian public hospital. These interviews explored experiences of Lean and included senior managers, middle managers, hybrids, clinical staff and others. In this paper, we focus specifically on the experiences of hybrid medical managers. Findings We demonstrate how the Lean initiative sparks identity-reconciliation work that differs among hybrids working in different parts of the hospital and with various contractual arrangements and levels of participatory voice. The hybrids in our study responded to the introduction of Lean, with heightened identity reconciliation work, but in different ways. This appears to be attributable to the organisational context, and particularly the hybrids’ contractual arrangements with the hospital. Originality/value There is a dearth of research in healthcare management that has sought to understand how hybrids reconstruct their identities in response to top-down implementations of managerial initiatives, such as Lean. Our findings offer healthcare managers practical insights into the engagement of hybrid-medical professionals through our novel understanding of the identity-reconciliation work necessary for hybrid professionals to engage with management initiatives.

Summary Each of the Pythagorean means corresponds to the centroid of a region in the Cartesian plane. We show how this insight leads to a short proof of a result that generalizes the HM-GM-AM inequality.

This paper presents a critical review of the physical impacts of decentralized water supply systems on existing centralized water infrastructures. This paper highlights the combination of centralized and decentralized systems, which is referred to as hybrid water supply systems. The system is hypothesized to generate more sustainable and resilient urban water systems. The basic concept is to use decentralized water supply options such as rainwater tanks, storm water harvesting and localized wastewater treatment and reuse in combination with centralized systems. Currently the impact of hybrid water supply technologies on the operational performance of the downstream infrastructure and existing treatment processes is yet to be known. The paper identifies a number of significant research gaps related to interactions between centralized and decentralized urban water services. It indicates that an improved understanding of the interaction between these systems is expected to provide a better integration of hybrid systems by improved sewerage and drainage design, as well as facilitate operation and maintenance planning. The paper also highlights the need for a framework to better understand the interaction between different components of hybrid water supply systems.

Urban water supply systems provide water for a range of water uses from human consumption to fire control, and from garden irrigation to industrial processes. The amount of water consumed in an urban area depends on the activities. Therefore, urban water use is categorised into different sectors such as residential, non-residential and unmetered water use. Modeling urban water use has significant importance in water resources planning and management. From the literature, a vast amount of research was found on modeling residential water use. However, a significant portion (e.g. around 30% of total water use in Melbourne, Australia) of urban water use belongs to non-residential, and limited attention has been given to modelling non-residential urban water use, possibly due to the difficulty of data collection at end-use level. However, billing data are now available in monthly and quarterly time steps with the latter being widely available. Such data can be utilized to build models for predicting non-residential water use. Therefore, this study aims to develop non-residential water demand models by identifying unique groups based on their homogeneous nature of water use and then further disaggregated into different sub-groups based on their volumes of water uses. Quarterly billing data from 2000 to 2011 were obtained within the Yarra Valley Water (YVW) service area for 46,000 non-residential customers. Of them, monthly water use data available only for 100 customers. Therefore, comparative study of quarterly and monthly time step modeling was carried out by developing a regression model to predict non-residential urban water use in two schools within YVW service area and is presented in this paper. Monthly water use data from 2005 to 2011 were used for this study as water usage patterns are significantly different in pre and post 2005 due in part to permanent water saving rules, which was introduced in 2005. Monthly data were accumulated into quarterly data for developing the quarterly model. Past water use, dummy variables for fixed quarterly effects, incidence of water restrictions, total rainfall and mean monthly maximum daily temperature were considered as influential variables. Although there were five levels of restrictions during this period, due to insufficient data points for some of the restriction levels, all types of restrictions were considered as a single level of restriction. Model performance was measured using Nash-Sutcliffe efficiency (E) and relative error values. Model calibration and validation were performed using two independent data sets by splitting the total record into two periods. Two sets of calibration periods: 2006-2009 and 2006-2010 and validation periods: 2010-2011 and 2011 were also tested to find the best period for model development and validating the models. It was found that the models developed with 2006-2010 calibration period have given better results for both of the schools. Although, both of the monthly and the quarterly time step models were found to predict well, quarterly model performed slightly better than the monthly model with less relative error and good E value. The 20th International Congress on Modelling and Simulation (MODSIM2013) was held at the Adelaide Convention Centre in Adelaide, South Australia, from 1 to 6 December 2013. It was held jointly with the 22nd National Conference of the Australian Society for Operations Research (ASOR 2013) and the DSTO led Defence Operations Research Symposium (DORS 2013). The theme for this event was Adapting to Change: the multiple roles of modelling.

Necrotizing soft tissue infections are a group of life- and limb-threatening infections. They are caused by aerobic and anaerobic bacteria occasionally in a synergistic polymicrobial combination. The literature describing necrotizing soft tissue infections is controversial and often contradictory. Depending on their clinical appearance, tissue level and microbiological findings, necrotizing soft tissue infections are classified into two major groups, infections within the subcutaneous/fascia niveau and within the muscle level. Necrotizing infections of the subcutaneous level are further differentiated in hemolytic streptococcal gangrene, necrotizing fasciitis, clostridium fasciitis, and anaerobic nonclostridium fasciitis. In particular, necrotizing fasciitis is a rapidly progressing process, which is characterized by suppurative fasciitis, following by vascular thrombosis and cutaneous gangrene and is often accompanied by severe systemic toxicity, seen as septic-toxic shock and progressive (multi-) organ failure. Nineteen cases of necrotizing soft tissue infections were treated at the Department of Surgery, University Hospital of Zurich, between 1989 and 1992. These infections originated from "neglected trauma" in 9 (9/19), drug injections in 4 (4/19), acute infections in 3 (3/19), operative wounds in 2 (2/19) and perforation of the intestine in 1 case (1/19). Most of the patients (13/19) suffered from chronic debilitating diseases and were compromised by a suppressed immune system. We treated two groups of patients, one with septic-toxic clinical course and the other without. Eleven patients (11/19) belonged to group one and four of them, showing necrotizing fasciitis of the trunk, died as a result of multiorgan failure (MOF). Furthermore, three patients in this group had a limb amputated. In the other group without septic-toxic signs, no one died or lost a limb. The two groups differed also in length of hospital stay, an average of 60 days in group one (23 days intensive care) and 25 days in group two. Our results suggest that prompt recognition and treatment of necrotizing soft tissue infections are essential for the patient's survival. Often the full extent of the infections is underestimated initially, resulting in delayed surgical therapy. To control the rapidly spreading necrosis, early diagnosis and radical debridement of the affected tissue are essential and should be done without compromise, even if the affected limb must be amputated.