Based upon 30-years of research by the author a new approach to hospital bed planning and international benchmarking is proposed. The number of hospital beds per 1000 population is commonly used to compare international bed numbers. This method is flawed because it does not consider population age structure or the effect of nearness-to-death on hospital utilization. Deaths are also serving as a proxy for wider bed demand arising from undetected outbreaks of 3000 species of human pathogens. To remedy this problem a new approach to bed modelling has been developed which plots beds per 1000 deaths against deaths per 1000 population. Lines of equivalence can be drawn on the plot to delineate countries with higher or lower bed supply. This method is extended to attempt to define the optimum region for bed supply in an effective health care system. England is used as an example of a health system descending into operational chaos due to too few beds and manpower. The former Soviet bloc countries represent a health system overly dependent on hospital beds. Several countries also show evidence for over-utilization of hospital beds. The new method is used to define a potential range for bed supply and manpower where the current most effective health systems currently reside. The method is applied to total curative beds, medical beds, psychiatric beds, critical care, geriatric care, etc., and can also be used to compare different types of healthcare staff, i.e., nurses, physicians, surgeons. Issues surrounding the optimum hospital size and the optimum average occupancy will also be discussed. The role of poor policy in the English NHS is used to show how the NHS has been led into a bed crisis. The method is also extended beyond international benchmarking to illustrate how it can be applied at a local or regional level in the process of long-term bed planning. Issues regarding the volatility in hospital admissions are also addressed to explain the need for surge capacity and why an adequate average bed occupancy margin is required for an optimally functioning hospital.

Keeping the bus voltage within acceptable limits depends on dispatching reactive power. Power quality improves as a result of creating an effective power flow system, which also helps to reduce power loss. Therefore, Optimal Reactive Power Dispatch (ORPD) studies aim at designing appropriate system configurations to enable a reliable operation of power systems. Establishment of such a configuration is handled through control variables in power systems. On the other hand, installing Distributed Generation Unit (DGU) into a power system can have an important effect on power quality and power loss minimization. In this paper, Grey Wolf Optimization (GWO method is applied to ORPD problem for the first time, to find optimal placement of newly installed DGUs at the power system. Active power loss and voltage minimization have been minimized by optimizing the control variables while keeping them within their upper and lower bounds, and by finding the optimal placement of a newly installed DGU in power system. On the basis of IEEE 30 bus and IEEE 118 bus systems, performance of the suggested approach is investigated. A comparison is also performed among the proposed method and some other methods. Test results demonstrate that the resulting configuration contributes to growing the rate of renewable integration to a power system. The results also indicate that the suggested optimization approach applied to ORPD problem has improved power system performance in terms of both on power loss and voltage deviation. The promising results highlight the potential of the GWO algorithm to facilitate the integration of renewable power sources, and its role in promoting sustainable energy solutions.

Faba bean is grown globally for human consumption and animal feed and is a significant rotation crop in cereal dominant areas in many countries including Australia. It is sensitive to several abiotic stresses, such as drought, frost and high temperatures, especially at the reproductive stage. However, little is known of the upper and lower temperature limits for successful podding. Experiments were conducted over two years at Breeza and Narrabri in north-western New South Wales to assess the impact of temperature on flowering and pod set of three genotypes; Doza, Cairo and IX1148f under field conditions. Flowering nodes were tagged from designated plants in the field and scored for podding, field temperatures were recorded. Optimum maximum temperature for podset ranged from 23.7-26.1 °C and the equivalent minimum temperature was 3.2-3.8 °C. Optimum average daily temperature for podset ranged from 12.7-13.9 °C. The strongest correlations between temperature and podding were observed at minimum temperatures, indicating that low temperatures are more important than high temperatures in determining yield in faba bean.

Mass hauling operations play central roles in construction projects. They typically use many haulers that consume large amounts of energy and emit significant quantities of CO₂. However, practical methods for estimating the energy consumption and CO₂ emissions of such operations during project planning are lacking. This paper presents a detailed model for estimating the energy consumption and CO₂ emissions of mass haulers that integrates the mass hauling plan with a set of predictive equations. The mass hauling plan is generated using a planning program such as DynaRoad in conjunction with data on the productivity of selected haulers and the amount of material to be hauled during cutting, filling, borrowing, and disposal operations. This plan is then used as input for estimating the energy consumption and CO₂ emissions of the selected hauling fleet. The proposed model will help planners to assess the energy and environmental performance of mass hauling plans, and to select hauler and fleet configurations that will minimize these quantities. The model was applied in a case study, demonstrating that it can reliably predict energy consumption, CO₂ emissions, and hauler productivity as functions of the hauling distance for individual haulers and entire hauling fleets.

This paper describes the optimal design of a miniature fiber-optic linear displacement sensor. It is characterized by its ability to measure displacements along a millimetric range with sub-micrometric resolution. The sensor consists of a triangular reflective grating and two fiber-optic probes. The measurement principle of the sensor is presented. The design of the sensor's triangular grating has been geometrically optimized by considering the step angle of the grating to enhance the sensor's resolution. The optimization method revealed a global optimum at which the highest resolution is obtained

Ca2+ is a crucial second messenger in plant cells, playing a vital role in various physiological and biochemical processes, including plant growth and development, photosynthesis, and enzyme regulation. Exogenous calcium concentration can have different effects on plant growth. This study aimed to investigate the optimal calcium concentration for the growth of four tree species, namely Pinus tabuliformis, Pinus sylvestris var. mongolica, Populus, and Morus alba seedlings, and whether the optimal calcium concentration varies among different tree species. The study utilized five calcium concentration gradients (0, 100, 200, 400, 800 mg·kg-1) for each species with three repeated treatments. Various growth indexes, photosynthetic parameters, chlorophyll fluorescence parameters, water use efficiency, and antioxidant enzyme activities were assessed to determine each species' calcium concentration requirements. The results showed that exogenous calcium significantly affected the growth and development of each seedling. The growth, biomass, photosynthetic parameters, photosynthetic products, photosynthetic pigments, water use efficiency, and antioxidant enzyme activity all increased initially and then decreased with increasing calcium concentration. Leaf calcium concentration also increased with the exogenous calcium content. Thus, there is an optimal calcium concentration for plant growth, and high or low calcium concentration is not conducive to plant growth. Furthermore, the study found that different tree species have varying optimal calcium concentrations. The optimal calcium concentration for Pinus tabuliformis, Pinus sylvestris var. mongolica, Populus, and Morus alba seedlings was 100, 100, 200, and 400 mg·kg-1, respectively. Finally, the study revealed that broadleaf species require higher calcium concentrations than coniferous species.

Global climatic event on Middle Miocene triggered by geology activity is called by Mid- Miocene Climatic Optimum (MMCO). This event was widely distributed and associated with increasing temperature and CO2 content in the atmosphere. The effect of MMCO was widely known the mid-latitude region, but still limited information in low latitude sediments. This study try to perform the effect of MMCO at Cibulakan Formation in which deposited in the low latitude basin, Bogor Basin. Fifty eights samples from Cileungsi River were taken at Cibulakan Formation and quantitative nannoplankton analysis was carried out for this study. Nannoplankton shows the sensitive response with sea surface temperature changes. Increasing of total population nannoplankton indicates the rising of temperature and dropping temperature is marked by decreasing population. The effect of sea surface temperature changes relates with salinity changes as the effect of evaporation. Helicosphaera carteri and Umbilicosphaera jafari were counted to know the salinity trend at Cibulakan Formation. Sea surfaces temperature changes was observed on Early Miocene which was influenced by small scale Early Miocene glaciation and active tectonic during this period. Warming temperature taken place on Middle Miocene as the effect of warm and open sea during Mid Miocene Climatic Optimum. Afterwards, hot temperature continued on Late Miocene triggered by global increasing temperature at Pacific Ocean and widely distribution of clean water at North West Java Basin.

Mineral nutrition is essential for plant growth and interaction of plants with biotic and abiotic stresses. Mango twig-tip dieback (MTTD) is a new type of mango decline, but its impact on the trees’ mineral nutrition is unknown. This study was conducted to determine the effect of MTTD infection on the nutrient status, balance, and resorption efficiency (RE) of mango. Leaf nutrient concentrations and deviation from the optimum percentage (DOP) indices of ‘Kensington Pride’ (KP) mango trees with low (LD) and high (HD) levels of MTTD infections were analyzed to compare the foliar nutrition status and nutrient balance between the LD and HD trees. Moreover, the nutrient resorption efficiency of MTTD-infected dried leaves (RE_D) was compared with the resorption efficiency of healthy (RE_S) leaves of KP mangoes. The concentrations of the total Ca, Mg, Cu, Fe, Mn, and Zn were lower in the HD trees than in the LD trees. But the total K content was higher in the HD trees, and its DOP index was sufficient, while the total K concentration was low and deficient level in LD trees. Moreover, DOP indices for total Ca, Mn, and Zn were less deficient in LD trees than in HD trees, and overall nutrient imbalances were exacerbated in HD trees. RE_D was significantly lower than RE_S for the total N, P, S, Cu, Fe, and Zn but significantly higher than RE_S for K. The study underscores the significant influence of MTTD on the mineral nutrition of KP mangoes, revealing distinct nutrient variations between trees with low and high MTTD infection levels. These findings have important implications for mango crop management, emphasizing the need for targeted nutrient interventions to address imbalances induced by MTTD and enhance the overall health and resistance of mango trees against MTTD infection.

The Electric Fish Optimization (EFO) Algorithm is inspired by the predation behavior and communication of weak electric fish. It is a novel meta-heuristic algorithm that attracts researchers because it has few tunable parameters,high robustness,and strong global search capabilities. Nevertheless, when operating in complex environments, the EFO algorithm encounters several challenges including premature convergence, susceptibility to local optimum, and issues related to passive electric field localization stagnation. To address these challenges, this study introduces an Adaptive Electric Fish Optimization Algorithm Based on Standstill Label and Level Flight (SLLF-EFO). This hybrid approach incorporates the Golden Sine Algorithm and Good Point Set Theory to augment the EFO algorithm’s capabilities, employs a variable step size Levy flight strategy to efficiently address passive electric field localization stagnation problems, and utilizes a standstill label strategy to mitigate the algorithm’s tendency to fall into local optimum during the iterative process. By leveraging multiple solutions to optimize the EFO algorithm, this framework enhances its adaptability in complex environments. Experimental results from benchmark functions reveal that the proposed SLLF-EFO algorithm exhibits improved performance in complex settings, demonstrating enhanced search speed and optimization accuracy This comprehensive optimization not only enhances the robustness and reliability of the EFO algorithm but also provides valuable insights for its future applications.

Small submersible drainage pumps discharge leaking water and rainwater in buildings. In an emergency (e.g., heavy rain or accident), monitoring the flow rate in advance is necessary to enable optimal operation, considering the point where the pump operates abnormally when the water level increases rapidly. In another, pump performance optimization is crucial for energy saving policy. Therefore, it is necessary to meet the challenges of submersible pump systems, including sustainability and pump efficiency. The final goal of this study is to develop an energy-saving, high-efficiency submersible drainage pump capable of responding to emergencies. In particular, this paper targeted the hydraulic performance improvement of a submersible drainage pump model. Before the development of driving mode-related technology capable of emergency response, we first tried to find a way to improve the performance characteristics of the existing submersible drainage pump. Rather than designing a new pump, we disassembled the current pump and reverse engineering. Then, numerical simulation was performed to analyze the flow characteristics and efficiency of the pump. Then, the pump test was carried out to obtain the performance and validated with numerical results. Results revealed that changing the cross-sectional shape of the impeller reduced the flow separation and enhanced velocity and pressure distributions. Also, it reduced the power and increased efficiency. Results also showed that the pump's efficiency increased to 5.56% at a discharge rate of 0.17 m3/min, and overall average efficiency increased to 6.53%. In addition, the submersible pump design method could be suitable for the optimized pump's impeller and casing numerically. This paper can provide insight and information on the design optimization of pumps.

In the end, this paper analyzed the economy from the investment in plant construction, raw material collection, product production and product sales. The resulting products include pyrolytic carbon, pyrolytic oil, pyrolysis gas. The results showed that when the treatment scale was 1 ton h−1, the pyrolysis plants with three loading modes will always be in a state of loss during the 20-year running time. When the processing scale was 9 ton h−1, the pyrolysis plant can be profitable in the first year. In the sensitivity analysis, the influence of three pyrolysis products on the total return on investment was explored. The results showed that the price change of pyrolysis oil has the greatest influence on the total return on investment (Total ROI) under the three loading methods, The price change of pyrolysis gas has minimal impact on the Total ROI. This study provides basic data and basis for the commercialization of coal-biomass co-pyrolysis technology and investment in plant construction.

This study focuses on a biogas dry reforming to produce H2. Biogas contains CO2 of 40 vol% approximately, indicating that the efficiency of the power generation is reduced because of the smaller heating value compared with a natural gas. The authors have proposed the combination system consisting of biogas dry reforming reactor and solid oxide fuel cell (SOFC). Since a biogas dry reforming is an endothermic reaction, this study adopts a membrane reactor which can be operated by causing the non-equilibrium state with H2 separation from the reaction space. This study aims to clarify the impact of thickness of Pd/Cu membrane on the characteristics of the biogas dry reforming membrane reactor using Pd/Cu membrane and Ni/Cr catalyst. The impact of the operation temperature, the molar ratio of CH4:CO2 and the differential pressure between the reaction chamber and the sweep chamber on the characteristics of the biogas dry reforming membrane reactor using Pd/Cu membrane and Ni/Cr catalyst is examined changing the thickness of Pd/Cu membrane. As a result, the highest concentration of H2 is 122711 ppmV which is obtained in case of CH4:CO2 =1:1 at the reaction temperature of 600 ℃ and the differential pressure of 0 MPa using the Pd/Cu membrane whose thickness of 40 m.

Coal bottom ash (CBA) is a byproduct of coal-burning power plants. This material can be used as a fine aggregate replacement in concrete to reduce global natural material depletion. Concrete usage is increasing rapidly; subsequently, the industry’s carbon footprint is increasing. Using CBA in the construction industry will reduce the technical and economic problems associated with power plants by reducing solid waste. This project aimed to determine if adding new sustainable materials, such as CBA, to concrete will reduce natural raw material usage, energy consumption, and greenhouse gas emissions while improving performance. This study included two projects: comparing increased CBA content to the two-control project and determining the optimum content based on the compressive strength. The optimum CBA content is 50%, which reduces fine aggregate usage in a concrete mix by 50% while maintaining equivalent or better concrete strength than a pure Portland concrete mix without CBA. The air content of the concrete mix containing % CBA decreased with increased CBA content and compressive strength, possibly due to the spacing factor of the voids in the mix and CBA’s porous and fineness behavior. The CBA optimum content had a unit weight lower than the controls for both projects, which makes the CBA mix a lightweight concrete. Using this material can significantly reduce natural material usage and environmental harm by reducing CBA waste disposal and improving concrete performance.

This experimental study examined the application effect of polycaprolactone (PCL), an organic resin material with excellent elasticity and ductility, on improving the mechanical performance of cellulose nanocrystal (CNC) cement composites. To analyze the effect, a test specimen containing CNC and PCL mixed, containing only CNC, and a control (plain) specimen containing nothing were compared. PCL was compared according to its shape, and in the case of Granules, which is the basic shape, interfacial adhesion with cement was not achieved, so a DCM solution was used to dissolve and use the Granules form. As a method for bonding PCL to the CNC surface, the CNC surface was modified using 3-aminopropyltriethoxysilane (APTES), and surface silylation was confirmed through Fourier transform infrared spectroscopy(FT-IR) analysis. To evaluate the dispersibility according to the application of PCL to the modified CNC, particle size analysis (PSA) and zeta potential analysis were performed according to the PCL mixing amount (0.1, 0.3, 0.5, and 1 vol.% compared with those of CNC) and size distribution. Through the zeta potential value, the highest dispersion stability was shown at 1 vol.%. The cohesive force of CNC was low and the dispersion stability was high according to the application of PCL. According to the results of the dispersion stability evaluation, the degree of hydration of the dissolved PCL 1 vol.%, CNC-only specimens, and plain specimens were analyzed. Hydration products increased by increasing the degree of hydration in the unhydrated area. However, the incorporation of PCL showed a low degree of hydration, and the analysis of strength characteristics also showed a decrease of approximately 27% compared with that of plain specimens. This was because the bonding with SiO2 was not smooth owing to the solvent, thus affecting internal hydration. To investigate the effect of the PCL shape, the compressive and flexural strength characteristics were compared using PCL powder as an additional parameter. The compressive and flexural strength values were improved by approximately 54% and 26%, respectively, compared with those of the plain specimen. Scanning electron microscopy (SEM) analysis determined that the filler effect that made the micropore structure denser, affected the mechanical performance improvement.

Undoubtedly the Wageningen B-screw Series is the most widely used systematic propeller series. It is very popular to preselect propeller dimensions during the preliminary design stage before performing a more thorough optimization, but in the smaller end of the market it is often used to merely select the final propeller. Over time the originally measured data sets were faired and scaled to a uniform Reynolds number of 2·10⁶ to increase the reliability of the series. With the advent of the computer, polynomials for the thrust and torque values were calculated based on the available data sets. The measured data are typically presented in the well-known open-water curves of thrust and torque coefficients K_T and K_Q versus the advance coefficient J. Changing the presentation from these diagrams to efficiency maps reveals some unsuspected and surprising behaviours, such as multiple optima when optimizing for efficiency or even no optimum at all for certain conditions. These artefacts get more pronounced at higher pitch to diameter ratios and low blade numbers. The present work builds upon the paper presented by the author at the AMT’17 and smp’19 conferences and now includes the extended efficiency maps, as suggested by Danckwardt, for all propellers of the Wageningen B-screw Series.

As the demand for liquefied petroleum gas (LPG) continues to increase worldwide, more LPG facilities are being constructed. However, the design and manufacture of pressure vessels used to store dangerous liquids or pressurised fluids, such as LPG, has been a major cause of hazards, including explosions and leakage. In this study, we aim to address this issue by designing and analysing a vertical pressure vessel with a capacity of 10 m3 of pressurised LPG in accordance with the American Society of Mechanical Engineers (ASME) code. Safety is the primary concern in designing pressure vessels due to the potential risks posed by accidents. Therefore, the main objective of this project is to design a pressure vessel that is safe from failure. The vessel is cylindrical with two elliptical heads, two nozzles, a manway and four leg supports, and we used Autodesk Inventor Professional 2023 for geometric modelling and Inventor Nastran for FEA analysis. To investigate the displacements, deflections and Von-Mises stresses in the pressure vessel, we used the finite element method, and Autodesk Inventor Nastran was employed for the analysis. Our results showed that changes to the structure of the pressure vessel were needed to reduce stress in the structure. Specifically, the displacement showed an inverse relationship with the tank section shell thickness. Moreover, we observed that the factor of safety increased linearly with shell thickness. We carefully considered permissible pressures and determined the required wall thickness to ensure acceptable maximum stresses. Our results indicate that the design is safe from failure, and the highest stresses are experienced by the manway followed by the shell, while the heads, nozzles and legs support experienced the lowest stresses. We also performed a theoretical calculation for the entire model and checked the results to ensure they were within the acceptable limits. In summary, our study highlights the importance of designing pressure vessels in accordance with ASME codes to ensure safety and prevent hazards caused by improper design and manufacturing. By using the finite element method, we identified potential stress points in the pressure vessel and were able to make modifications to improve its safety.

Real-time energy management of a converter-based microgrid is difficult to determine optimal operating points of a storage system in order to save costs and minimise energy waste. This complexity arises due to time-varying electricity prices, stochastic energy sources and power demand. Many countries have imposed real-time electricity pricing to efficiently control demand side management. This paper presents a particle swarm optimisation (PSO) for the application of real-time energy management to find optimal battery controls of a community microgrid. The modification of the PSO consists in altering the cost function to better model the battery charging/discharging operations. As optimal control is performed by formulating a cost function, it is suitably analysed and then a dynamic penalty function in order to obtain the best cost function is proposed. Several case studies with different scenarios are conducted to determine the effectiveness of the proposed cost function. The proposed cost function can reduce operational cost by 12% as compared to the original cost function over a time horizon of 96 hours. Simulation results reveal the suitability of applying the regularised PSO algorithm with the proposed cost function, which can be adjusted according to the need of the community, for real-time energy management.

Ferulic acid esters have been suggested as a group of natural chemicals with sunscreen function. The study aimed to utilize an environment-friendly enzymatic method to produce octyl ferulate by esterification of ferulic acid with octanol. The Box-Behnken design with response surface methodology (RSM) was adopted to evaluate the effects of synthesis variables, including reaction temperature (70–90 °C), enzyme amount (1000–2000 PLU) and stir speed (50–150 rpm), on the molar conversion of octyl ferulate. According to the joint test, both the reaction temperature and enzyme amount had great impacts on the molar conversion. RSM-developed second-order polynomial equation further showed great ability on data-fitting. Based on ridge max analysis, the optimum parameters for the biocatalyzed reaction were: 72 h reaction time, 92.2 °C reaction temperature, 1831 PLU enzyme amount and 92.4 rpm stir speed, respectively. Finally, the molar conversion of octyl ferulate under optimum condition was verified to be 93.2 ± 1.5%. In conclusion, high yield of octyl ferulate synthesized by commercial immobilized lipase under elevated temperature conditions has been suggested, which our findings could broaden the utilization of the lipase and provide a biocatalytic approach, instead of the chemical method, for ferulic acid ester synthesis.

The forest is a complex and dynamic ecosystem that requires integrated planning and management, considering economic, social, environmental, and ecological dimensions. Different stakeholders often have conflicting goals, making optimal management decisions challenging. This study aims to balance increasing economic benefits for forest users with reducing negative environmental impacts, aligning the interests of managers, government institutions, and policymakers. To achieve this, multi-objective optimization methods and game theory were used. The objectives were to maximize the net present value of wood harvesting and the amount of carbon sequestration. The study was conducted in the Shafarood forest in northern Iran. Data collected included stumpage prices, variable harvesting costs, tree density per ha, volume per ha, growth rates, interest rates, carbon sequestration, and labor costs. Using this data, models were developed for the expected mean price of various species, stored carbon, logistics growth, and labor. After adjusting the objective functions and model constraints, the range of Pareto optimal solutions for the multi-objective model and the Nash equilibrium for the game theory model were determined using the epsilon-constrain method. The results indicate that both modeling approaches can identify optimal points for balancing economic and environmental goals. The Pareto optimal range and Nash equilibrium allow for informed decision-making in managing the Hyrcanian forests, accommodating different user goals. Therefore, both models are effective tools for forest management planning and provide a framework for achieving sustainable management practices.

Thailand has formulated her climate change policy and updated relevant plans and policies to align with the goal of achieving carbon neutrality and net zero GHG emissions. This study investigates the optimal level of GHG mitigation in Thailand, taking into account the marginal abatement cost (MAC) and social cost of carbon (SCC). It evaluates how energy efficiency and renewable energy technologies influence GHG reduction in the power and industrial sector and illustrates policy recommendations that align with the 2020 to 2050 policy and plan period. The findings indicate that there may be instances where GHG mitigation potential is insufficient to reach the national mile-stone. In such cases, it becomes imperative to leverage all technologies within the marginal abatement cost curve (MACC) and also utilization of the social cost of carbon for policy decision making and meeting the desired goals. In certain scenarios, the adoption of additional technologies or measures may be necessary, such as flexible power generation and deploying carbon capture and storage or hydrogen which are high-cost technologies. Furthermore, preparations should be made for multiple levels of climate change policies and plans beyond 2030.

This paper proposes a methodology for multi-criteria calibration of a thermo-mechanical model for numerical simulation of welding in vacuum. A finite element model of a steel plate is created. Experimental and computational data are obtained. An inverse problem is formulated for the vector identification of five calibration parameters from the heat flow model. They are evaluated for adequacy with controlled accuracy according to four criteria. An optimization problem is solved using a two-step interactive procedure. The parameter space studying method (PSI) has been applied to the study of multidimensional regions by means of quasi-uniform sounding. A Pareto-optimal set is defined. It is used to determine reduced ranked Pareto subsets by -selection. Salukvadze optimum is also determined.

Immune checkpoint inhibition therapy (ICIT) is an emerging field in oncology especially opening new horizons to chemotherapy refractory patients. This paper provides deep insight into immune related adverse events (irAEs) posing a major challenge and drawback to ICIT, and presents right management strategies for very complex complications. Moreover, for the first time in literature, a non-linear mathematical model is introduced to measure the ICIT success rate and to decide about the optimum ICIT duration. Furthermore, a strategy is presented to overcome or to delay the progression after initial good response in a subset of patients.

This paper identifies a criterion for choosing the largest set of rejected hypotheses in high-dimensional data analysis where Multiple Hypothesis testing is used in exploratory research to identify significant associations among many variables. The method neither requires predetermined thresholds for level of significance, nor uses presumed thresholds for false discovery rate. The upper limit for number of rejected hypotheses is determined by finding maximum difference between expected true hypotheses and false hypotheses among all possible sets of rejected hypotheses. Methods of choosing a reasonable number of rejected hypotheses and application to non-parametric analysis of ordinal survey data are presented.

This study investigates the process of planning for future inpatient resources (beds, staff and costs) for maternity (pregnancy and childbirth) services. The process of planning is approached from a patient centered philosophy; hence, how do we discharge a suitably rested healthy mother who is fully capable of caring for the newborn baby back into the community. It demonstrates some of the difficulties in predicting future births and investigates trends in the average length of stay. While it is relatively easy to document longer-term (past) trends in births and the conditions relating to pregnancy and birth, it is exceedingly difficult to predict the future nature of such trends. The issue of optimum average bed occupancy is addressed via the Erlang B equation which links number of beds, average bed occupancy and turn-away. Turn-away is the proportion of times that there is not an immediately available bed for the next arriving inpatient. Economy of scale implied by queuing theory (and the implied role of population density) explains why many well intended community-based schemes fail to gain traction. The paper also addresses some of the erroneous ideas around the dogma that reducing length of stay ‘saves’ money. Maternity departments are encouraged to understand how their costs are calculated to avoid the trap where it is suggested by others that in reducing the length of stay, they will reduce costs and increase ‘efficiency’. Indeed, up to 60% of calculated maternity ‘costs’ are apportioned hospital overheads from supporting departments such as finance, personnel, buildings and grounds, IT, information, etc., along with depreciation charges on the hospital-wide buildings and equipment. These costs, “the fixed costs dilemma”, are totally beyond the control of the maternity department and will vary by hospital depending on how these costs are apportioned to the maternity unit. Premature discharge, one of the unfortunate outcomes of turn-away, is demonstrated to shift maternity costs into the pediatric and neonatal departments as ‘boomerang babies’ then require the cost of avoidable inpatient care. Examples are given from the English NHS of how misdirected government policy can create unforeseen problems.