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Sample records for r-process waiting point

  1. Approaching the r-process "waiting point" nuclei below $^{132}$Sn: quadrupole collectivity in $^{128}$Cd

    CERN Multimedia

    Reiter, P; Blazhev, A A; Nardelli, S; Voulot, D; Habs, D; Schwerdtfeger, W; Iwanicki, J S

    We propose to investigate the nucleus $^{128}$Cd neighbouring the r-process "waiting point" $^{130}$Cd. A possible explanation for the peak in the solar r-abundances at A $\\approx$ 130 is a quenching of the N = 82 shell closure for spherical nuclei below $^{132}$Sn. This explanation seems to be in agreement with recent $\\beta$-decay measurements performed at ISOLDE. In contrast to this picture, a beyond-mean-field approach would explain the anomaly in the excitation energy observed for $^{128}$Cd rather with a quite large quadrupole collectivity. Therefore, we propose to measure the reduced transition strengths B(E2) between ground state and first excited 2$^{+}$-state in $^{128}$Cd applying $\\gamma$-spectroscopy with MINIBALL after "safe" Coulomb excitation of a post-accelerated beam obtained from REX-ISOLDE. Such a measurement came into reach only because of the source developments made in 2006 for experiment IS411, in particular the use of a heated quartz transfer line. The result from the proposed measure...

  2. Neutron-rich isotopes around the r-process 'waiting-point' nuclei 2979Cu50 and 3080Zn50

    International Nuclear Information System (INIS)

    Kratz, K.L.; Gabelmann, H.; Pfeiffer, B.; Woehr, A.

    1991-01-01

    Beta-decay half-lives (T 1/2 ) and delayed-neutron emission probabilities (P n ) of very neutron-rich Cu to As nuclei have been measured, among them the new isotopes 77 Cu 48 , 79 Cu 50 , 81 Zn 51 and 84 Ga 53 . With the T 1/2 and P n -values of now four N≅50 'waiting-point' nuclei known, our hypothesis that the r-process has attained a local β-flow equilibrium around A≅80 is further strengthened. (orig.)

  3. Neutron-Rich Silver Isotopes Produced by a Chemically Selective Laser Ion-Source: Test of the R-Process " Waiting-Point " Concept

    CERN Multimedia

    2002-01-01

    The r-process is an important nucleosynthesis mechanism for several reasons: \\begin{enumerate} \\item It is crucial to an understanding of about half of the A>60 elemental composition of the Galaxy; \\item It is the mechanism that forms the long-lived Th-U-Pu nuclear chronometers which are used for cosmochronolgy; \\item It provides an important probe for the temperature (T$ _{9} $)-neutron density ($n_{n}$) conditions in explosive events; and last but not least \\item It may serve to provide useful clues to and constraints upon the nuclear properties of very neutron-rich heavy nuclei. \\end{enumerate} \\\\ \\\\With regard to nuclear-physics data, of particular interest are the T$ _{1/2} $ and P$_{n-} $ values of certain$\\,$ "waiting-point"$\\,$ isotopes in the regions of the A $ \\approx $ 80 and 130. r-abundance peaks. Previous studies of $^{130}_{\\phantom{1}48}$Cd$_{82}$ and $^{79}_{29}$Cu$_{50}$. $\\beta$-decay properties at ISOLDE using a hot plasma ion source were strongly complicated by isobar and molecular-ion c...

  4. Bottlenecks and Waiting Points in Nucleosynthesis in X-ray bursts and Novae

    Science.gov (United States)

    Smith, Michael S.; Sunayama, Tomomi; Hix, W. Raphael; Lingerfelt, Eric J.; Nesaraja, Caroline D.

    2010-08-01

    To better understand the energy generation and element synthesis occurring in novae and X-ray bursts, we give quantitative definitions to the concepts of ``bottlenecks'' and ``waiting points'' in the thermonuclear reaction flow. We use these criteria to search for bottlenecks and waiting points in post-processing element synthesis explosion simulations. We have incorporated these into the Computational Infrastructure for Nuclear Astrophysics, a suite of nuclear astrophysics codes available online at nucastrodata.org, so that anyone may perform custom searches for bottlenecks and waiting points.

  5. Mass measurement on the rp-process waiting point {sup 72}Kr

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez, D. [Gesellschaft fuer Schwerionenforschung mbH, Darmstadt (Germany); Kolhinen, V.S. [Jyvaeskylae Univ. (Finland); Audi, G. [CSNSM-IN2P3-Centre National de la Recherche Scientifique (CNRS), 91 - Orsay (FR)] [and others

    2004-06-01

    The mass of one of the three major waiting points in the astrophysical rp-process {sup 72}Kr was measured for the first time with the Penning trap mass spectrometer ISOLTRAP. The measurement yielded a relative mass uncertainty of {delta}m/m=1.2 x 10{sup -7} ({delta}m=8 keV). Other Kr isotopes, also needed for astrophysical calculations, were measured with more than one order of magnitude improved accuracy. We use the ISOLTRAP masses of{sup 72-74}Kr to reanalyze the role of the {sup 72}Kr waiting point in the rp-process during X-ray bursts. (orig.)

  6. Weak interaction rates for Kr and Sr waiting-point nuclei under rp-process conditions

    International Nuclear Information System (INIS)

    Sarriguren, P.

    2009-01-01

    Weak interaction rates are studied in neutron deficient Kr and Sr waiting-point isotopes in ranges of densities and temperatures relevant for the rp process. The nuclear structure is described within a microscopic model (deformed QRPA) that reproduces not only the half-lives but also the Gamow-Teller strength distributions recently measured. The various sensitivities of the decay rates to both density and temperature are discussed. Continuum electron capture is shown to contribute significantly to the weak rates at rp-process conditions.

  7. Shape study of the N=Z waiting-point nucleus 72Kr via beta decay

    CERN Document Server

    Briz Monago, Jose Antonio; Nácher González, Enrique

    The Ph.D. thesis entitled “Shape study of the N=Z waiting-point nucleus 72Kr via beta decay” is devoted to the study of the shape of the ground state of the 72Kr nucleus. It is an N=Z nucleus in the mass region A~70-80 where shape transitions and the shape coexistence phenomena have been identified. Furthermore, this nucleus participates in the rp-process as a waiting point due to the slowdown of the process taking place at the arrival to this nucleus. The study of the properties of this nucleus is interesting from the Nuclear Structure point of view, for the phenomena occurring in its mass region and have been predicted for it, and from the Nuclear Astrophysics for the accurate performance of astrophysical calculations. The β+/EC decay of the 72Kr nucleus has been studied through two complementary experiments at the ISOLDE facility at CERN in Geneva (Switzerland). In one of them, the low-spin structure of the daughter nucleus, 72Br, has been revised via conversion electron spectroscopy where the convers...

  8. Nuclear binding around the RP-process waiting points $^{68}$Se and $^{72}$Kr

    CERN Multimedia

    2002-01-01

    Encouraged by the success of mass determinations of nuclei close to the Z=N line performed at ISOLTRAP during the year 2000 and of the recent decay spectroscopy studies on neutron-deficient Kr isotopes (IS351 collaboration), we aim to measure masses and proton separation energies of the bottleneck nuclei defining the flow of the astrophysical rp-process beyond A$\\sim$70. In detail, the program includes mass measurements of the rp-process waiting point nuclei $^{68}$Se and $^{72}$Kr and determination of proton separation energies of the proton-unbound $^{69}$Br and $^{73}$Rb via $\\beta$-decays of $^{69}$Kr and $^{73}$Sr, respectively. The aim of the project is to complete the experimental database for astrophysical network calculations and for the liquid-drop type of mass models typically used in the modelling of the astrophysical rp process in the region. The first beamtime is scheduled for the August 2001 and the aim is to measure the absolute mass of the waiting-point nucleus $^{72}$Kr.

  9. Nuclear structure and weak rates of heavy waiting point nuclei under rp-process conditions

    Science.gov (United States)

    Nabi, Jameel-Un; Böyükata, Mahmut

    2017-01-01

    The structure and the weak interaction mediated rates of the heavy waiting point (WP) nuclei 80Zr, 84Mo, 88Ru, 92Pd and 96Cd along N = Z line were studied within the interacting boson model-1 (IBM-1) and the proton-neutron quasi-particle random phase approximation (pn-QRPA). The energy levels of the N = Z WP nuclei were calculated by fitting the essential parameters of IBM-1 Hamiltonian and their geometric shapes were predicted by plotting potential energy surfaces (PESs). Half-lives, continuum electron capture rates, positron decay rates, electron capture cross sections of WP nuclei, energy rates of β-delayed protons and their emission probabilities were later calculated using the pn-QRPA. The calculated Gamow-Teller strength distributions were compared with previous calculation. We present positron decay and continuum electron capture rates on these WP nuclei under rp-process conditions using the same model. For the rp-process conditions, the calculated total weak rates are twice the Skyrme HF+BCS+QRPA rates for 80Zr. For remaining nuclei the two calculations compare well. The electron capture rates are significant and compete well with the corresponding positron decay rates under rp-process conditions. The finding of the present study supports that electron capture rates form an integral part of the weak rates under rp-process conditions and has an important role for the nuclear model calculations.

  10. The waiting room: vector for health education? The general practitioner's point of view.

    Science.gov (United States)

    Gignon, Maxine; Idris, Hadjila; Manaouil, Cecile; Ganry, Oliver

    2012-09-18

    General practitioners (GPs) play a central role in disseminating information and most health policies are tending to develop this pivotal role of GPs in dissemination of health-related information to the public. The objective of this study was to evaluate use of the waiting room by GPs as a vector for health promotion. A cross-sectional study was conducted on a representative sample of GPs using semi-structured, face-to-face interviews. A structured grid was used to describe the documents. Quantitative and qualitative analysis was performed. Sixty GPs participated in the study. They stated that a waiting room had to be pleasant, but agreed that it was a useful vector for providing health information. The GPs stated that they distributed documents designed to improve patient care by encouraging screening, providing health education information and addressing delicate subjects more easily. However, some physicians believed that this information can sometimes make patients more anxious. A large number of documents were often available, covering a variety of topics. General practitioners intentionally use their waiting rooms to disseminate a broad range of health-related information, but without developing a clearly defined strategy. It would be interesting to correlate the topics addressed by waiting room documents with prevention practices introduced during the visit.

  11. R-process signatures

    International Nuclear Information System (INIS)

    Kratz, K.L.; Pfeiffer, B.

    2003-01-01

    We compare r-process calculations with recent astronomical observations from the solar system and from ultra-metal-poor, neutron-capture-rich halo stars. These measurements include elemental as well as isotopic r-abundances. We deduce astrophysical conditions under which the observed r-patterns can be obtained, and derive criteria to determine Th/U chronometric ages. (orig.)

  12. Application of the relativistic mean-field mass model to the r-process and the influence of mass uncertainties

    International Nuclear Information System (INIS)

    Sun, B.; Montes, F.; Geng, L. S.; Geissel, H.; Litvinov, Yu. A.; Meng, J.

    2008-01-01

    A new mass table calculated by the relativistic mean-field approach with the state-dependent BCS method for the pairing correlation is applied for the first time to study r-process nucleosynthesis. The solar r-process abundance is well reproduced within a waiting-point approximation approach. Using an exponential fitting procedure to find the required astrophysical conditions, the influence of mass uncertainty is investigated. The r-process calculations using the FRDM, ETFSI-Q, and HFB-13 mass tables have been used for that purpose. It is found that the nuclear physical uncertainty can significantly influence the deduced astrophysical conditions for the r-process site. In addition, the influence of the shell closure and shape transition have been examined in detail in the r-process simulations

  13. Cardiac EASE (Ensuring Access and Speedy Evaluation) – the impact of a single-point-of-entry multidisciplinary outpatient cardiology consultation program on wait times in Canada

    Science.gov (United States)

    Bungard, Tammy J; Smigorowsky, Marcie J; Lalonde, Lucille D; Hogan, Terry; Doliszny, Katharine M; Gebreyesus, Ghirmay; Garg, Sipi; Archer, Stephen L

    2009-01-01

    BACKGROUND: Universal access to health care is valued in Canada but increasing wait times for services (eg, cardiology consultation) raise safety questions. Observations suggest that deficiencies in the process of care contribute to wait times. Consequently, an outpatient clinic was designed for Ensuring Access and Speedy Evaluation (Cardiac EASE) in a university group practice, providing cardiac consultative services for northern Alberta. Cardiac EASE has two components: a single-point-of-entry intake service (prospective testing using physician-approved algorithms and previsit triage) and a multidisciplinary clinic (staffed by cardiologists, nurse practitioners and doctoral-trained pharmacists). OBJECTIVES: It was hypothesized that Cardiac EASE would reduce the time to initial consultation and a definitive diagnosis, and also increase the referral capacity. METHODS: The primary and secondary outcomes were time from referral to initial consultation, and time to achieve a definitive diagnosis and management plan, respectively. A conventionally managed historical control group (three-month pre-EASE period in 2003) was compared with the EASE group (2004 to 2006). The conventional referral mechanism continued concurrently with EASE. RESULTS: A comparison between pre-EASE (n=311) and EASE (n=3096) revealed no difference in the mean (± SD) age (60±16 years), sex (55% and 52% men, respectively) or reason for referral, including chest pain (31% and 40%, respectively) and arrhythmia (27% and 29%, respectively). Cardiac EASE reduced the time to initial cardiac consultation (from 71±45 days to 33±19 days) and time to a definitive diagnosis (from 120±86 days to 51±58 days) (P<0.0001). The annual number of new referrals increased from 1512 in 2002 to 2574 in 2006 due to growth in the Cardiac EASE clinic. The number of patients seen through the conventional referral mechanism and their wait times remained constant during the study period. CONCLUSIONS: Cardiac EASE reduced

  14. Weighing waiting

    Directory of Open Access Journals (Sweden)

    Samuel M. Duncan

    2007-12-01

    Full Text Available People have been shown to delay decision making to wait for missing noninstrumental attribute information --- information that would not have altered their decision if known at the outset --- with this delay originally attributed to uncertainty obscuring one's true preference (Bastardi and Shafir, 1998. To test this account, relative to an alternative that delay arises from low confidence in one's preference (Tykocinski and Ruffle, 2003, we manipulated information certainty and the magnitude of a penalty for delay, the latter intended to reduce the influence of easily resolved sources of delay and to magnify any influence of uncertainty. Contrary to expectations, the results were largely inconsistent with the uncertainty account in that, under a low penalty, delay did not depend on information certainty; and, under a high penalty, delay rate was actually much lower when information was uncertain. To explain the latter, we propose that people use a strategy for resolving choice under uncertainty that does not require establishing a confident preference for each value of the missing information. These findings are related to others in which choice difficulty has been found to be a major source of delay.

  15. The Hamburg/ESO R-process Enhanced Star survey (HERES). XI. The highly r-process-enhanced star CS 29497-004

    Science.gov (United States)

    Hill, V.; Christlieb, N.; Beers, T. C.; Barklem, P. S.; Kratz, K.-L.; Nordström, B.; Pfeiffer, B.; Farouqi, K.

    2017-11-01

    We report an abundance analysis for the highly r-process-enhanced (r-II) star CS 29497-004, a very metal-poor giant with solar system Teff = 5013 K and [Fe/H] = -2.85, whose nature was initially discovered in the course of the HERES project. Our analysis is based on high signal-to-noise ratio, high-resolution (R 75 000) VLT/UVES spectra and MARCS model atmospheres under the assumption of local thermodynamic equilibrium, and obtains abundance measurements for a total of 46 elements, 31 of which are neutron-capture elements. As is the case for the other 25 r-II stars currently known, the heavy-element abundance pattern of CS 29497-004 well-matches a scaled solar system second peak r-process-element abundance pattern. We confirm our previous detection of Th, and demonstrate that this star does not exhibit an "actinide boost". Uranium is also detected (log ɛ(U) = -2.20 ± 0.30), albeit with a large measurement error that hampers its use as a precision cosmo-chronometer. Combining the various elemental chronometer pairs that are available for this star, we derive a mean age of 12.2 ± 3.7 Gyr using the theoretical production ratios from published waiting-point approximation models. We further explore the high-entropy wind model (Farouqi et al. 2010, ApJ, 712, 1359) production ratios arising from different neutron richness of the ejecta (Ye), and derive an age of 13.7 ± 4.4 Gyr for a best-fitting Ye = 0.447. The U/Th nuclei-chronometer is confirmed to be the most resilient to theoretical production ratios and yields an age of 16.5 ± 6.6 Gyr. Lead (Pb) is also tentatively detected in CS 29497-004, at a level compatible with a scaled solar r-process, or with the theoretical expectations for a pure r-process in this star. Based on observations collected at the European Southern Observatory, Paranal, Chile (Proposal Number 170.D-0010).Table B.1 is only available at the CDS via anonymous ftp to http://cdsarc.u-strasbg.fr (http://130.79.128.5) or via http://cdsarc

  16. β-Decay half-lives and nuclear structure of exotic proton-rich waiting point nuclei under rp-process conditions

    Science.gov (United States)

    Nabi, Jameel-Un; Böyükata, Mahmut

    2016-03-01

    We investigate even-even nuclei in the A ∼ 70 mass region within the framework of the proton-neutron quasi-particle random phase approximation (pn-QRPA) and the interacting boson model-1 (IBM-1). Our work includes calculation of the energy spectra and the potential energy surfaces V (β , γ) of Zn, Ge, Se, Kr and Sr nuclei with the same proton and neutron number, N = Z. The parametrization of the IBM-1 Hamiltonian was performed for the calculation of the energy levels in the ground state bands. Geometric shape of the nuclei was predicted by plotting the potential energy surfaces V (β , γ) obtained from the IBM-1 Hamiltonian in the classical limit. The pn-QRPA model was later used to compute half-lives of the neutron-deficient nuclei which were found to be in very good agreement with the measured ones. The pn-QRPA model was also used to calculate the Gamow-Teller strength distributions and was found to be in decent agreement with the measured data. We further calculate the electron capture and positron decay rates for these N = Z waiting point (WP) nuclei in the stellar environment employing the pn-QRPA model. For the rp-process conditions, our total weak rates are within a factor two compared with the Skyrme HF +BCS +QRPA calculation. All calculated electron capture rates are comparable to the competing positron decay rates under rp-process conditions. Our study confirms the finding that electron capture rates form an integral part of the weak rates under rp-process conditions and should not be neglected in the nuclear network calculations.

  17. $\\beta$- decay of the N=Z, rp-process waiting points: $^{64}$Ge, $^{68}$Se and the N=Z+2: $^{66}$Ge, $^{70}$Se for accurate stellar weak-decay rates

    CERN Multimedia

    The contribution of electron capture to weak-decay rates has been neglected in model calculations of Type I X-ray bursts so far. Nucleosynthesis in these astrophysical events eventually proceeds through the rp-process near the proton drip-line. In particular, several N=Z nuclei such as $^{64}$Ge and $^{68}$Se act as waiting points in the nuclear flow due to the low S${_P}$ values of their Z+1 neighbours. Recent theoretical calculations have shown that, in these high density ($\\thicksim10^{6}$ g/cm$^3$) and high temperature (1 - 2 GK) scenarios, continuum electron capture rates might play an important role, in particular for species at and around these waiting point nuclei. This proposal is aimed at the study of the $\\beta^{+}$/EC-decay of the waiting point nuclei $^{64}$Ge, $^{68}$Se and their N=Z+2 second neighbours $^{66}$Ge and $^{70}$Se with the Total Absorption Spectroscopy method. This will allow for a detailed analysis of their contribution to the EC-decay rates in X-Ray burst explosions. The proposed ...

  18. Neutron Star Mergers and the R process

    Science.gov (United States)

    Joniak, Ronald; Ugalde, Claudio

    2017-09-01

    About half of the elements of the periodic table that are present today in the Solar System were synthesized before the formation of the Sun via a rapid neutron capture process (r process). However, the astrophysical site of the r process is a longstanding problem that has captivated both experimental and theoretical astrophysicists. Up to date, two possible scenarios for the site of the r process have been suggested: the first involves the high entropy wind of core collapse supernovae, and the second corresponds to the merger of two compact stellar objects such as neutron stars. We will study the robustness of the nucleosynthesis abundance pattern between the second and third r process peaks as produced by neutron star mergers with r process-like neutron exposures. First, we will vary parameters to obtain an understanding of the astrophysical mechanisms that create the r process. Next, we will create a program to obtain the best possible parameters based on a chi-squared test. Once we have the best fits, we will test the effect of fission in the overall isotope abundance pattern distribution. Later on, we will vary the ratio of masses of the two fission fragments and study its effect on elemental abundances. This research was supported by the UIC College of Liberal Arts and Sciences Undergraduate Research Initiative (LASURI).

  19. Ethnographies of Waiting

    DEFF Research Database (Denmark)

    Janeja, Manpreet Kaur; Bandak, Andreas

    We all wait – in traffic jams, passport offices, school meal queues, for better weather, an end to fighting, peace. Time spent waiting produces hope, boredom, anxiety, doubt, or uncertainty. Ethnographies of Waiting explores the social phenomenon of waiting and its centrality in human society...... worth the wait?" Waiting thus conceived is intrinsic to the ethnographic method at the heart of the anthropological enterprise. Featuring detailed ethnographies from Japan, Georgia, England, Ghana, Norway, Russia and the United States, a Foreword by Craig Jeffrey and an Afterword by Ghassan Hage...

  20. Wait times in Canada.

    Science.gov (United States)

    MacKinnon, Janice Christine

    2017-07-01

    A significant barrier to accessing healthcare in Canada is long waiting lists, which can be linked to the way that Medicare was structured. After significant pressure, provincial governments began to address wait times. An example of a successful strategy to reduce wait times for elective surgery is the Saskatchewan Surgical Initiative, which saw wait times in the province change from being among the longest in Canada to the shortest.

  1. Learning to wait

    DEFF Research Database (Denmark)

    Dungey, Claire Elisabeth; Meinert, Lotte

    2017-01-01

    enforced through discipline, prepare young people to expect that waiting and enduring hardship will pay off in the end. This expectation makes the status of adulthood particularly vulnerable because the jobs and opportunities that young men learn to wait for often do not come into being by waiting....

  2. Bell inequalities and waiting times

    Energy Technology Data Exchange (ETDEWEB)

    Poeltl, Christina; Governale, Michele [School of Chemical and Physical Sciences and MacDiarmid Institute for Advanced Materials and Nanotechnology, Victoria University of Wellington, PO Box 600, Wellington 6140 (New Zealand)

    2015-07-01

    We propose a Bell test based on waiting time distributions for spin entangled electron pairs, which are generated and split in mesoscopic Coulomb blockade structures, denoted as entanglers. These systems have the advantage that quantum point contacts enable a time resolved observation of the electrons occupying the system, which gives access to quantities such as full counting statistics and waiting time distributions. We use the partial waiting times to define a CHSH-Bell test, which is a purely electronic analogue of the test used in quantum optics. After the introduction of the Bell inequality we discuss the findings on the two examples of a double quantum dot and a triple quantum dot. This Bell test allows the exclusion of irrelevant tunnel processes from the statistics normally used for the Bell correlations. This can improve the parameter range for which a violation of the Bell inequality can be measured significantly.

  3. Costly waiting for the future gas energy

    International Nuclear Information System (INIS)

    1999-01-01

    The article discusses solutions while waiting for the pollution free gas power plant and points out that Norway will have to import Danish power from coal and Swedish nuclear energy for a long time yet. Various future scenarios are mentioned

  4. Waiting for a pacemaker

    DEFF Research Database (Denmark)

    Risgaard, Bjarke; Elming, Hanne; Jensen, Gunnar

    2012-01-01

    AIMS: To determine waiting period-related morbidity, mortality, and adverse events in acute patients waiting for a permanent pacemaker (PPM).METHODS AND RESULTS: A retrospective chart review of all PPM implantations in Region Zealand, Denmark, in 2009 was conducted. Patients were excluded...... at least one adverse event during the waiting period. The present study indicates that a waiting period is dangerous as it is associated with an increased risk of adverse events. Acute PPMs should be implanted with a 24-h pacemaker implantation service capacity....

  5. R-process nucleosynthesis: a dynamical model

    Energy Technology Data Exchange (ETDEWEB)

    Hillebrandt, W; Takahashi, K [Technische Hochschule Darmstadt (Germany, F.R.). Inst. fuer Kernphysik; Kodama, T [Centro Brasileiro de Pesquisas Fisicas, Rio de Janeiro

    1976-10-01

    The synthesis of heavy and neutron-rich elements (with the mass number A > approximately 70) is reconsidered in the framework of a dynamical supernova model. The synthesis equation for the rapid neutron-capture (or, the r-) process and the hydrodynamical equations for the supernova explosion are solved simultaneously. Improved systematics of nuclear parameters are used, and the energy release due to ..beta..-decays as well as the energy loss due to neutrinos is taken into account. It is shown that the observed solar-system abundance curve can be reproduced fairly well by assuming only one supernova event on a time-scale of the order of 1 s. However there are still some discrepancies which may be explained by uncertainties in the nuclear data used.

  6. Waiting when hospitalised

    DEFF Research Database (Denmark)

    Ludvigsen, Mette Spliid

    2004-01-01

    on participating observations during a period of one and a half year. The material is analysed with inspiration from Mattingly's ideas of narrative and time. ConclusionsAlthough waiting times is not a clinically serious problem, the satisfaction levels of patients with the care they receive have become...... increasingly important in today's health care environment. The indicative conclusions form this study suggest that nurses play an important role in ensuring that patients are satisfied and receive quality care when waiting....

  7. Waiting in the surgery.

    Science.gov (United States)

    Fry, F

    1994-07-01

    The concise Oxford English Dictionary defines 'dilemma' as an argument forcing one to choose one of two alternatives, both of which are unfavourable. This is a situation that frequently confronts the general practitioner. This paper will present one practitioner's view on the subject of patients waiting to see the doctor.

  8. wait and wipe

    African Journals Online (AJOL)

    and wipe strategy” as an alternative to circumcision for HIV prevention. In this paper, we argue that waiting for ten minutes and wiping with a dry cloth does not prevent men from becoming infected by HIV. We ... HIV infected despite having reported no sex or 100% condom .... In a qualitative study conducted in Kenya, men.

  9. Challenging "Waiting for Superman"

    Science.gov (United States)

    Bruhn, Molle

    2014-01-01

    A group of New York City public school teachers, angry about the depiction of public schools in 'Waiting for Superman," decide to make their own film about the realities of the current education reform movement. They persevered even though they had no budget when they started and lacked a background in filmmaking. "The Inconvenient Truth…

  10. New calculations of gross β-decay properties for astrophysical applications: Speeding-up the classical r process

    International Nuclear Information System (INIS)

    Moeller, Peter; Pfeiffer, Bernd; Kratz, Karl-Ludwig

    2003-01-01

    Recent compilations of experimental gross β-decay properties, i.e., half-lives (T 1/2 ) and neutron-emission probabilities (P n ), are compared to improved global macroscopic-microscopic model predictions. The model combines calculations within the quasiparticle (QP) random-phase approximation for the Gamow-Teller (GT) part with an empirical spreading of the QP strength and the gross theory for the first-forbidden part of β - decay. Nuclear masses are either taken from the 1995 data compilation of Audi et al., when available, otherwise from the finite-range droplet model. Especially for spherical and neutron-(sub-)magic isotopes a considerable improvement compared to our earlier predictions for pure GT decay (ADNDT, 1997) is observed. T 1/2 and P n values up to the neutron drip line have been used in r-process calculations within the classical 'waiting-point' approximation. With the new nuclear-physics input, a considerable speeding-up of the r-matter flow is observed, in particular at those r-abundance peaks which are related to magic neutron-shell closures

  11. Helium-driven r-process in supernovae

    International Nuclear Information System (INIS)

    Truran, J.W.; Cowan, J.J.; Cameron, A.G.W.

    1978-01-01

    The discovery of r-process anomalies in two inclusions in the Allende meteorite, together with their associated oxygen and magnesium anomalies, has caused us to examine the consequences of supernova shocks in the helium zones of massive stars. We find that powerful r-processes can operate under such conditions. The details of these processes will vary in different stellar masses. The studied Allende inclusions apparently did not receive material which had been very extensively r-processed

  12. r-PROCESS LANTHANIDE PRODUCTION AND HEATING RATES IN KILONOVAE

    Energy Technology Data Exchange (ETDEWEB)

    Lippuner, Jonas; Roberts, Luke F., E-mail: jlippuner@tapir.caltech.edu [TAPIR, Walter Burke Institute for Theoretical Physics, California Institute of Technology, MC 350-17, 1200 E California Boulevard, Pasadena CA 91125 (United States)

    2015-12-20

    r-process nucleosynthesis in material ejected during neutron star mergers may lead to radioactively powered transients called kilonovae. The timescale and peak luminosity of these transients depend on the composition of the ejecta, which determines the local heating rate from nuclear decays and the opacity. Kasen et al. and Tanaka and Hotokezaka pointed out that lanthanides can drastically increase the opacity in these outflows. We use the new general-purpose nuclear reaction network SkyNet to carry out a parameter study of r-process nucleosynthesis for a range of initial electron fractions Y{sub e}, initial specific entropies s, and expansion timescales τ. We find that the ejecta is lanthanide-free for Y{sub e} ≳ 0.22−0.30, depending on s and τ. The heating rate is insensitive to s and τ, but certain, larger values of Y{sub e} lead to reduced heating rates, due to individual nuclides dominating the heating. We calculate approximate light curves with a simplified gray radiative transport scheme. The light curves peak at about a day (week) in the lanthanide-free (-rich) cases. The heating rate does not change much as the ejecta becomes lanthanide-free with increasing Y{sub e}, but the light-curve peak becomes about an order of magnitude brighter because it peaks much earlier when the heating rate is larger. We also provide parametric fits for the heating rates between 0.1 and 100 days, and we provide a simple fit in Y{sub e}, s, and τ to estimate whether or not the ejecta is lanthanide-rich.

  13. r-PROCESS LANTHANIDE PRODUCTION AND HEATING RATES IN KILONOVAE

    International Nuclear Information System (INIS)

    Lippuner, Jonas; Roberts, Luke F.

    2015-01-01

    r-process nucleosynthesis in material ejected during neutron star mergers may lead to radioactively powered transients called kilonovae. The timescale and peak luminosity of these transients depend on the composition of the ejecta, which determines the local heating rate from nuclear decays and the opacity. Kasen et al. and Tanaka and Hotokezaka pointed out that lanthanides can drastically increase the opacity in these outflows. We use the new general-purpose nuclear reaction network SkyNet to carry out a parameter study of r-process nucleosynthesis for a range of initial electron fractions Y e , initial specific entropies s, and expansion timescales τ. We find that the ejecta is lanthanide-free for Y e ≳ 0.22−0.30, depending on s and τ. The heating rate is insensitive to s and τ, but certain, larger values of Y e lead to reduced heating rates, due to individual nuclides dominating the heating. We calculate approximate light curves with a simplified gray radiative transport scheme. The light curves peak at about a day (week) in the lanthanide-free (-rich) cases. The heating rate does not change much as the ejecta becomes lanthanide-free with increasing Y e , but the light-curve peak becomes about an order of magnitude brighter because it peaks much earlier when the heating rate is larger. We also provide parametric fits for the heating rates between 0.1 and 100 days, and we provide a simple fit in Y e , s, and τ to estimate whether or not the ejecta is lanthanide-rich

  14. Iran - waiting and watching

    International Nuclear Information System (INIS)

    Malhotra, T. C.

    2007-01-01

    Global oil companies are reported to be divided on the issue of possible energy deals in Iran. Some companies may adopt wait and watch policy before singing a fresh deal with Iran, but there are some oil companies, those are still interested to sign a deal with Iran, despite the risks, even as Tehran decided to expand its uranium enrichment programme rather than complying with a UN Security Council ultimatum to freeze it, which clears the path for further harsher sanctions (author) (ml)

  15. Understanding r-process nucleosynthesis with dwarf galaxies

    Science.gov (United States)

    Ji, Alexander P.

    2018-06-01

    The Milky Way's faintest dwarf galaxy satellites each sample short, independent bursts of star formation from the first 1-2 Gyr of the universe. Their simple formation history makes them ideal systems to understand how rare events like neutron star mergers contribute to early enrichment of r-process elements. I will focus on the ultra-faint galaxy Reticulum II, which experienced a single prolific r-process event that left ~80% of its stars extremely enriched in r-process elements. I will present abundances of ~40 elements derived from the highest signal-to-noise high-resolution spectrum ever taken for an ultra-faint dwarf galaxy star. Precise measurements of elements from all three r-process peaks reaffirm the universal nature of the r-process abundance pattern from Ba to Ir. The first r-process peak is significantly lower than solar but matches other r-process enhanced stars. This constrains the neutron-richness of r-process ejecta in neutron star mergers. The radioactive element thorium is detected with a somewhat low abundance. Naive application of currently predicted initial production ratios could imply an age >20 Gyr, but more likely indicates that the initial production ratios require revision. The abundance of lighter elements up to Zn are consistent with extremely metal-poor Milky Way halo stars. These elements may eventually provide a way to test for other hypothesized r-process sites, but only after a more detailed understanding of the chemical evolution in this galaxy. Reticulum II provides a clean view of early r-process enrichment that can be used to understand the increasing number of r-process measurements in other dwarf galaxies.

  16. A national analysis of dental waiting lists and point-in-time geographic access to subsidised dental care: can geographic access be improved by offering public dental care through private dental clinics?

    Science.gov (United States)

    Dudko, Yevgeni; Kruger, Estie; Tennant, Marc

    2017-01-01

    Australia is one of the least densely populated countries in the world, with a population concentrated on or around coastal areas. Up to 33% of the Australian population are likely to have untreated dental decay, while people with inadequate dentition (fewer than 21 teeth) account for up to 34% of Australian adults. Historically, inadequate access to public dental care has resulted in long waiting lists, received much media coverage and been the subject of a new federal and state initiative. The objective of this research was to gauge the potential for reducing the national dental waiting list through geographical advantage, which could arise from subcontracting the delivery of subsidised dental care to the existing network of private dental clinics across Australia. Eligible population data were collected from the Australian Bureau of Statistics website. Waiting list data from across Australia were collected from publicly available sources and confirmed through direct communication with each individual state or territory dental health body. Quantum geographic information system software was used to map distribution of the eligible population across Australia by statistical area, and to plot locations of government and private dental clinics. Catchment areas of 5 km for metropolitan clinics and 5 km and 50 km for rural clinics were defined. The number of people on the waiting list and those eligible for subsidised dental care covered by each of the catchment areas was calculated. Percentage of the eligible population and those on the waiting list that could benefit from the potential improvement in geographic access was ascertained for metropolitan and rural residents. Fifty three percent of people on the waiting list resided within metropolitan areas. Rural and remote residents made up 47% of the population waiting to receive care. The utilisation of both government and private dental clinics for the delivery of subsidised dental care to the eligible population

  17. Influence patterns of transportation parameters in suburban traffic on fatigue of passengers during bus waiting

    Directory of Open Access Journals (Sweden)

    Тетяна Михайлівна Григорова

    2015-05-01

    Full Text Available The change of transport fatigue of suburban traffic passengers during waiting transport waiting is investigated. The results of the processing site examinations allow defining the regularities of the influence of parameters of transportation process of passengers to change index activity of regulatory systems in passenger waiting at stopping points of suburban traffic. The discovered patterns were mathematically formalized

  18. (n,γ) (γ,n) unstability in the r process of nucleosynthesis

    International Nuclear Information System (INIS)

    Duarte, S.J.B.

    1977-01-01

    The equilibrium approximation for capture and neutron photoemission reactions within r process of nucleosynthesis is analysed. This analysis is considered for whole range of neutron density and temperature which enable the ocurrence of the process. In this way it is necessary to know capture and photo-emission rates for approximately 2000 nuclei. The detailed balance is used in rate relation of above-mencioned reactions, and its application, under temperature, and its application, under temperature conditions and neutron density is discussed. The others nuclear parameters used in face of the nuclei involved in r process are far away of the β stability line. The temperature conditions and neutron density are presented from the point where the equilirbium approximation is not applicable. The procedure to be used in the application of the obtained results in dynamical models of r process is also presented. (M.C.K.) [pt

  19. Universality and the astrophysical sites for the r-process

    International Nuclear Information System (INIS)

    Otsuki, Kaori; Mathews, Grant J.; Wilson, James; Kajino, Toshitaka; Aoki, Wako; Honda, Satoshi

    2003-01-01

    Several observations of r-process elements in metal-deficient halo stars have been reported which show a Z>56 formed abundance distribution pattern similar to the Solar-system r-process distribution. It was believed that r-process elements for Z>56 in the same ratio and their astrophysical origin is unique because of this. However, quite recently, several controversial observational results have been reported. We calculated nucleosynthesis in various environments using a dynamical code. We find it is possible to reproduce the observed universal abundance distribution for stable Z>56 elements in various environments. Our results do not support a unique astrophysical site for Z>56 elements. These results significantly affect nuclear chronology using actinide elements. We also introduce a recent r-process nucleosynthesis calculation based on a supernovae simulation. Our tentative results indicate over-production of lighter elements and a shortage of actinide elements. (author)

  20. Monte Carlo calculations for r-process nucleosynthesis

    Energy Technology Data Exchange (ETDEWEB)

    Mumpower, Matthew Ryan [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-11-12

    A Monte Carlo framework is developed for exploring the impact of nuclear model uncertainties on the formation of the heavy elements. Mass measurements tightly constrain the macroscopic sector of FRDM2012. For r-process nucleosynthesis, it is necessary to understand the microscopic physics of the nuclear model employed. A combined approach of measurements and a deeper understanding of the microphysics is thus warranted to elucidate the site of the r-process.

  1. ON THE r -PROCESS ENRICHMENT OF DWARF SPHEROIDAL GALAXIES

    Energy Technology Data Exchange (ETDEWEB)

    Bramante, Joseph [Department of Physics, 225 Nieuwland Science Hall, University of Notre Dame, Notre Dame, IN 46556 (United States); Linden, Tim [Center for Cosmology and AstroParticle Physics (CCAPP) and Department of Physics The Ohio State University, Columbus OH, 43210 (United States)

    2016-07-20

    Recent observations of Reticulum II have uncovered an overabundance of r -process elements compared to similar ultra-faint dwarf spheroidal galaxies (UFDs). Because the metallicity and star formation history of Reticulum II appear consistent with all known UFDs, the high r -process abundance of Reticulum II suggests enrichment through a single, rare event, such as a double neutron star (NS) merger. However, we note that this scenario is extremely unlikely, as binary stellar evolution models require significant supernova natal kicks to produce NS–NS or NS–black hole (BH) mergers, and these kicks would efficiently remove compact binary systems from the weak gravitational potentials of UFDs. We examine alternative mechanisms for the production of r -process elements in UFDs, including a novel mechanism wherein NSs in regions of high dark matter (DM) density implode after accumulating a BH-forming mass of DM. We find that r -process proto-material ejection by tidal forces, when a single NS implodes into a BH, can occur at a rate matching the r -process abundance of both Reticulum II and the Milky Way. Remarkably, DM models which collapse a single NS in observed UFDs also solve the missing pulsar problem in the Milky Way Galactic Center. We propose tests specific to DM r -process production which may uncover or rule out this model.

  2. Waiting experience in railway environments

    NARCIS (Netherlands)

    van Hagen, M.; Galetzka, Mirjam; Pruyn, Adriaan T.H.

    2014-01-01

    At railway stations, waiting time is usually an unavoidable aspect of the journey for train passengers. According to the attentional model of time, pleasant surroundings and other forms of distraction reduce perceived waiting time. Not every individual reacts identically in the same surroundings.

  3. Waiting for surgery: is waiting bad for anyone or everyone?

    Science.gov (United States)

    Sutherland, J M; Liu, G; Crump, R T; Karimuddin, A A

    2017-12-01

    For Canadians, as in many countries, waiting for elective surgery is expected. The duration of the wait raises questions about the maximum amount of time patients should wait for their surgery. The primary objective of this study was to test for a relationship between the length of time patients waited for elective hernia repair surgery and change in patients' self-reported health. This study was based on a prospectively recruited longitudinal cohort of patients waiting for elective hernia repair surgery. Participants completed the PHQ-9, PEG, EQ-5D(3L) generic instruments, and the condition-specific COMI-hernia. Multivariate regression models explored associations between patient-reported outcomes and potential confounders, including age, sex, socio-economic status, and medical comorbidities. There were 118 participants and the modal age group was 61-70 years. The average wait time for participants was 22.5 weeks. There were no relationships between the duration of participants' wait for hernia repair and the change in patients' self-reported health for hernia-specific outcomes or overall health-related quality of life. There are gains in health-related quality of life to be realized by prioritizing symptomatic patients. Participants with greater pre-operative depression, pain, and hernia-related symptoms experienced an improvement in health prior to surgery, though more clarity is needed on the mechanisms that led to improved health. Many countries face problems with wait lists for elective surgery-and few have effective processes for triaging patients. This study shows that duration of time on the wait list was not associated with change in hernia patients' self-reported health.

  4. Sensitivity studies for the main r process: nuclear masses

    Directory of Open Access Journals (Sweden)

    A. Aprahamian

    2014-02-01

    Full Text Available The site of the rapid neutron capture process (r process is one of the open challenges in all of physics today. The r process is thought to be responsible for the creation of more than half of all elements beyond iron. The scientific challenges to understanding the origin of the heavy elements beyond iron lie in both the uncertainties associated with astrophysical conditions that are needed to allow an r process to occur and a vast lack of knowledge about the properties of nuclei far from stability. One way is to disentangle the nuclear and astrophysical components of the question. On the nuclear physics side, there is great global competition to access and measure the most exotic nuclei that existing facilities can reach, while simultaneously building new, more powerful accelerators to make even more exotic nuclei. On the astrophysics side, various astrophysical scenarios for the production of the heaviest elements have been proposed but open questions remain. This paper reports on a sensitivity study of the r process to determine the most crucial nuclear masses to measure using an r-process simulation code, several mass models (FRDM, Duflo-Zuker, and HFB-21, and three potential astrophysical scenarios.

  5. r-process nucleosynthesis in dynamic helium-burning environments

    Science.gov (United States)

    Cowan, J. J.; Cameron, A. G. W.; Truran, J. W.

    1985-01-01

    The results of an extended examination of r-process nucleosynthesis in helium-burning enviroments are presented. Using newly calculated nuclear rates, dynamical r-process calculations have been made of thermal runaways in helium cores typical of low-mass stars and in the helium zones of stars undergoing supernova explosions. These calculations show that, for a sufficient flux of neutrons produced by the C-13 neutron source, r-process nuclei in solar proportions can be produced. The conditions required for r-process production are found to be 10 to the 20th-10 to the 21st neutrons per cubic centimeter for times of 0.01-0.1 s and neutron number densities in excess of 10 to the 19th per cubic centimeter for times of about 1 s. The amount of C-13 required is found to be exceedingly high - larger than is found to occur in any current stellar evolutionary model. It is thus unlikely that these helium-burning environments are responsible for producing the bulk of the r-process elements seen in the solar system.

  6. Supernova and r-process simulations with relativistic EOS table

    International Nuclear Information System (INIS)

    Sumiyoshi, Kohsuke

    2000-01-01

    We study the neutrino-driven wind from the proto-neutron star by the general relativistic hydrodynamical simulations. We examine the properties of the neutrino-driven wind to explore the possibility of the r-process nucleosynthesis. The numerical simulations with the neutrino heating and cooling processes are performed with the assumption of the constant neutrino luminosity by using realistic profiles of the proto-neutron star (PNS) as well as simplified models. The dependence on the mass of PNS and the neutrino luminosity is studied systematically. Comparisons with the analytic treatment in the previous studies are also done. In the cases with the realistic PNS, we found that the entropy per baryon and the expansion time scale are neither high nor short enough for the r-process within the current assumptions. On the other hand, we found that the expansion time scale obtained by the hydrodynamical simulations is systematically shorter than that in the analytic solutions due to our proper treatment of the equation of state. This fact might lead to the increase of the neutron-to-seed ratio, which is suitable for the r-process in the neutrino-driven wind. Indeed, in the case of massive and compact proto-neutron stars with high neutrino luminosities, the expansion time scale is found short enough in the hydrodynamical simulations and the r-process elements up to A ∼ 200 are produced in the r-process network calculation. (author)

  7. Retainment of r-process material in dwarf galaxies

    Science.gov (United States)

    Beniamini, Paz; Dvorkin, Irina; Silk, Joe

    2018-04-01

    The synthesis of r-process elements is known to involve extremely energetic explosions. At the same time, recent observations find significant r-process enrichment even in extremely small ultra-faint dwarf (UFD) galaxies. This raises the question of retainment of those elements within their hosts. We estimate the retainment fraction and find that it is large ˜0.9, unless the r-process event is very energetic (≳ 1052erg) and / or the host has lost a large fraction of its gas prior to the event. We estimate the r-process mass per event and rate as implied by abundances in UFDs, taking into account imperfect retainment and different models of UFD evolution. The results are consistent with previous estimates (Beniamini et al. 2016b) and with the constraints from the recently detected macronova accompanying a neutron star merger (GW170817). We also estimate the distribution of abundances predicted by these models. We find that ˜0.07 of UFDs should have r-process enrichment. The results are consistent with both the mean values and the fluctuations of [Eu/Fe] in galactic metal poor stars, supporting the possibility that UFDs are the main 'building blocks' of the galactic halo population.

  8. r-process nucleosynthesis in dynamic helium-burning environments

    International Nuclear Information System (INIS)

    Cowan, J.J.; Cameron, A.G.W.; Truran, J.W.

    1985-01-01

    The results of an extended examination of r-process nucleosynthesis in helium-burning environments are presented. Using newly calculated nuclear rates, dynamical r-process calculations have been made of thermal runaways in helium cores typical of low-mass stars and in the helium zones of stars undergoing supernova explosions. These calculations show that, for a sufficient flux of neutrons produced by the 13 C neutron source, r-process nuclei in solar proportions can be produced. The conditions required for r-process production are found to be: 10 20 --10 21 neutrons cm -3 for times of 0.01--0.1 s and neutron number densities in excess of 10 19 cm -3 for times of approx.1 s. The amount of 13 C required is found to be exceedingly high: larger than is found to occur in any current stellar evolutionary model. It is thus unlikely that these helium-burning environments are responsible for producing the bulk of the r-process elements seen in the solar system

  9. Fission properties of superheavy nuclei for r -process calculations

    Science.gov (United States)

    Giuliani, Samuel A.; Martínez-Pinedo, Gabriel; Robledo, Luis M.

    2018-03-01

    We computed a new set of static fission properties suited for r -process calculations. The potential energy surfaces and collective inertias of 3640 nuclei in the superheavy region are obtained from self-consistent mean-field calculations using the Barcelona-Catania-Paris-Madrid energy density functional. The fission path is computed as a function of the quadrupole moment by minimizing the potential energy and exploring octupole and hexadecapole deformations. The spontaneous fission lifetimes are evaluated employing different schemes for the collective inertias and vibrational energy corrections. This allows us to explore the sensitivity of the lifetimes to those quantities together with the collective ground-state energy along the superheavy landscape. We computed neutron-induced stellar reaction rates relevant for r -process nucleosynthesis using the Hauser-Feshbach statistical approach and study the impact of collective inertias. The competition between different reaction channels including neutron-induced rates, spontaneous fission, and α decay is discussed for typical r -process conditions.

  10. Collective neutrino oscillations and r-process nucleosynthesis in supernovae

    Science.gov (United States)

    Duan, Huaiyu

    2012-10-01

    Neutrinos can oscillate collectively in a core-collapse supernova. This phenomenon can occur much deeper inside the supernova envelope than what is predicted from the conventional matter-induced Mikheyev-Smirnov-Wolfenstein effect, and hence may have an impact on nucleosynthesis. The oscillation patterns and the r-process yields are sensitive to the details of the emitted neutrino fluxes, the sign of the neutrino mass hierarchy, the modeling of neutrino oscillations and the astrophysical conditions. The effects of collective neutrino oscillations on the r-process will be illustrated using representative late-time neutrino spectra and outflow models.

  11. Strategy as active waiting.

    Science.gov (United States)

    Sull, Donald N

    2005-09-01

    Successful executives who cut their teeth in stable industries or in developed countries often stumble when they face more volatile markets. They falter, in part, because they assume they can gaze deep into the future and develop a long-term strategy that will confer a sustainable competitive advantage. But visibility into the future of volatile markets is sharply limited because so many different variables are in play. Factors such as technological innovation, customers' evolving needs, government policy, and changes in the capital markets interact with one another to create unexpected outcomes. Over the past six years, Donald Sull, an associate professor at London Business School, has led a research project examining some of the world's most volatile markets, from national markets like China and Brazil to industries like enterprise software, telecommunications, and airlines. One of the most striking findings from this research is the importance of taking action during comparative lulls in the storm. Huge business opportunities are relatively rare; they come along only once or twice in a decade. And, for the most part, companies can't manufacture those opportunities; changes in the external environment converge to make them happen. What managers can do is prepare for these golden opportunities by managing smart during the comparative calm of business as usual. During these periods of active waiting, leaders must probe the future and remain alert to anomalies that signal potential threats or opportunities; exercise restraint to preserve their war chests; and maintain discipline to keep the troops battle ready. When a golden opportunity or"sudden death"threat emerges, managers must have the courage to declare the main effort and concentrate resources to seize the moment.

  12. The role of nuclear inputs in r-process nucleosynthesis

    Energy Technology Data Exchange (ETDEWEB)

    Giuliani, Samuel Andrea; Arzhanov, Alexander; Friess, Stephen; Martinez-Pinedo, Gabriel; Moeller, Heiko; Sieverding, Andre; Wu, Meng-Ru [TU Darmstadt (Germany)

    2016-07-01

    We have studied the sensitivity of the r-process abundances produced in dynamical ejecta from neutron star mergers to different nuclear mass models. For each mass model, the resulting abundances are almost independent of the astrophysical conditions and reproduce the general features of the observed r-process abundance. We find that the second peak around A ∝ 130 is produced by the fission yields of the material that piles up in nuclei with A >or similar 250. We also find distinct differences in the predictions at and just above the third peak (A ∝ 195) for different mass models, due to different neutron separation energies at N = 130. Due to the crucial role that fission plays in r-process nucleosynthesis, we have computed the fission properties of superheavy nuclei using the BCPM energy density functional. We found that certain combinations of neutron and proton number lead to an enhanced stability against the spontaneous fission process, related with the existence of magic numbers in the superheavy region. However, the systematic of the fission properties is strongly affected by the choice of the collective degree of freedom when the fission path is obtained by minimizing the action integral. Finally, a comparison with other theoretical models and the consequences for r-process nucleosynthesis are discussed.

  13. The r-process nucleosynthesis: Nuclear physics challenges

    Energy Technology Data Exchange (ETDEWEB)

    Goriely, S. [Institut d' Astronomie et d' Astrophysique, Universite Libre de Bruxelles Campus de la Plaine, CP 226, 1050 Brussels (Belgium)

    2012-10-20

    About half of the nuclei heavier than iron observed in nature are produced by the socalled rapid neutron capture process, or r-process, of nucleosynthesis. The identification of the astrophysics site and the specific conditions in which the r-process takes place remains, however, one of the still-unsolved mysteries of modern astrophysics. Another underlying difficulty associated with our understanding of the r-process concerns the uncertainties in the predictions of nuclear properties for the few thousands exotic neutron-rich nuclei involved and for which essentially no experimental data exist. The present contribution emphasizes some important future challenges faced by nuclear physics in this problem, particularly in the determination of the nuclear structure properties of exotic neutron-rich nuclei as well as their radiative neutron capture rates and their fission probabilities. These quantities are particularly relevant to determine the composition of the matter resulting from the r-process. Their impact on the r-abundance distribution resulting from the decompression of neutron star matter is discussed.

  14. Fission and r-process nucleosynthesis in neutron star mergers

    International Nuclear Information System (INIS)

    Giuliani, Samuel Andrea

    2018-01-01

    Fission plays a crucial role for the r-process nucleosynthesis in neutron star mergers. Due to the high neutron densities achieved in this astrophysical scenario the sequence of neutron captures and beta decays that constitutes the r process produces superheavy neutron rich nuclei that become unstable against fission. Fission determines thus the heaviest nuclei that can be produced by the r process and the fission yields shape the abundances of lighter nuclei. But despite the key role of fission the sensitivity of the r-process nucleosynthesis to uncertainties in fission predictions has not been explored. Nowadays there are only few set of fission rates suited for r-process calculations and most of them rely on a simplified treatment of the fission process. In this thesis we go beyond these approximations and compute the fission properties of r-process nuclei using the energy density functional approach. Fission is described as a tunneling process where the nucleus ''moves'' in a collective space characterized by coordinates describing the nuclear shape. Thus fission depends on the evolution of the energy with the deformation but also on the inertia due to the motion in the collective space. This is analogous to the quantum mechanical tunneling of a particle inside a potential well. In our study the relevant quantities for the description of the fission process are consistently computed for 3642 nuclei following the Hartree-Fock-Bogolyubov theory with constraining operators. We perform an extensive benchmark against the available experimental data and explore the variations of the fission properties along the superheavy landscape. We find that while collective inertias have a strong impact in the fission probabilities of light nuclei their role becomes less relevant in r -process nuclei. Within the statistical model we compute the neutron induced stellar reaction rates relevant for the r-process nucleosynthesis. These sets of stellar reaction

  15. Wait times for gastroenterology consultation in Canada: The patients’ perspective

    Science.gov (United States)

    Paterson, WG; Barkun, AN; Hopman, WM; Leddin, DJ; Paré, P; Petrunia, DM; Sewitch, MJ; Switzer, C; van Zanten, S Veldhuyzen

    2010-01-01

    Long wait times for health care have become a significant issue in Canada. As part of the Canadian Association of Gastroenterology’s Human Resource initiative, a questionnaire was developed to survey patients regarding wait times for initial gastroenterology consultation and its impact. A total of 916 patients in six cities from across Canada completed the questionnaire at the time of initial consultation. Self-reported wait times varied widely, with 26.8% of respondents reporting waiting less than two weeks, 52.4% less than one month, 77.1% less than three months, 12.5% reported waiting longer than six months and 3.6% longer than one year. One-third of patients believed their wait time was too long, with 9% rating their wait time as ‘far too long’; 96.4% believed that maximal wait time should be less than three months, 78.9% believed it should be less than one month and 40.3% believed it should be less than two weeks. Of those working or attending school, 22.6% reported missing at least one day of work or school because of their symptoms in the month before their appointment, and 9.0% reported missing five or more days in the preceding month. A total of 20.2% of respondents reported being very worried about having a serious disease (ie, scored 6 or higher on 7-point Likert scale), and 17.6% and 14.8%, respectively, reported that their symptoms caused major impairment of social functioning and with the activities of daily living. These data suggest that a significant proportion of Canadians with digestive problems are not satisfied with their wait time for gastroenterology consultation. Furthermore, while awaiting consultation, many patients experience an impaired quality of life because of their gastrointestinal symptoms. PMID:20186353

  16. 46 CFR 9.10 - Waiting time.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Waiting time. 9.10 Section 9.10 Shipping COAST GUARD... § 9.10 Waiting time. The same construction should be given the act when charging for waiting time as... for duty the waiting time amounts to at least one hour. ...

  17. Enrichment of r-Process Elements by Neutron Star Mergers through the Sub-Halo Clustering

    Science.gov (United States)

    Ishimaru, Yuhri; Ojima, Takuya; Wanajo, Shinya; Prantzos, Nikos

    Neutron star mergers (NSMs) are suggested to be the most plausible site of r-process by nucleosynthesis studies, while previous chemical evolution models pointed out that the long lifetimes of NS binaries are in conflict with the observed [r/Fe] of the Galactic halo stars. We attempt to solve this problem, assuming the Galactic halo was formed from merging sub-halos. We find that [r/Fe] start increasing at [Fe/H] < -3, if the star formation efficiencies are smaller for less massive sub-halos. We also show that small numbers of NSMs for least massive sub-halos could cause the large enhancement of [r/Fe]. Our results support NSMs as the major site of r-process.

  18. Longer wait times affect future use of VHA primary care.

    Science.gov (United States)

    Wong, Edwin S; Liu, Chuan-Fen; Hernandez, Susan E; Augustine, Matthew R; Nelson, Karin; Fihn, Stephan D; Hebert, Paul L

    2017-07-29

    Improving access to the Veterans Health Administration (VHA) is a high priority, particularly given statutory mandates of the Veterans Access, Choice and Accountability Act. This study examined whether patient-reported wait times for VHA appointments were associated with future reliance on VHA primary care services. This observational study examined 13,595 VHA patients dually enrolled in fee-for-service Medicare. Data sources included VHA administrative data, Medicare claims and the Survey of Healthcare Experiences of Patients (SHEP). Primary care use was defined as the number of face-to-face visits from VHA and Medicare in the 12 months following SHEP completion. VHA reliance was defined as the number of VHA visits divided by total visits (VHA+Medicare). Wait times were derived from SHEP responses measuring the usual number of days to a VHA appointment with patients' primary care provider for those seeking immediate care. We defined appointment wait times categorically: 0 days, 1day, 2-3 days, 4-7 days and >7 days. We used fractional logistic regression to examine the relationship between wait times and reliance. Mean VHA reliance was 88.1% (95% CI = 86.7% to 89.5%) for patients reporting 0day waits. Compared with these patients, reliance over the subsequent year was 1.4 (p = 0.041), 2.8 (p = 0.001) and 1.6 (p = 0.014) percentage points lower for patients waiting 2-3 days, 4-7 days and >7 days, respectively. Patients reporting longer usual wait times for immediate VHA care exhibited lower future reliance on VHA primary care. Longer wait times may reduce care continuity and impact cost shifting across two federal health programs. Copyright © 2017. Published by Elsevier Inc.

  19. Approximating the r-process on earth with thermonuclear explosions

    International Nuclear Information System (INIS)

    Becker, S.A.

    1992-01-01

    The astrophysical r-process can be approximately simulated in certain types of thermonuclear explosions. Between 1952 and 1969 twenty-three nuclear tests were fielded by the United States which had as one of their objectives the production of heavy transuranic elements. Of these tests, fifteen were at least partially successful. Some of these shots were conducted under the project Plowshare Peaceful Nuclear Explosion Program as scientific research experiments. A review of the program, target nuclei used, and heavy element yields achieved, will be presented as well as discussion of plans for a new experiment in a future nuclear test

  20. China: the long wait

    International Nuclear Information System (INIS)

    Anon.

    1990-01-01

    The repercussions of Tiananmen Square coupled with worse than expected balance of payments problems have been made it even more difficult than usual to discern the likely future direction of China's nuclear power programme. Currently there are three power reactors under construction, an indigenously designed 300MWe PWR at Qinsham and the two 900MWe Framatome units at Daya Bay, Guang-dong. Prior to the events of June the most likely way forward, beyond these units under construction, appeared to be development of 600MWe units for Chinese conditions in a joint venture with Western companies. There are strong pressures to ''go indigenous'', and attempt to develop a home grown 600MWe design or, perhaps more likely, go for repeats of the 300 MWe plant - assuming it can be operated successfully, a point on which some factions of the Chinese nuclear industry have their doubts. Nuclear district heating still has strong advocates, as an environmentally sound way of meeting the country's huge projected increases in primary energy consumption over the coming years. Construction of a 5MWt district heating reactor at Tsinghua University, Beijing, started in 1986, entered operation at the end of 1989 following a test phase and is now supplying 3MWt to heating of university buildings. (author)

  1. Brazil well worth the wait

    Energy Technology Data Exchange (ETDEWEB)

    Duey, R.

    1999-11-01

    Oil companies weren't the only ones waiting for Brazil to make up its mind about privatizing its oil and gas industry. Seismic firms are flocking to the area in droves to work their spec magic. Exploratory activities in these large offshore blocks are described.

  2. Waiting time guarantee - an update

    DEFF Research Database (Denmark)

    Socha, Karolina; Bech, Mickael

    2008-01-01

    The rule of extended free choice of hospital, in force since 2002, provides patients with an option to choose a private hospital if the public system is unable to provide a treatment within the guaranteed waiting time of one month. In June 2008 the Government declared in their yearly budget agree...

  3. Barium from a mini r-process in supernovae

    Science.gov (United States)

    Heymann, D.

    1983-01-01

    McCulloch and Wasserburg (1978) have reported nonlinear isotopic anomalies in barium for two Ca-Al-rich inclusions of the Allende carbonaceous chondrite, known as EK-1-4-1 and C-1. In an attempt to account for these anomalies, it has been proposed that Ba from an r-process of nucleosynthesis, containing Ba-135 and Ba-137, was injected into the primeval color system but was not totally homogenized. Questions arise in connection with the relations of Xe isotopes in carbonaceous chondrites. This has prompted Heymann and Dziczkaniec (1979, 1980, 1981) to study the formation of r-Xe, r-Kr, and r-Te by the mini r-process which is thought to occur in the O, Ne-rich shells of Type II supernovae. Lee et al. (1979) have studied the formation of r-Ba, r-Nd, and r-Sm by the same process. Certain differences regarding the approaches used by Lee et al. and by Heymann and Dziczkaniec make it necessary to restudy the work of Lee et al. Attention is given to the survival probabilities of nuclear species of interest, taking into accounts the elements Cs, Ba, I, and Xe.

  4. Primordial Black Holes and r-Process Nucleosynthesis.

    Science.gov (United States)

    Fuller, George M; Kusenko, Alexander; Takhistov, Volodymyr

    2017-08-11

    We show that some or all of the inventory of r-process nucleosynthesis can be produced in interactions of primordial black holes (PBHs) with neutron stars (NSs) if PBHs with masses 10^{-14}  M_{⊙}r-process content and evolution histories in these sites. Ejected matter is heated by beta decay, which leads to emission of positrons in an amount consistent with the observed 511-keV line from the Galactic center.

  5. R -process Element Cosmic Rays from Neutron Star Mergers

    Energy Technology Data Exchange (ETDEWEB)

    Komiya, Yutaka; Shigeyama, Toshikazu [Research Center for the Early Universe, Graduate School of Science, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, 113-0033, Tokyo (Japan)

    2017-09-10

    Neutron star mergers (NSMs) are one of the most plausible sources of r -process elements in the universe. Therefore, NSMs can also be a major source of ultra-heavy elements in cosmic rays. In this paper, we first estimate the contribution of r -process elements synthesized in NSMs to the ultra-heavy element cosmic rays (UHCRs) by calculating transport equations that take into account energy loss processes and spallations. We show that the flux of UHCRs accelerated by the NSMs themselves fluctuates by many orders of magnitude on a timescale of several million years and can overwhelm UHCRs accelerated by supernova remnants (SNRs) after an NSM takes place within a few kiloparsec from the solar system. Experiments with very long exposure times using meteorites as UHCR detectors can detect this fluctuation. As a consequence, we show that if NSMs are the primary source of UHCRs, future experiments using meteorites may be able to reveal the event history of NSMs in the solar vicinity. We also describe a possible difference in the abundance pattern and energy spectrum of UHCRs between NSM and SNR accelerations.

  6. SU-F-P-20: Predicting Waiting Times in Radiation Oncology Using Machine Learning

    International Nuclear Information System (INIS)

    Joseph, A; Herrera, D; Hijal, T; Kildea, J; Hendren, L; Leung, A; Wainberg, J; Sawaf, M; Gorshkov, M; Maglieri, R; Keshavarz, M

    2016-01-01

    Purpose: Waiting times remain one of the most vexing patient satisfaction challenges facing healthcare. Waiting time uncertainty can cause patients, who are already sick or in pain, to worry about when they will receive the care they need. These waiting periods are often difficult for staff to predict and only rough estimates are typically provided based on personal experience. This level of uncertainty leaves most patients unable to plan their calendar, making the waiting experience uncomfortable, even painful. In the present era of electronic health records (EHRs), waiting times need not be so uncertain. Extensive EHRs provide unprecedented amounts of data that can statistically cluster towards representative values when appropriate patient cohorts are selected. Predictive modelling, such as machine learning, is a powerful approach that benefits from large, potentially complex, datasets. The essence of machine learning is to predict future outcomes by learning from previous experience. The application of a machine learning algorithm to waiting time data has the potential to produce personalized waiting time predictions such that the uncertainty may be removed from the patient’s waiting experience. Methods: In radiation oncology, patients typically experience several types of waiting (eg waiting at home for treatment planning, waiting in the waiting room for oncologist appointments and daily waiting in the waiting room for radiotherapy treatments). A daily treatment wait time model is discussed in this report. To develop a prediction model using our large dataset (with more than 100k sample points) a variety of machine learning algorithms from the Python package sklearn were tested. Results: We found that the Random Forest Regressor model provides the best predictions for daily radiotherapy treatment waiting times. Using this model, we achieved a median residual (actual value minus predicted value) of 0.25 minutes and a standard deviation residual of 6.5 minutes

  7. SU-F-P-20: Predicting Waiting Times in Radiation Oncology Using Machine Learning

    Energy Technology Data Exchange (ETDEWEB)

    Joseph, A; Herrera, D; Hijal, T; Kildea, J [McGill University Health Centre, Montreal, Quebec (Canada); Hendren, L; Leung, A; Wainberg, J; Sawaf, M; Gorshkov, M; Maglieri, R; Keshavarz, M [McGill University, Montreal, Quebec (Canada)

    2016-06-15

    Purpose: Waiting times remain one of the most vexing patient satisfaction challenges facing healthcare. Waiting time uncertainty can cause patients, who are already sick or in pain, to worry about when they will receive the care they need. These waiting periods are often difficult for staff to predict and only rough estimates are typically provided based on personal experience. This level of uncertainty leaves most patients unable to plan their calendar, making the waiting experience uncomfortable, even painful. In the present era of electronic health records (EHRs), waiting times need not be so uncertain. Extensive EHRs provide unprecedented amounts of data that can statistically cluster towards representative values when appropriate patient cohorts are selected. Predictive modelling, such as machine learning, is a powerful approach that benefits from large, potentially complex, datasets. The essence of machine learning is to predict future outcomes by learning from previous experience. The application of a machine learning algorithm to waiting time data has the potential to produce personalized waiting time predictions such that the uncertainty may be removed from the patient’s waiting experience. Methods: In radiation oncology, patients typically experience several types of waiting (eg waiting at home for treatment planning, waiting in the waiting room for oncologist appointments and daily waiting in the waiting room for radiotherapy treatments). A daily treatment wait time model is discussed in this report. To develop a prediction model using our large dataset (with more than 100k sample points) a variety of machine learning algorithms from the Python package sklearn were tested. Results: We found that the Random Forest Regressor model provides the best predictions for daily radiotherapy treatment waiting times. Using this model, we achieved a median residual (actual value minus predicted value) of 0.25 minutes and a standard deviation residual of 6.5 minutes

  8. Client waiting time in an urban primary health care centre in Lagos ...

    African Journals Online (AJOL)

    Background: Primary Health Care is the usual entry point into the health system and has the potential to touch the lives of most people. However one of the reasons for poor uptake of health services at primary health care facilities in Nigeria is long waiting time. This study was carried out to assess client waiting time and ...

  9. The r-process nucleosynthesis and related challenges

    Directory of Open Access Journals (Sweden)

    Goriely Stephane

    2017-01-01

    Full Text Available The rapid neutron-capture process, or r-process, is known to be of fundamental importance for explaining the origin of approximately half of the A > 60 stable nuclei observed in nature. Recently, special attention has been paid to neutron star (NS mergers following the confirmation by hydrodynamic simulations that a non-negligible amount of matter can be ejected and by nucleosynthesis calculations combined with the predicted astrophysical event rate that such a site can account for the majority of r-material in our Galaxy. We show here that the combined contribution of both the dynamical (prompt ejecta expelled during binary NS or NS-black hole (BH mergers and the neutrino and viscously driven outflows generated during the post-merger remnant evolution of relic BH-torus systems can lead to the production of r-process elements from mass number A ≳ 90 up to actinides. The corresponding abundance distribution is found to reproduce the solar distribution extremely well. It can also account for the elemental distributions observed in low-metallicity stars. However, major uncertainties still affect our understanding of the composition of the ejected matter. These concern (i the β-interactions of electron (antineutrinos with free neutrons and protons, as well as their inverse reactions, which may affect the neutron-richness of the matter at the early phase of the ejection, and (ii the nuclear physics of exotic neutron-rich nuclei, including nuclear structure as well as nuclear interaction properties, which impact the calculated abundance distribution. Both aspects are discussed in the light of recent hydrodynamical simulations of NS mergers and microscopic calculations of nuclear decay and reaction probabilities.

  10. Advertising emergency department wait times.

    Science.gov (United States)

    Weiner, Scott G

    2013-03-01

    Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED setting instead to primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times are discussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects to the public health, caution about its use is advised.

  11. Advertising Emergency Department Wait Times

    Science.gov (United States)

    Weiner, Scott G.

    2013-01-01

    Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED setting instead to primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times are discussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects to the public health, caution about its use is advised. PMID:23599836

  12. Advertising Emergency Department Wait Times

    Directory of Open Access Journals (Sweden)

    Scott G. Weiner

    2013-03-01

    Full Text Available Advertising emergency department (ED wait times has become a common practice in the UnitedStates. Proponents of this practice state that it is a powerful marketing strategy that can help steerpatients to the ED. Opponents worry about the risk to the public health that arises from a patient withan emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standarddefinition of the reported time, and directing lower acuity patients to the higher cost ED setting insteadto primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times arediscussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects tothe public health, caution about its use is advised

  13. Advertising Emergency Department Wait Times

    OpenAIRE

    Weiner, Scott G

    2013-01-01

    Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED se...

  14. Two Effective Ways to Implement Wait Time. A Symposium on Wait Time.

    Science.gov (United States)

    Swift, J. Nathan; And Others

    The effects of instructional guides and a wait time feedback device (called a "Wait Timer") on the classroom interaction of middle school science teachers are examined. The Wait Timer, an unobtrusive indicator of wait time, is an automatic device that activates a light when a person speaks. The duration of the light at the end of a…

  15. Consumer behaviour in the waiting area.

    Science.gov (United States)

    Mobach, Mark P

    2007-02-01

    To determine consumer behaviour in the pharmacy waiting area. The applied methods for data-collection were direct observations. Three Dutch community pharmacies were selected for the study. The topics in the observation list were based on available services at each waiting area (brochures, books, illuminated new trailer, children's play area, etc.). Per patient each activity was registered, and at each pharmacy the behaviour was studied for 2 weeks. Most patients only waited during the waiting time at the studied pharmacies. Few consumers obtained written information during their wait. The waiting area may have latent possibilities to expand the information function of the pharmacy and combine this with other activities that distract the consumer from the wait. Transdisciplinary research, combining knowledge from pharmacy practice research with consumer research, has been a useful approach to add information on queueing behaviour of consumers.

  16. WAITING FOR GODOT - ABSURD TEATER

    OpenAIRE

    Thorup, Rasmus; Leitthof, Anneliese; Kock, Felizia; Johansson, Lars; Moustgaard, Mie; Rosenkrands, Tobias; Staalhøj, Sarah; Jeppesen, Freja

    2013-01-01

    This project aims to reassess and discuss the different interpretations of Samuel Beckett’s play Waiting for Godot, made by Martin Esslin and Michael Y. Bennett. The analytical tools needed to enable the reassessment is found in the dimensional courses of Philosophy and Scientific theory (Da: Filosofi og Videnskabsteori) and Text-analysis (Da: Tekst og Tegn) and the discussion is based on Esslin’s The Theatre of The Absurd and Bennett’s Reassessing The Theatre of The Absurd. The conclusion is...

  17. Handgun waiting periods reduce gun deaths.

    Science.gov (United States)

    Luca, Michael; Malhotra, Deepak; Poliquin, Christopher

    2017-11-14

    Handgun waiting periods are laws that impose a delay between the initiation of a purchase and final acquisition of a firearm. We show that waiting periods, which create a "cooling off" period among buyers, significantly reduce the incidence of gun violence. We estimate the impact of waiting periods on gun deaths, exploiting all changes to state-level policies in the Unites States since 1970. We find that waiting periods reduce gun homicides by roughly 17%. We provide further support for the causal impact of waiting periods on homicides by exploiting a natural experiment resulting from a federal law in 1994 that imposed a temporary waiting period on a subset of states. Copyright © 2017 the Author(s). Published by PNAS.

  18. Queues with waiting time dependent service

    DEFF Research Database (Denmark)

    Bekker, R.; Koole, G. M.; Nielsen, Bo Friis

    2011-01-01

    Motivated by service levels in terms of the waiting-time distribution seen, for instance, in call centers, we consider two models for systems with a service discipline that depends on the waiting time. The first model deals with a single server that continuously adapts its service rate based...... derive steady-state waiting-time distributions for both models. The results are illustrated with numerical examples....... on the waiting time of the first customer in line. In the second model, one queue is served by a primary server which is supplemented by a secondary server when the waiting of the first customer in line exceeds a threshold. Using level crossings for the waiting-time process of the first customer in line, we...

  19. WAITING TIME IN THE WAITING ROOM IN FAMILY PRACTICE AND PATIENT SATISFACTION

    Directory of Open Access Journals (Sweden)

    Janko Kersnik

    2001-05-01

    Full Text Available Background: Appointment system shortens the waiting time in the waiting room for the patient and allows better use of time for the doctor. We wanted to examine how long patients are willing to wait in the waiting room, how long they waited at the last visit, patient satisfaction with the last visit, the satisfaction with the length of waiting in the past 12 months and the overall patient satisfaction score for the last 12 months. Appointment system proved to be effective means of organising practice time. Waiting time in the waiting room with appointment system was considerably shorter (mean 18.5 minutes as compared to the waiting time in the practices without appointment system (mean 55.4 minutes, the fact which is reflected also in higher satisfaction with waiting in the waiting room in the past 12 months. Three quarters of patients in practices with appointment system waited standard 20 minutes or less, as opposed to the other practices where only one quarter of patients waited 20 minutes or less.Conclusions: The overall satisfaction with the doctor with the appointment system does not differ in both types of practices. The patients from practices with appointment system evaluated better possibility to get an appointment to suit the patients, but worse help of the doctors’ staff, possibility to get through to the office by phone, the length of time during the consultation and the doctors’ thoroughness.

  20. Waiting for surgery from the patient perspective

    Directory of Open Access Journals (Sweden)

    Tracey Carr

    2009-10-01

    Full Text Available Tracey Carr1, Ulrich Teucher2, Jackie Mann4, Alan G Casson31Health Sciences, 2Department of Psychology, 3Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; 4Acute Care, Saskatoon Health Region, Saskatoon, Saskatchewan, CanadaAbstract: The aim of this study was to perform a systematic review of the impact of waiting for elective surgery from the patient perspective, with a focus on maximum tolerance, quality of life, and the nature of the waiting experience. Searches were conducted using Medline, PubMed, CINAHL, EMBASE, and HealthSTAR. Twenty-seven original research articles were identified which included each of these three themes. The current literature suggested that first, patients tend to state longer wait times as unacceptable when they experienced severe symptoms or functional impairment. Second, the relationship between length of wait and health-related quality of life depended on the nature and severity of proposed surgical intervention at the time of booking. Third, the waiting experience was consistently described as stressful and anxiety provoking. While many patients expressed anger and frustration at communication within the system, the experience of waiting was not uniformly negative. Some patients experienced waiting as an opportunity to live full lives despite pain and disability. The relatively unexamined relationship between waiting, illness and patient experience of time represents an area for future research.Keywords: wait time, scheduled surgery, patient perspective, literature review

  1. Can We Predict Patient Wait Time?

    Science.gov (United States)

    Pianykh, Oleg S; Rosenthal, Daniel I

    2015-10-01

    The importance of patient wait-time management and predictability can hardly be overestimated: For most hospitals, it is the patient queues that drive and define every bit of clinical workflow. The objective of this work was to study the predictability of patient wait time and identify its most influential predictors. To solve this problem, we developed a comprehensive list of 25 wait-related parameters, suggested in earlier work and observed in our own experiments. All parameters were chosen as derivable from a typical Hospital Information System dataset. The parameters were fed into several time-predicting models, and the best parameter subsets, discovered through exhaustive model search, were applied to a large sample of actual patient wait data. We were able to discover the most efficient wait-time prediction factors and models, such as the line-size models introduced in this work. Moreover, these models proved to be equally accurate and computationally efficient. Finally, the selected models were implemented in our patient waiting areas, displaying predicted wait times on the monitors located at the front desks. The limitations of these models are also discussed. Optimal regression models based on wait-line sizes can provide accurate and efficient predictions for patient wait time. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  2. Wait too long to talk about kidney disease and you could be waiting for a kidney.

    Science.gov (United States)

    ... Home Current Issue Past Issues Public Service Announcement Kidney Disease Past Issues / Summer 2006 Table of Contents ... Javascript on. Wait too long to talk about kidney disease and you could be waiting for a ...

  3. Worth the wait? How restaurant waiting time influences customer behavior and revenue

    NARCIS (Netherlands)

    de Vries, J.; Roy, Debjit; De Koster, Rene

    2018-01-01

    In many service industries, customers have to wait for service. When customers have a choice, this waiting may influence their service experience, sojourn time, and ultimately spending, reneging, and return behavior. Not much is known however, about the system-wide impact of waiting on customer

  4. Waiting Online: A Review and Research Agenda.

    Science.gov (United States)

    Ryan, Gerard; Valverde, Mireia

    2003-01-01

    Reviews 21 papers based on 13 separate empirical studies on waiting on the Internet, drawn from the areas of marketing, system response time, and quality of service studies. The article proposes an agenda for future research, including extending the range of research methodologies, broadening the definition of waiting on the Internet, and…

  5. Improving Patient Satisfaction with Waiting Time

    Science.gov (United States)

    Eilers, Gayleen M.

    2004-01-01

    Waiting times are a significant component of patient satisfaction. A patient satisfaction survey performed in the author's health center showed that students rated waiting time lowest of the listed categories--A ratings of 58% overall, 63% for scheduled appointments, and 41% for the walk-in clinic. The center used a quality improvement process and…

  6. Factors of Perceived Waiting Time and Implications on Passengers’ Satisfaction with Waiting Time

    Directory of Open Access Journals (Sweden)

    Shumin Feng

    2016-04-01

    Full Text Available In order to explore the influence factors on perceived waiting time, a multiple linear regression model has been used to quantitatively describe the relationship between perceived waiting time and various factors. The model is established with 234 data, which is surveyed with questionnaire at three stops in Harbin, China. The results show that several certain factors (“trip purpose - where to”, “presence of a companion - whether one has a companion or not”, “having a timing device - whether one has a timing device or not”, “riding frequency - how many times one takes one line per week” and “waiting behaviour - what one does while waiting for a bus” have significant influence on perceived waiting time, which confirms previous findings and supports transferability of results. The significance of “waiting mood - howabout the mood while waiting for a bus” and “reserved waiting time - how long one will wait” are confirmed for the first time in this study. In contrast to previous studies, “waiting time interval - for how long in one day” is a negative variable and socioeconomic variables are non-significant. And it is found that the relationship between perceived waiting time and passengers’ satisfaction with the waiting time follows a decreasing exponential distribution. With this model, the variation trend of the section, where passenger satisfaction value is larger than 0 is obviously steeper than the section smaller than 0. Such result proves that passenger mood with short waiting time is more sensitive than with longer waiting time. And the borderline perceived waiting time, distinguishing satisfied from dissatisfied passengers is proven to be 7.87 minutes when assignment interval of satisfaction is (-25.25], when satisfaction is positive (larger than 0, the accuracy being 70.30%, while the accuracy is 82.71% fornegative satisfaction (less than 0.

  7. Simulating neutron star mergers as r-process sources in ultrafaint dwarf galaxies

    Science.gov (United States)

    Safarzadeh, Mohammadtaher; Scannapieco, Evan

    2017-10-01

    To explain the high observed abundances of r-process elements in local ultrafaint dwarf (UFD) galaxies, we perform cosmological zoom simulations that include r-process production from neutron star mergers (NSMs). We model star formation stochastically and simulate two different haloes with total masses ≈108 M⊙ at z = 6. We find that the final distribution of [Eu/H] versus [Fe/H] is relatively insensitive to the energy by which the r-process material is ejected into the interstellar medium, but strongly sensitive to the environment in which the NSM event occurs. In one halo, the NSM event takes place at the centre of the stellar distribution, leading to high levels of r-process enrichment such as seen in a local UFD, Reticulum II (Ret II). In a second halo, the NSM event takes place outside of the densest part of the galaxy, leading to a more extended r-process distribution. The subsequent star formation occurs in an interstellar medium with shallow levels of r-process enrichment that results in stars with low levels of [Eu/H] compared to Ret II stars even when the maximum possible r-process mass is assumed to be ejected. This suggests that the natal kicks of neutron stars may also play an important role in determining the r-process abundances in UFD galaxies, a topic that warrants further theoretical investigation.

  8. Colour Consideration for Waiting areas in hospitals

    Science.gov (United States)

    Zraati, Parisa

    2012-08-01

    Colour is one the most important factors in the nature that can have some affects on human behaviour. Many years ago, it was proven that using colour in public place can have some affect on the users. Depend of the darkness and lightness; it can be vary from positive to negative. The research will mainly focus on the colour and psychological influences and physical factors. The statement of problem in this research is what is impact of colour usually applied to waiting area? The overall aim of the study is to explore the visual environment of hospitals and to manage the colour psychological effect of the hospital users in the waiting area by creating a comfortable, pleasant and cozy environment for users while spend their time in waiting areas. The analysisconcentrate on satisfaction and their interesting regarding applied colour in two private hospital waiting area in Malaysia.

  9. DETECTION OF THE SECOND r-PROCESS PEAK ELEMENT TELLURIUM IN METAL-POOR STARS ,

    International Nuclear Information System (INIS)

    Roederer, Ian U.; Lawler, James E.; Cowan, John J.; Beers, Timothy C.; Frebel, Anna; Ivans, Inese I.; Schatz, Hendrik; Sobeck, Jennifer S.; Sneden, Christopher

    2012-01-01

    Using near-ultraviolet spectra obtained with the Space Telescope Imaging Spectrograph on board the Hubble Space Telescope, we detect neutral tellurium in three metal-poor stars enriched by products of r-process nucleosynthesis, BD +17 3248, HD 108317, and HD 128279. Tellurium (Te, Z = 52) is found at the second r-process peak (A ≈ 130) associated with the N = 82 neutron shell closure, and it has not been detected previously in Galactic halo stars. The derived tellurium abundances match the scaled solar system r-process distribution within the uncertainties, confirming the predicted second peak r-process residuals. These results suggest that tellurium is predominantly produced in the main component of the r-process, along with the rare earth elements.

  10. The impact of global nuclear mass model uncertainties on r-process abundance predictions

    Directory of Open Access Journals (Sweden)

    Mumpower M.

    2015-01-01

    Full Text Available Rapid neutron capture or ‘r-process’ nucleosynthesis may be responsible for half the production of heavy elements above iron on the periodic table. Masses are one of the most important nuclear physics ingredients that go into calculations of r-process nucleosynthesis as they enter into the calculations of reaction rates, decay rates, branching ratios and Q-values. We explore the impact of uncertainties in three nuclear mass models on r-process abundances by performing global monte carlo simulations. We show that root-mean-square (rms errors of current mass models are large so that current r-process predictions are insufficient in predicting features found in solar residuals and in r-process enhanced metal poor stars. We conclude that the reduction of global rms errors below 100 keV will allow for more robust r-process predictions.

  11. R-process enrichment from a single event in an ancient dwarf galaxy.

    Science.gov (United States)

    Ji, Alexander P; Frebel, Anna; Chiti, Anirudh; Simon, Joshua D

    2016-03-31

    Elements heavier than zinc are synthesized through the rapid (r) and slow (s) neutron-capture processes. The main site of production of the r-process elements (such as europium) has been debated for nearly 60 years. Initial studies of trends in chemical abundances in old Milky Way halo stars suggested that these elements are produced continually, in sites such as core-collapse supernovae. But evidence from the local Universe favours the idea that r-process production occurs mainly during rare events, such as neutron star mergers. The appearance of a plateau of europium abundance in some dwarf spheroidal galaxies has been suggested as evidence for rare r-process enrichment in the early Universe, but only under the assumption that no gas accretes into those dwarf galaxies; gas accretion favours continual r-process enrichment in these systems. Furthermore, the universal r-process pattern has not been cleanly identified in dwarf spheroidals. The smaller, chemically simpler, and more ancient ultrafaint dwarf galaxies assembled shortly after the first stars formed, and are ideal systems with which to study nucleosynthesis events such as the r-process. Reticulum II is one such galaxy. The abundances of non-neutron-capture elements in this galaxy (and others like it) are similar to those in other old stars. Here, we report that seven of the nine brightest stars in Reticulum II, observed with high-resolution spectroscopy, show strong enhancements in heavy neutron-capture elements, with abundances that follow the universal r-process pattern beyond barium. The enhancement seen in this 'r-process galaxy' is two to three orders of magnitude higher than that detected in any other ultrafaint dwarf galaxy. This implies that a single, rare event produced the r-process material in Reticulum II. The r-process yield and event rate are incompatible with the source being ordinary core-collapse supernovae, but consistent with other possible sources, such as neutron star mergers.

  12. The waiting time distribution as a graphical approach to epidemiologic measures of drug utilization

    DEFF Research Database (Denmark)

    Hallas, J; Gaist, D; Bjerrum, L

    1997-01-01

    that effectively conveys some essential utilization parameters for a drug. The waiting time distribution for a group of drug users is a charting of their first prescription presentations within a specified time window. For a drug used for chronic treatment, most current users will be captured at the beginning...... of the window. After a few months, the graph will be dominated by new, incident users. As examples, we present waiting time distributions for insulin, ulcer drugs, systemic corticosteroids, antidepressants, and disulfiram. Appropriately analyzed and interpreted, the waiting time distributions can provide...... information about the period prevalence, point prevalence, incidence, duration of use, seasonality, and rate of prescription renewal or relapse for specific drugs. Each of these parameters has a visual correlate. The waiting time distributions may be an informative supplement to conventional drug utilization...

  13. Stochastic nature of series of waiting times

    Science.gov (United States)

    Anvari, Mehrnaz; Aghamohammadi, Cina; Dashti-Naserabadi, H.; Salehi, E.; Behjat, E.; Qorbani, M.; Khazaei Nezhad, M.; Zirak, M.; Hadjihosseini, Ali; Peinke, Joachim; Tabar, M. Reza Rahimi

    2013-06-01

    Although fluctuations in the waiting time series have been studied for a long time, some important issues such as its long-range memory and its stochastic features in the presence of nonstationarity have so far remained unstudied. Here we find that the “waiting times” series for a given increment level have long-range correlations with Hurst exponents belonging to the interval 1/2waiting time distribution. We find that the logarithmic difference of waiting times series has a short-range correlation, and then we study its stochastic nature using the Markovian method and determine the corresponding Kramers-Moyal coefficients. As an example, we analyze the velocity fluctuations in high Reynolds number turbulence and determine the level dependence of Markov time scales, as well as the drift and diffusion coefficients. We show that the waiting time distributions exhibit power law tails, and we were able to model the distribution with a continuous time random walk.

  14. Third degree waiting time discrimination: optimal allocation of a public sector healthcare treatment under rationing by waiting.

    Science.gov (United States)

    Gravelle, Hugh; Siciliani, Luigi

    2009-08-01

    In many public healthcare systems treatments are rationed by waiting time. We examine the optimal allocation of a fixed supply of a given treatment between different groups of patients. Even in the absence of any distributional aims, welfare is increased by third degree waiting time discrimination: setting different waiting times for different groups waiting for the same treatment. Because waiting time imposes dead weight losses on patients, lower waiting times should be offered to groups with higher marginal waiting time costs and with less elastic demand for the treatment.

  15. Protocol to Exploit Waiting Resources for UASNs

    Directory of Open Access Journals (Sweden)

    Li-Ling Hung

    2016-03-01

    Full Text Available The transmission speed of acoustic waves in water is much slower than that of radio waves in terrestrial wireless sensor networks. Thus, the propagation delay in underwater acoustic sensor networks (UASN is much greater. Longer propagation delay leads to complicated communication and collision problems. To solve collision problems, some studies have proposed waiting mechanisms; however, long waiting mechanisms result in low bandwidth utilization. To improve throughput, this study proposes a slotted medium access control protocol to enhance bandwidth utilization in UASNs. The proposed mechanism increases communication by exploiting temporal and spatial resources that are typically idle in order to protect communication against interference. By reducing wait time, network performance and energy consumption can be improved. A performance evaluation demonstrates that when the data packets are large or sensor deployment is dense, the energy consumption of proposed protocol is less than that of existing protocols as well as the throughput is higher than that of existing protocols.

  16. Shorter Perceived Outpatient MRI Wait Times Associated With Higher Patient Satisfaction.

    Science.gov (United States)

    Holbrook, Anna; Glenn, Harold; Mahmood, Rabia; Cai, Qingpo; Kang, Jian; Duszak, Richard

    2016-05-01

    The aim of this study was to assess differences in perceived versus actual wait times among patients undergoing outpatient MRI examinations and to correlate those times with patient satisfaction. Over 15 weeks, 190 patients presenting for outpatient MR in a radiology department in which "patient experience" is one of the stated strategic priorities were asked to (1) estimate their wait times for various stages in the imaging process and (2) state their satisfaction with their imaging experience. Perceived times were compared with actual electronic time stamps. Perceived and actual times were compared and correlated with standardized satisfaction scores using Kendall τ correlation. The mean actual wait time between patient arrival and examination start was 53.4 ± 33.8 min, whereas patients perceived a mean wait time of 27.8 ± 23.1 min, a statistically significant underestimation of 25.6 min (P perceived wait times at all points during patient encounters were correlated with higher satisfaction scores (P perceived and actual wait times were both correlated with higher satisfaction scores. As satisfaction surveys play a larger role in an environment of metric transparency and value-based payments, better understanding of such factors will be increasingly important. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  17. Teaching Evaluation: Waiting for Initiatives

    Directory of Open Access Journals (Sweden)

    Alejandro Canales Sánchez

    2008-08-01

    Full Text Available In this text, it is sustained that, despite the fact that the teaching activity is one of the main functions of higher education institutions or even the only one in most of them, it hasn’t been reflected in the leading initiatives that have been set in motion in this area for the last two decades. In particular, it points out that the wide evaluation politics established in the education system during the late eighties, didn’t consider the teaching activity as a concern issue for the mechanisms or rewards in the evaluation system. Even though the implementation of new actions tried to repair the situation, mainly by improving the quality of working time and the qualifications of the personnel performing these activities; teaching, in strict sense, and the design or application of a new evaluation scheme to strengthen it, didn’t get better.

  18. Time while waiting: patients' experiences of scheduled surgery.

    Science.gov (United States)

    Carr, Tracey; Teucher, Ulrich C; Casson, Alan G

    2014-12-01

    Research on patients' experiences of wait time for scheduled surgery has centered predominantly on the relative tolerability of perceived wait time and impacts on quality of life. We explored patients' experiences of time while waiting for three types of surgery with varied wait times--hip or knee replacement, shoulder surgery, and cardiac surgery. Thirty-two patients were recruited by their surgeons. We asked participants about their perceptions of time while waiting in two separate interviews. Using interpretative phenomenological analysis (IPA), we discovered connections between participant suffering, meaningfulness of time, and agency over the waiting period and the lived duration of time experience. Our findings reveal that chronological duration is not necessarily the most relevant consideration in determining the quality of waiting experience. Those findings helped us create a conceptual framework for lived wait time. We suggest that clinicians and policy makers consider the complexity of wait time experience to enhance preoperative patient care. © The Author(s) 2014.

  19. Consumer behaviour in the waiting area

    NARCIS (Netherlands)

    Mobach, M.P.

    Objective of the study: To determine consumer behaviour in the pharmacy waiting area. Method: The applied methods for data-collection were direct observations. Three Dutch community pharmacies were selected for the study. The topics in the observation list were based on available services at each

  20. Parental strategies for assisting children to wait.

    Science.gov (United States)

    Cuskelly, Monica; Jobling, Anne; Gilmore, Linda; Glenn, Sheila

    2006-09-01

    This study examined parents' behaviours as they waited with their child. Children were presented with an attractively wrapped gift and then asked not to touch it until the experimenter returned from finishing some work in another room. Three parent groups and their children participated in the study - parents of children with Down syndrome, parents of children with intellectual disability from another cause, and parents of children who were developing typically. There were no significant differences between children in how long they were able to wait before touching the gift. The data from the first two groups were combined for all analyses after it was established that there were no significant differences between them. There were few significant differences between parents of a child with intellectual disability and comparison parents. The former group were more likely to be classified as Authoritarian than were comparison parents, however with one exception, parenting style was unrelated to the strategies parents used in the waiting situation. Very few parents in either group used the opportunity to teach or explicitly praise effective waiting strategies in their children.

  1. The r-process nucleosynthesis during the decompression of neutron star crust material

    Energy Technology Data Exchange (ETDEWEB)

    Goriely, S. [Institut d' Astronomie et d' Astrophysique, CP-226, Université Libre de Bruxelles, 1050 Brussels (Belgium); Bauswein, A. [Department of Physics, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece and Max-Planck-Institut für Astrophysik, Postfach 1317, 85741 Garching (Germany); Janka, H.-T. [Max-Planck-Institut für Astrophysik, Postfach 1317, 85741 Garching (Germany); Sida, J.-L.; Lemaître, J.-F.; Panebianco, S. [C.E.A. Saclay, Irfu/Service de Physique Nucléaire, 91191 Gif-sur-Yvette (France); Dubray, N.; Hilaire, S. [CEA, DAM, DIF, F-91297 Arpajon (France)

    2014-05-02

    About half of the nuclei heavier than iron observed in nature are produced by the so-called rapid neutron capture process, or r-process, of nucleosynthesis. The identification of the astrophysics site and the specific conditions in which the r-process takes place remains, however, one of the still-unsolved mysteries of modern astrophysics. Another underlying difficulty associated with our understanding of the r-process concerns the uncertainties in the predictions of nuclear properties for the few thousands exotic neutron-rich nuclei involved, for which essentially no experimental data exist. The present paper emphasizes some important future challenges faced by nuclear physics in this problem, particularly in the determination of the nuclear structure properties of exotic neutron-rich nuclei as well as their radiative neutron capture rates and their fission probabilities. These quantities are particularly relevant to determine the composition of the matter resulting from the r-process. Both the astrophysics and the nuclear physics difficulties are critically reviewed with special attention paid to the r-process taking place during the decompression of neutron star matter following the merging of two neutron stars.

  2. Ramsey waits: allocating public health service resources when there is rationing by waiting.

    Science.gov (United States)

    Gravelle, Hugh; Siciliani, Luigi

    2008-09-01

    The optimal allocation of a public health care budget across treatments must take account of the way in which care is rationed within treatments since this will affect their marginal value. We investigate the optimal allocation rules for public health care systems where user charges are fixed and care is rationed by waiting. The optimal waiting time is higher for treatments with demands more elastic to waiting time, higher costs, lower charges, smaller marginal welfare loss from waiting by treated patients, and smaller marginal welfare losses from under-consumption of care. The results hold for a wide range of welfarist and non-welfarist objective functions and for systems in which there is also a private health care sector. They imply that allocation rules based purely on cost effectiveness ratios are suboptimal because they assume that there is no rationing within treatments.

  3. Fission in R-processes Elements (FIRE) - Annual Report: Fiscal Year 2017

    Energy Technology Data Exchange (ETDEWEB)

    Schunck, Nicolas [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2017-10-18

    The goal of the FIRE topical collaboration in nuclear theory is to determine the astrophysical conditions of the rapid neutron capture process (r-process), which is responsible for the formation of heavy elements. This will be achieved by including in r-process simulations the most advanced models of fission (spontaneous, neutron-induced, beta-delayed) that have been developed at LLNL and LANL. The collaboration is composed of LLNL (lead) and LANL for work on nuclear data (ground-state properties, fission, beta-decay), BNL for nuclear data management, and the university of Notre Dame and North Carolina State University for r-process simulations. Under DOE/NNSA agreement, both universities receive funds from the DOE Office of Science, while national laboratories receive funds directly from NA221.

  4. The AMBRE Project: r-process element abundances in the Milky Way thin and thick discs

    Science.gov (United States)

    Guiglion, Guillaume; de Laverny, Patrick; Recio-Blanco, Alejandra; Worley, C. Clare

    2018-04-01

    Chemical evolution of r-process elements in the Milky Way disc is still a matter of debate. We took advantage of high resolution HARPS spectra from the ESO archive in order to derive precise chemical abundances of 3 r-process elements Eu, Dy & Gd for a sample of 4 355 FGK Milky Way stars. The chemical analysis has been performed thanks to the automatic optimization pipeline GAUGUIN. Based on the [α/Fe] ratio, we chemically characterized the thin and the thick discs, and present here results of these 3 r-process element abundances in both discs. We found an unexpected Gadolinium and Dysprosium enrichment in the thick disc stars compared to Europium, while these three elements track well each other in the thin disc.

  5. Analysis of emergency department waiting lines

    Directory of Open Access Journals (Sweden)

    Urška Močnik

    2014-10-01

    Full Text Available Background: Steady increase in the numbers of patients seeking medical assistance has recently been observed at the emergency department of the health center under study. This has led to increases in waiting times for patients. The management of the health center has been considering to implement certain measures to remedy this situation. One proposed solution is to add an additional physician to the emergency department. A computer model was constructed to simulate waiting lines and analyze the economic feasibility of employing an additional physician.Aim: This paper analyzes the waiting lines at the emergency department and performs an economic feasibility study to determine whether adding an additional physician to the department would be economically justified.Methods: Data about waiting times at the emergency department were collected to study the situation. For each patient, the arrival time at the waiting room and the starting and ending times of the examination were registered. The data were collected from 13 June 2011 to 25 September 2011. The sample included data on 65 nightly standbys, nine standbys on Saturdays, and 16 standbys on Sundays. Due to incomplete entries, data for nine weekly standbys and six Saturday standbys were excluded from the sample. Based on the data collected, we calculated the waiting and examination times per patient, average number of patients, average waiting time, average examination time, share of active standby teams in total standby time, and number of patients in different time periods. The study involved 1,039 patients. Using a synthesis method, we designed a computer model of waiting lines and economic feasibility. The model was validated using comparative analysis. A what-if analysis was performed using various computer simulations with various scenarios to consider the outcomes of decision alternatives. We applied economic analysis to select the best possible solution.Results: The research results

  6. ENRICHMENT OF r-PROCESS ELEMENTS IN DWARF SPHEROIDAL GALAXIES IN CHEMO-DYNAMICAL EVOLUTION MODEL

    Energy Technology Data Exchange (ETDEWEB)

    Hirai, Yutaka; Kajino, Toshitaka [Department of Astronomy, Graduate School of Science, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033 (Japan); Ishimaru, Yuhri [Department of Material Science,International Christian University, 3-10-2 Osawa, Mitaka, Tokyo 181-8585 (Japan); Saitoh, Takayuki R. [Earth-Life Science Institute, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro-ku, Tokyo 152-8551 (Japan); Fujii, Michiko S.; Hidaka, Jun, E-mail: yutaka.hirai@nao.ac.jp [Division of Theoretical Astronomy, National Astronomical Observatory of Japan, 2-21-1 Osawa Mitaka, Tokyo 181-8588 (Japan)

    2015-11-20

    The rapid neutron-capture process (r-process) is a major process for the synthesis of elements heavier than iron-peak elements, but the astrophysical site(s) of the r-process has not yet been identified. Neutron star mergers (NSMs) are suggested to be a major r-process site according to nucleosynthesis studies. Previous chemical evolution studies, however, required unlikely short merger times of NSMs to reproduce the observed large star-to-star scatters in the abundance ratios of r-process elements to iron: the [Eu/Fe] of extremely metal-poor stars in the Milky Way (MW) halo. This problem can be solved by considering chemical evolution in dwarf spheroidal galaxies (dSphs), which would be building blocks of the MW and have lower star formation efficiencies than the MW halo. We demonstrate the enrichment of r-process elements in dSphs by NSMs using an N-body/smoothed particle hydrodynamics code. Our high-resolution model reproduces the observed [Eu/Fe] due to NSMs with a merger time of 100 Myr when the effect of metal mixing is taken into account. This is because metallicity is not correlated with time ∼300 Myr from the start of the simulation due to the low star formation efficiency in dSphs. We also confirm that this model is consistent with observed properties of dSphs such as radial profiles and metallicity distribution. The merger time and the Galactic rate of NSMs are suggested to be ≲300 Myr and ∼10{sup −4} year{sup −1}, respectively, which are consistent with the values suggested by population synthesis and nucleosynthesis studies. This study supports the argument that NSMs are the major astrophysical site of the r-process.

  7. VHA Support Service Center Electronic Wait List (EWL)

    Data.gov (United States)

    Department of Veterans Affairs — The goal of the Electronic Wait List (EWL) is to provide care to the patient as quickly as possible. To facilitate this goal, patients may be placed on a Wait List...

  8. Shell-model calculations of beta-decay rates for s- and r-process nucleosyntheses

    International Nuclear Information System (INIS)

    Takahashi, K.; Mathews, G.J.; Bloom, S.D.

    1985-01-01

    Examples of large-basis shell-model calculations of Gamow-Teller β-decay properties of specific interest in the astrophysical s- and r- processes are presented. Numerical results are given for: (1) the GT-matrix elements for the excited state decays of the unstable s-process nucleus 99 Tc; and (2) the GT-strength function for the neutron-rich nucleus 130 Cd, which lies on the r-process path. The results are discussed in conjunction with the astrophysics problems. 23 refs., 3 figs

  9. Maternity waiting homes in Rural Health Centers of Ethiop: The ...

    African Journals Online (AJOL)

    Conclusions: It is necessary to prepare guidelines for the establishment and management of waiting homes as well as set up admission and discharge criteria and to initiate quality control mechanisms. Keywords: Maternity waiting homes, waiting homes, prenatal care, intention to stay postpartum, postpartum care, Ethiopia, ...

  10. Waiting time distribution in M/D/1 queueing systems

    DEFF Research Database (Denmark)

    Iversen, Villy Bæk; Staalhagen, Lars

    1999-01-01

    The well-known formula for the waiting time distribution of M/D/1 queueing systems is numerically unsuitable when the load is close to 1.0 and/or the results for a large waiting time are required. An algorithm for any load and waiting time is presented, based on the state probabilities of M/D/1...

  11. Outpatient waiting time in Jos University Teaching Hospital ...

    African Journals Online (AJOL)

    Problem Long waiting time for services has been identified as a reason people avoid presenting to for care in African countries. Design Examination of causes for long outpatient waiting time and the effect of measures to reduce waiting time. Setting Outpatient department of the Jos University Teaching Hospital.

  12. Sustainability: orthopaedic surgery wait time management strategies.

    Science.gov (United States)

    Amar, Claudia; Pomey, Marie-Pascale; SanMartin, Claudia; De Coster, Carolyn; Noseworthy, Tom

    2015-01-01

    The purpose of this paper is to examine Canadian organizational and systemic factors that made it possible to keep wait times within federally established limits for at least 18 months. The research design is a multiple cases study. The paper selected three cases: Case 1 - staff were able to maintain compliance with requirements for more than 18 months; Case 2 - staff were able to meet requirements for 18 months, but unable to sustain this level; Case 3 - staff were never able to meet the requirements. For each case the authors interviewed persons involved in the strategies and collected documents. The paper analysed systemic and organizational-level factors; including governance and leadership, culture, resources, methods and tools. Findings indicate that the hospital that was able to maintain compliance with the wait time requirements had specific characteristics: an exclusive mandate to do only hip and knee replacement surgery; motivated staff who were not distracted by other concerns; and a strong team spirit. The authors' research highlights an important gradient between three cases regarding the factors that sustain waiting times. The paper show that the hospital factory model seems attractive in a super-specialized surgery context. However, patients are selected for simple surgeries, without complications, and so this cannot be considered a unique model.

  13. Waiting narratives of lung transplant candidates.

    Science.gov (United States)

    Yelle, Maria T; Stevens, Patricia E; Lanuza, Dorothy M

    2013-01-01

    Before 2005, time accrued on the lung transplant waiting list counted towards who was next in line for a donor lung. Then in 2005 the lung allocation scoring system was implemented, which meant the higher the illness severity scores, the higher the priority on the transplant list. Little is known of the lung transplant candidates who were listed before 2005 and were caught in the transition when the lung allocation scoring system was implemented. A narrative analysis was conducted to explore the illness narratives of seven lung transplant candidates between 2006 and 2007. Arthur Kleinman's concept of illness narratives was used as a conceptual framework for this study to give voice to the illness narratives of lung transplant candidates. Results of this study illustrate that lung transplant candidates expressed a need to tell their personal story of waiting and to be heard. Recommendation from this study calls for healthcare providers to create the time to enable illness narratives of the suffering of waiting to be told. Narrative skills of listening to stories of emotional suffering would enhance how healthcare providers could attend to patients' stories and hear what is most meaningful in their lives.

  14. Waiting Narratives of Lung Transplant Candidates

    Directory of Open Access Journals (Sweden)

    Maria T. Yelle

    2013-01-01

    Full Text Available Before 2005, time accrued on the lung transplant waiting list counted towards who was next in line for a donor lung. Then in 2005 the lung allocation scoring system was implemented, which meant the higher the illness severity scores, the higher the priority on the transplant list. Little is known of the lung transplant candidates who were listed before 2005 and were caught in the transition when the lung allocation scoring system was implemented. A narrative analysis was conducted to explore the illness narratives of seven lung transplant candidates between 2006 and 2007. Arthur Kleinman’s concept of illness narratives was used as a conceptual framework for this study to give voice to the illness narratives of lung transplant candidates. Results of this study illustrate that lung transplant candidates expressed a need to tell their personal story of waiting and to be heard. Recommendation from this study calls for healthcare providers to create the time to enable illness narratives of the suffering of waiting to be told. Narrative skills of listening to stories of emotional suffering would enhance how healthcare providers could attend to patients’ stories and hear what is most meaningful in their lives.

  15. Long gamma-ray burst as a production site of r-process elements

    International Nuclear Information System (INIS)

    Nakamrua, Ko; Harikae, Seiji; Kajino, Toshitaka; Mathews, Grant J.

    2012-01-01

    We simulated the r-process nucleosynthesis in and around a high entropy jet from a long gamma-ray burst (GRB). Our simulation is based on the collapsar scenario for long GRBs and on relativistic magnetohydrodynamic simulations (Harikae et al. 2009, 2010) including ray-tracing neutrino transport, which describe the development of the black hole accretion disk and the heating of the funnel region to produce a relativistic jet. The time evolution of the jet was then extended to later phase via axi-symmetric special relativistic hydrodynamic simulation to follow the temperature, entropy, electron fraction, and density evolution for representative test particles. The evolution of nuclear abundances from nucleons to heavy nuclei for representative test particle trajectories was solved in a large nuclear reaction network including more than 5000 isotopes. We show that a robust r-process successfully occurs within the collapsar jet outflow and that sufficient mass is ejected within the flow to account for the observed r-process abundance distribution along with the large dispersion in r-process elements observed in metal-poor halo stars.

  16. Microscopic calculations of β-decay characteristics near the A = 130 r-process peak

    International Nuclear Information System (INIS)

    Borzov, I.N.; Goriely, S.; Pearson, J.M.

    1997-01-01

    The β-decay half-lives of r-process nuclides near Z=50, N=82 shell closures are calculated within the finite Fermi-system theory. To describe the ground state properties, the ETFSI approximation has been used. Comparison is made with exact self-consistent calculations, previous large-scale predictions and experimental data. (orig.)

  17. Evolution of r-process elements in the hot supernova bubble

    International Nuclear Information System (INIS)

    Mathews, G.J.; Wilson, J.R.; Woosley, S.E.

    1993-02-01

    We review some of the recent arguments as to why the r-process is thought to be associated with supernovae and how the high-temperature, high-entropy inner region of a core-collapse supernova is an ideal r-process site. We present preliminary extensions of our earlier work on the formation of the high-entropy ''bubble'' that describe more accurately its late-time evolution and the ejection of the neutrino-energized wind from the surface of the nascent neutron star. This site leads naturally to a distribution of temperature, density, neutron excess, and entropy for material ejected at different times in the wind as required by Solar abundances. We present simple analytic expressions which approximate these distributions. This site also predicts an amount of reprocess material ejected per event in agreement with simple galactic evolution arguments. However, it is not yet clear whether the entropy in this model is high enough (or the electron fraction is low enough) to produce an optimum fit to the Solar r-process abundance curve and additional mechanisms may be required to increase the entropy per baryon. We conclude with a discussion of nuclear measurements which would help to probe this r-process environment

  18. THE LINK BETWEEN RARE-EARTH PEAK FORMATION AND THE ASTROPHYSICAL SITE OF THE R PROCESS

    Energy Technology Data Exchange (ETDEWEB)

    Mumpower, Matthew R. [Theory Division, Los Alamos National Laboratory, Los Alamos, NM 87544 (United States); McLaughlin, Gail C. [Department of Physics, North Carolina State University, Raleigh, NC 27695 (United States); Surman, Rebecca [Department of Physics, University of Notre Dame, Notre Dame, IN 46556 (United States); Steiner, Andrew W., E-mail: matthew@mumpower.net [Department of Physics and Astronomy, University of Tennessee, Knoxville, TN 37996 (United States)

    2016-12-20

    The primary astrophysical source of the rare-earth elements is the rapid neutron capture process ( r process). The rare-earth peak that is seen in the solar r -process residuals has been proposed to originate as a pile-up of nuclei during the end of the r process. We introduce a new method utilizing Monte Carlo studies of nuclear masses in the rare-earth region, that includes self-consistently adjusting β -decay rates and neutron capture rates, to find the mass surfaces necessary for the formation of the rare-earth peak. We demonstrate our method with two types of astrophysical scenario, one corresponding to conditions typical of hot winds from core-collapse supernovae and stellar-mass accretion disks, and one corresponding to conditions typical of the ejection of the material from the tidal tails of neutron star mergers. In each type of astrophysical condition, this method successfully locates a region of enhanced stability in the mass surface that is responsible for the rare-earth peak. For each scenario, we find that the change in the mass surface has qualitatively different features, thus future measurements can shed light on the type of environment in which the r process occurred.

  19. Complete Element Abundances of Nine Stars in the r-process Galaxy Reticulum II

    Science.gov (United States)

    Ji, Alexander P.; Frebel, Anna; Simon, Joshua D.; Chiti, Anirudh

    2016-10-01

    We present chemical abundances derived from high-resolution Magellan/Magellan Inamori Kyocera Echelle spectra of the nine brightest known red giant members of the ultra-faint dwarf galaxy Reticulum II (Ret II). These stars span the full metallicity range of Ret II (-3.5 contaminated known r-process pattern. The abundances of lighter elements up to the iron peak are otherwise similar to abundances of stars in the halo and in other ultra-faint dwarf galaxies. However, the scatter in abundance ratios is large enough to suggest that inhomogeneous metal mixing is required to explain the chemical evolution of this galaxy. The presence of low amounts of neutron-capture elements in other ultra-faint dwarf galaxies may imply the existence of additional r-process sites besides the source of r-process elements in Ret II. Galaxies like Ret II may be the original birth sites of r-process enhanced stars now found in the halo. This paper includes data gathered with the 6.5 m Magellan Telescopes located at Las Campanas Observatory, Chile.

  20. THE LINK BETWEEN RARE-EARTH PEAK FORMATION AND THE ASTROPHYSICAL SITE OF THE R PROCESS

    International Nuclear Information System (INIS)

    Mumpower, Matthew R.; McLaughlin, Gail C.; Surman, Rebecca; Steiner, Andrew W.

    2016-01-01

    The primary astrophysical source of the rare-earth elements is the rapid neutron capture process ( r process). The rare-earth peak that is seen in the solar r -process residuals has been proposed to originate as a pile-up of nuclei during the end of the r process. We introduce a new method utilizing Monte Carlo studies of nuclear masses in the rare-earth region, that includes self-consistently adjusting β -decay rates and neutron capture rates, to find the mass surfaces necessary for the formation of the rare-earth peak. We demonstrate our method with two types of astrophysical scenario, one corresponding to conditions typical of hot winds from core-collapse supernovae and stellar-mass accretion disks, and one corresponding to conditions typical of the ejection of the material from the tidal tails of neutron star mergers. In each type of astrophysical condition, this method successfully locates a region of enhanced stability in the mass surface that is responsible for the rare-earth peak. For each scenario, we find that the change in the mass surface has qualitatively different features, thus future measurements can shed light on the type of environment in which the r process occurred.

  1. Methodology for Analysis, Modeling and Simulation of Airport Gate-waiting Delays

    Science.gov (United States)

    Wang, Jianfeng

    This dissertation presents methodologies to estimate gate-waiting delays from historical data, to identify gate-waiting-delay functional causes in major U.S. airports, and to evaluate the impact of gate operation disruptions and mitigation strategies on gate-waiting delay. Airport gates are a resource of congestion in the air transportation system. When an arriving flight cannot pull into its gate, the delay it experiences is called gate-waiting delay. Some possible reasons for gate-waiting delay are: the gate is occupied, gate staff or equipment is unavailable, the weather prevents the use of the gate (e.g. lightning), or the airline has a preferred gate assignment. Gate-waiting delays potentially stay with the aircraft throughout the day (unless they are absorbed), adding costs to passengers and the airlines. As the volume of flights increases, ensuring that airport gates do not become a choke point of the system is critical. The first part of the dissertation presents a methodology for estimating gate-waiting delays based on historical, publicly available sources. Analysis of gate-waiting delays at major U.S. airports in the summer of 2007 identifies the following. (i) Gate-waiting delay is not a significant problem on majority of days; however, the worst delay days (e.g. 4% of the days at LGA) are extreme outliers. (ii) The Atlanta International Airport (ATL), the John F. Kennedy International Airport (JFK), the Dallas/Fort Worth International Airport (DFW) and the Philadelphia International Airport (PHL) experience the highest gate-waiting delays among major U.S. airports. (iii) There is a significant gate-waiting-delay difference between airlines due to a disproportional gate allocation. (iv) Gate-waiting delay is sensitive to time of a day and schedule peaks. According to basic principles of queueing theory, gate-waiting delay can be attributed to over-scheduling, higher-than-scheduled arrival rate, longer-than-scheduled gate-occupancy time, and reduced gate

  2. Astrophysical site(s of r-process elements in galactic chemodynamical evolution model

    Directory of Open Access Journals (Sweden)

    Hirai Yutaka

    2016-01-01

    Full Text Available Astrophysical site(s of rapid neutron-capture process (r-process is (are not identified yet. Although core-collapse supernovae have been regarded as one of the possible candidates of the astrophysical site of r-process, nucleosynthesis studies suggest that serious difficulties in core-collapse supernovae to produce heavy elements with mass number of ≳110. Recent studies show that neutron star mergers (NSMs can synthesize these elements due to their neutron rich environment. Some chemical evolution studies of the Milky Way halo, however, hardly reproduce the observed star-to-star scatters of the abundance ratios of r-process elements (e.g., Eu in extremely metal-poor stars. This is because of their low rate (∼ 10−4 yr−1 for a Milky Way size galaxy and long merger time (≳ 100 Myr. This problem might be solved if the stars in the Galactic halo are consisted of the stars formed in dwarf galaxies where the star formation efficiencies were very low. In this study, we carry out numerical simulations of galactic chemo-dynamical evolution using an N-body/smoothed particle hydrodynamics code. We construct detailed chemo-dynamical evolution model for the Local Group dwarf spheroidal galaxies (dSphs assuming that the NSMs are the major source of r-process elements. Our models successfully reproduce the observed dispersion in [Eu/Fe] as a function of [Fe/H] if we set merger time of NSMs, ≲ 300 Myr with the Galactic NSM rate of ∼ 10−4 yr−1. In addition, our results are consistent with the observed metallicity distribution of dSphs. In the early phase (≲1 Gyr of galaxy evolution is constant due to low star formation efficiency of dSphs. This study supports the idea that NSMs are the major site of r-process nucleosynthesis.

  3. The Origin of r-process Elements in the Milky Way

    Science.gov (United States)

    Côté, Benoit; Fryer, Chris L.; Belczynski, Krzysztof; Korobkin, Oleg; Chruślińska, Martyna; Vassh, Nicole; Mumpower, Matthew R.; Lippuner, Jonas; Sprouse, Trevor M.; Surman, Rebecca; Wollaeger, Ryan

    2018-03-01

    Some of the heavy elements, such as gold and europium (Eu), are almost exclusively formed by the rapid neutron capture process (r-process). However, it is still unclear which astrophysical site between core-collapse supernovae and neutron star–neutron star (NS–NS) mergers produced most of the r-process elements in the universe. Galactic chemical evolution (GCE) models can test these scenarios by quantifying the frequency and yields required to reproduce the amount of europium (Eu) observed in galaxies. Although NS–NS mergers have become popular candidates, their required frequency (or rate) needs to be consistent with that obtained from gravitational wave measurements. Here, we address the first NS–NS merger detected by LIGO/Virgo (GW170817) and its associated gamma-ray burst and analyze their implication for the origin of r-process elements. The range of NS–NS merger rate densities of 320–4740 Gpc‑3 yr‑1 provided by LIGO/Virgo is remarkably consistent with the range required by GCE to explain the Eu abundances in the Milky Way with NS–NS mergers, assuming the solar r-process abundance pattern for the ejecta. Under the same assumption, this event has produced about 1–5 Earth masses of Eu, and 3–13 Earth masses of gold. When using theoretical calculations to derive Eu yields, constraining the role of NS–NS mergers becomes more challenging because of nuclear astrophysics uncertainties. This is the first study that directly combines nuclear physics uncertainties with GCE calculations. If GW170817 is a representative event, NS–NS mergers can produce Eu in sufficient amounts and are likely to be the main r-process site.

  4. The R-process: supernovae and other sources of the heaviest elements

    International Nuclear Information System (INIS)

    Thielemann, F.-K.; Moceli, D.; Panov, I.

    2007-01-01

    Rapid neutron capture in stellar explosions is responsible for the heaviest elements in nature, up to Th, U and beyond. This nucleosynthesis process, the r-process, is unique in the sense that a combination of nuclear physics far from stability (masses, half-lives, neutron-capture and photodisintegration, neutron-induced and beta-delayed fission and last but not least neutrino-nucleus interactions) is intimately linked to ejecta from astrophysical explosions (core collapse supernovae or other neutron star related events). The astrophysics and nuclear physics involved still harbor many uncertainties, either in the extrapolation of nuclear properties far beyond present experimental explorations or in the modeling of multidimensional, general relativistic (neutrino-radiation) hydrodynamics with rotation and possibly required magnetic fields. Observational clues about the working of the r-process are mostly obtained from solar abundances and from the abundance evolution of the heaviest elements as a function of galactic age, as witnessed in old extremely metal-poor stars. They contain information whether the r-process is identical for all stellar events, how abundance features develop with galactic time and whether the frequency of r-process events is comparable to that of average core collapse supernovae - producing oxygen through titanium, as well as iron-group nuclei. The theoretical modeling of the r-process has advanced from simple approaches, where the use of static neutron densities and temperatures can aid to test the influence of nuclear properties far from stability on abundance features, to more realistic expansions with a given entropy, global neutron/proton ratio and expansion timescales, as expected from explosive astrophysical events. The direct modeling in astrophysical events such as supernovae still faces the problem whether the required conditions can be met. (author)

  5. Learning to wait: A laboratory investigation

    Science.gov (United States)

    Oprea, R.; Friedman, D.; Anderson, S.T.

    2009-01-01

    Human subjects decide when to sink a fixed cost C to seize an irreversible investment opportunity whose value V is governed by Brownian motion. The optimal policy is to invest when V first crosses a threshold V* = (1 + w*) C, where the wait option premium w* depends on drift, volatility, and expiration hazard parameters. Subjects in the Low w* treatment on average invest at values quite close to optimum. Subjects in the two Medium and the High w* treatments invested at values below optimum, but with the predicted ordering, and values approached the optimum by the last block of 20 periods. ?? 2009 The Review of Economic Studies Limited.

  6. Evidence for supernova injection into the solar nebula and the decoupling of r-process nucleosynthesis.

    Science.gov (United States)

    Brennecka, Gregory A; Borg, Lars E; Wadhwa, Meenakshi

    2013-10-22

    The isotopic composition of our Solar System reflects the blending of materials derived from numerous past nucleosynthetic events, each characterized by a distinct isotopic signature. We show that the isotopic compositions of elements spanning a large mass range in the earliest formed solids in our Solar System, calcium-aluminum-rich inclusions (CAIs), are uniform, and yet distinct from the average Solar System composition. Relative to younger objects in the Solar System, CAIs contain positive r-process anomalies in isotopes A 140. This fundamental difference in the isotopic character of CAIs around mass 140 necessitates (i) the existence of multiple sources for r-process nucleosynthesis and (ii) the injection of supernova material into a reservoir untapped by CAIs. A scenario of late supernova injection into the protoplanetary disk is consistent with formation of our Solar System in an active star-forming region of the galaxy.

  7. Neutrino-induced neutral-current reaction cross sections for r-process nuclei

    CERN Document Server

    Langanke, K

    2002-01-01

    Neutrino-induced reactions play an important role during and after the r-process, if the latter occurs in an environment with extreme neutrino fluxes such as the neutrino-driven wind model or neutron star mergers. Recently we have evaluated the charged-current neutrino-nucleus cross sections relevant for r-process simulations. We extend our approach here to the neutral-current cross sections. Our tabulation considers neutron-rich nuclei with neutron numbers N=41-135 and charge numbers Z=21-82 and lists total as well as partial neutron spallation cross sections. The calculations have been performed within the random phase approximation considering multipole transitions with J<=3 and both parities. The supernova neutrino spectrum is described by a Fermi-Dirac distribution with various temperature parameters between T=2.8 MeV and T=10 MeV and with the degeneracy parameters alpha=0 and alpha=3.

  8. THE UNREASONABLE WEAKNESS OF R -PROCESS COSMIC RAYS IN THE NEUTRON-STAR-MERGER NUCLEOSYNTHESIS SCENARIO

    Energy Technology Data Exchange (ETDEWEB)

    Kyutoku, Koutarou [Interdisciplinary Theoretical Science (iTHES) Research Group, RIKEN, Wako, Saitama 351-0198 (Japan); Ioka, Kunihito, E-mail: koutarou.kyutoku@riken.jp [Center for Gravitational Physics, Yukawa Institute for Theoretical Physics, Kyoto University, Kyoto, 606-8502 (Japan)

    2016-08-10

    We reach the robust conclusion that, by combining the observed cosmic rays of r -process elements with the fact that the velocity of the neutron-star-merger ejecta is much higher than that of the supernova ejecta, either (1) the reverse shock in the neutron-star-merger ejecta is a very inefficient accelerator that converts less than 0.003% of the ejecta kinetic energy to the cosmic-ray energy or (2) the neutron star merger is not the origin of the Galactic r -process elements. We also find that the acceleration efficiency should be less than 0.1% for the reverse shock of the supernova ejecta with observed cosmic rays lighter than the iron.

  9. Large-scale calculations of the beta-decay rates and r-process nucleosynthesis

    Energy Technology Data Exchange (ETDEWEB)

    Borzov, I N; Goriely, S [Inst. d` Astronomie et d` Astrophysique, Univ. Libre de Bruxelles, Campus Plaine, Bruxelles (Belgium); Pearson, J M [Inst. d` Astronomie et d` Astrophysique, Univ. Libre de Bruxelles, Campus Plaine, Bruxelles (Belgium); [Lab. de Physique Nucleaire, Univ. de Montreal, Montreal (Canada)

    1998-06-01

    An approximation to a self-consistent model of the ground state and {beta}-decay properties of neutron-rich nuclei is outlined. The structure of the {beta}-strength functions in stable and short-lived nuclei is discussed. The results of large-scale calculations of the {beta}-decay rates for spherical and slightly deformed nuclides of relevance to the r-process are analysed and compared with the results of existing global calculations and recent experimental data. (orig.)

  10. Advanced LIGO constraints on neutron star mergers and r-process sites

    International Nuclear Information System (INIS)

    Côté, Benoit; Belczynski, Krzysztof; Fryer, Chris L.; Ritter, Christian

    2017-01-01

    The role of compact binary mergers as the main production site of r-process elements is investigated by combining stellar abundances of Eu observed in the Milky Way, galactic chemical evolution (GCE) simulations, and binary population synthesis models, and gravitational wave measurements from Advanced LIGO. We compiled and reviewed seven recent GCE studies to extract the frequency of neutron star–neutron star (NS–NS) mergers that is needed in order to reproduce the observed [Eu/Fe] versus [Fe/H] relationship. We used our simple chemical evolution code to explore the impact of different analytical delay-time distribution functions for NS–NS mergers. We then combined our metallicity-dependent population synthesis models with our chemical evolution code to bring their predictions, for both NS–NS mergers and black hole–neutron star mergers, into a GCE context. Finally, we convolved our results with the cosmic star formation history to provide a direct comparison with current and upcoming Advanced LIGO measurements. When assuming that NS–NS mergers are the exclusive r-process sites, and that the ejected r-process mass per merger event is 0.01 M_⊙, the number of NS–NS mergers needed in GCE studies is about 10 times larger than what is predicted by standard population synthesis models. Here, these two distinct fields can only be consistent with each other when assuming optimistic rates, massive NS–NS merger ejecta, and low Fe yields for massive stars. For now, population synthesis models and GCE simulations are in agreement with the current upper limit (O1) established by Advanced LIGO during their first run of observations. Upcoming measurements will provide an important constraint on the actual local NS–NS merger rate, will provide valuable insights on the plausibility of the GCE requirement, and will help to define whether or not compact binary mergers can be the dominant source of r-process elements in the universe.

  11. Neutrino-heated winds from millisecond protomagnetars as sources of the weak r-process

    Science.gov (United States)

    Vlasov, Andrey D.; Metzger, Brian D.; Lippuner, Jonas; Roberts, Luke F.; Thompson, Todd A.

    2017-06-01

    We explore heavy element nucleosynthesis in neutrino-driven winds from rapidly rotating, strongly magnetized protoneutron stars ('millisecond protomagnetars') for which the magnetic dipole is aligned with the rotation axis, and the field is assumed to be a static force-free configuration. We process the protomagnetar wind trajectories calculated by Vlasov, Metzger & Thompson through the r-process nuclear reaction network SkyNet using contemporary models for the evolution of the wind electron fraction during the protoneutron star cooling phase. Although we do not find a successful second or third-peak r-process for any rotation period P, we show that protomagnetars with P ˜ 1-5 ms produce heavy element abundance distributions that extend to higher nuclear mass number than from otherwise equivalent spherical winds (with the mass fractions of some elements enhanced by factors of ≳100-1000). The heaviest elements are synthesized by outflows emerging along flux tubes that graze the closed zone and pass near the equatorial plane outside the light cylinder. Due to dependence of the nucleosynthesis pattern on the magnetic field strength and rotation rate of the protoneutron star, natural variations in these quantities between core collapse events could contribute to the observed diversity of the abundances of weak r-process nuclei in metal-poor stars. Further diversity, including possibly even a successful third-peak r-process, could be achieved for misaligned rotators with non-zero magnetic inclination with respect to the rotation axis. If protomagnetars are central engines for GRBs, their relativistic jets should contain a high-mass fraction of heavy nuclei of characteristic mass number \\bar{A}≈ 100, providing a possible source for ultrahigh energy cosmic rays comprised of heavy nuclei with an energy spectrum that extends beyond the nominal Grezin-Zatsepin-Kuzmin cut-off for protons or iron nuclei.

  12. Reactions to waiting online by men and women.

    Science.gov (United States)

    Chebat, Jean-Charles; Salem, Narjes Haj; Poirier, Jean-François; Gélinas-Chebat, Claire

    2010-06-01

    The goal of the present study was to identify factors which may affect the difference between the actual time participants expected to wait for downloading a web page and the perceived waiting time, i.e., the online waiting-time gap. The findings from an experiment in which the music tempo (fast vs. slow) and waiting-duration information (presence vs. absence) were manipulated showed that sex moderated the relation between the manipulated variables and waiting-time gap; emotional response was more important between the manipulated variables and waiting-time gap than was cognitive response. The type of emotional response with an effect on waiting-time gap varied by sex: pleasure for women and arousal for men. For women, pleasure was affected by their cognitive response, while cognitive response played no significant role for men. For both sexes, information on waiting duration increased the perceived waiting time. This study leads to reconsidering the role of emotional response and sex in evaluating waiting time.

  13. Neutrino-induced charged-current reaction rates for r-process nuclei

    CERN Document Server

    Langanke, K

    2001-01-01

    Neutrino-induced reactions play an important role during and after the r-process if it occurs in an environment with extreme neutrino fluxes, as in the neutrino-driven wind model or neutron star mergers. The neutrino reactions can excite the daughter nucleus above the neutron threshold, which is quite low for r-process nuclei. Thus the daughter nucleus will decay by emission of one or several neutrons. We have calculated the relevant total (nu sub e , e sup -) cross sections as well as the partial neutron spallation cross sections for r-process nuclei with neutron numbers N=41-135 and proton numbers Z=21-82. The supernova neutrino spectrum is described by a Fermi-Dirac distribution with various temperature parameters between T=2.8 MeV and T=10 MeV and with the degeneracy parameters alpha=0 and alpha=3. Our calculations of the nuclear response are based on the random phase approximation and consider allowed as well as forbidden transitions.

  14. Waiting list in a public health facility in Santiago, Chile

    Directory of Open Access Journals (Sweden)

    Alejandro Letelier

    2014-07-01

    Full Text Available Introduction Waiting lists are a well-known problem in public healthcare systems worldwide. For instance, England had over one million people in waiting lists for elective surgical procedures in 2000. Spain had over 360 000 patients in surgical waiting lists in 2007. Chile has been trying to manage waiting times through the GES (Explicit Guarantees in Healthcare plan, which was established by the Chilean government in 2005. Waiting lists for the guaranteed-care diseases in the GES plan had 380 000 patients at the beginning of 2010, and that number was reduced to zero in 2011. Internationally, there are some descriptive studies about waiting lists that focus on variables such as waiting times and number of patients in the list. In Chile, however, this type of study is lacking. Purpose This study aims to describe the characteristics of waiting lists for medical specialties between April and October 2011. It also aims to identify the components of management models in public healthcare centers, and to identify and analyze waiting-time frames of patients referred to a secondary or tertiary healthcare public center from a public primary healthcare center. Methods A descriptive cross-sectional study of the waiting list for first-time consultations for medical specialties was carried out. Referred patients were described and grouped using indicators of access to healthcare and waiting time between April and October 2011. Each consultation request or referral of a new patient was included in the waiting list and analyzed. Results There were 15 935 requests for consultations; 5 717 requests were resolved, and 8 544 were not (54% of the total requests for consultation. There was a mean waiting time of 498 days for non-resolved requests for consultation, and a mean of 141 days for resolved requests. The specialties in highest demand were orthopedic surgery and ophthalmology. The main waiting-list management processes were referral and reception of requests

  15. Estimating bus passenger waiting times from incomplete bus arrivals data

    OpenAIRE

    McLeod, F.N.

    2007-01-01

    This paper considers the problem of estimating bus passenger waiting times at bus stops using incomplete bus arrivals data. This is of importance to bus operators and regulators as passenger waiting time is a key performance measure. Average waiting times are usually estimated from bus headways, that is, time gaps between buses. It is both time-consuming and expensive to measure bus arrival times manually so methods using automatic vehicle location systems are attractive; however, these syste...

  16. The Effects of Immigration on NHS Waiting Times

    OpenAIRE

    Giuntella, Osea; Nicodemo, Catia; Vargas-Silva, Carlos

    2015-01-01

    This paper analyses the effects of immigration on waiting times in the National Health Service (NHS) in England. Linking administrative records from the Hospital Episode Statistics (2003-2012) with immigration data drawn from the UK Labour Force Survey, we find that immigration reduced waiting times for outpatient referrals and did not have significant effects on waiting times in Accident and Emergency (A&E) and elective care. These results are explained by the fact that immigration increases...

  17. Waiting room time: An opportunity for parental oral health education.

    Science.gov (United States)

    Soussou, Randa; Aleksejūnienė, Jolanta; Harrison, Rosamund

    2017-09-14

    The UBC Children's Dental Program (CDP) has provided free dental treatments to underserved low-income children, but its preventive component needs to be enhanced. The study aims were: 1) to develop a "waiting-room based" dental education program engaging caregivers of these children, and 2) to assess the program's feasibility, acceptability and effectiveness. In preparation, a situational analysis (SA) included structured interviews with caregivers, and with various stakeholders (e.g., dental students, instructors, health authority) involved in the CDP program. Based on the SA, caregiver-centered education was designed using an interactive power point presentation; after the presentation, each caregiver set personalized goals for modifying his/her child's dental behaviours. Evaluation of the program was done with follow-up telephone calls; the program's effectiveness was assessed by comparing before/after proportions of caregivers brushing their child's teeth, children brushing teeth in the morning and evening, children eating sugar-containing snacks, and children drinking sugar-containing drinks. The program proved to be easy to implement (feasible) and the recruitment rate was 99% (acceptable). The follow-up rate was 81%. The SA identified that the caregivers' knowledge about caries etiology and prevention was limited. All recruited caregivers completed the educational session and set goals for their family. The evaluation demonstrated an increase in caregiver-reported short-term diet and oral self-care behaviours of their children. A dental education program engaging caregivers in the waiting room was a feasible, acceptable and promising strategy for improving short-term dental behaviours of children.

  18. 'Waiting for' and 'waiting in' public and private hospitals: a qualitative study of patient trust in South Australia.

    Science.gov (United States)

    Ward, Paul R; Rokkas, Philippa; Cenko, Clinton; Pulvirenti, Mariastella; Dean, Nicola; Carney, A Simon; Meyer, Samantha

    2017-05-05

    Waiting times for hospital appointments, treatment and/or surgery have become a major political and health service problem, leading to national maximum waiting times and policies to reduce waiting times. Quantitative studies have documented waiting times for various types of surgery and longer waiting times in public vs private hospitals. However, very little qualitative research has explored patient experiences of waiting, how this compares between public and private hospitals, and the implications for trust in hospitals and healthcare professionals. The aim of this paper is to provide a deep understanding of the impact of waiting times on patient trust in public and private hospitals. A qualitative study in South Australia, including 36 in-depth interviews (18 from public and 18 from private hospitals). Data collection occurred in 2012-13, and data were analysed using pre-coding, followed by conceptual and theoretical categorisation. Participants differentiated between experiences of 'waiting for' (e.g. for specialist appointments and surgery) and 'waiting in' (e.g. in emergency departments and outpatient clinics) public and private hospitals. Whilst 'waiting for' public hospitals was longer than private hospitals, this was often justified and accepted by public patients (e.g. due to reduced government funding), therefore it did not lead to distrust of public hospitals. Private patients had shorter 'waiting for' hospital services, increasing their trust in private hospitals and distrust of public hospitals. Public patients also recounted many experiences of longer 'waiting in' public hospitals, leading to frustration and anxiety, although they rarely blamed or distrusted the doctors or nurses, instead blaming an underfunded system and over-worked staff. Doctors and nurses were seen to be doing their best, and therefore trustworthy. Although public patients experienced longer 'waiting for' and 'waiting in' public hospitals, it did not lead to widespread distrust

  19. TSA Security Checkpoint Wait Times – API (PMIS)

    Data.gov (United States)

    Department of Homeland Security — TSA operational data including: Airport wait time (hourly) data Airport throughput (hourly) data Prohibited item (hourly) data Monthly Objectives Report (MOR) data...

  20. Waiting for the Barbarians: Conrad, Kafka, Coetzee

    Directory of Open Access Journals (Sweden)

    Simona Micali

    2017-12-01

    Full Text Available The threat of the “Barbarians at the gates”, who bring chaos and death upon civilization, has gradually become one of the thematic obsessions of contemporary imagination. Along the course of the 20th century, the Enemy became less and less the bearer of another culture, and more and more the carrier of a Nonculture or an Anticulture. Such evolution is particularly evident in popular imagination, in all the comics and blockbuster films which stage the final battle between the heros of (white, Western civilization against a dreadful army of barbarian enemies. The article focus on three works – Heart of Darkness by Joseph Conrad, Beim Bau der chinesischen Mauer by Franz Kafka, Waiting for the Barbarians by J.M. Coetzee – which investigate on this mechanism from within, highlighting its ideological implications and its tragic potential.

  1. Workshop: Waiting for the top quark

    International Nuclear Information System (INIS)

    Anon.

    1991-01-01

    The world of elementary particle physics is eagerly waiting for the top quark, probably the final element of the 'periodic table' of elementary particle constituents. This table consists of two families of weakly interacting particles (leptons) - one series carrying electric charge; the other being electrically neutral - together with a family of quarks carrying electric charge 2/3 (up, charm, top) and a family of charge -1/3 quarks (down, strange, beauty). It was then not surprising that the 1990 Theory Workshop at the DESY Laboratory in Hamburg in October, devoted this time to 'top physics', attracted some 200 physicists, substantially more than previous workshops in the series

  2. Relativistic QRPA calculation of β-decay rates of r-process nuclei

    International Nuclear Information System (INIS)

    Marketin, T.; Paar, N.; Niksic, T.

    2009-01-01

    The rapid neutron-capture process (r-process) is responsible for the creation of many nuclei heavier than iron. To describe the r-process, precise data is needed on a large number of neutron-rich nuclei, most of which are not experimentally reachable. One crucial parameter in modeling the nucleosynthesis are the half-lives of the nuclei through which the r-process runs. Therefore, it is of great importance to develop a reliable predictive model which can be applied to the decay of exotic nuclei. A fully self-consistent calculation of β-decay rates is presented, based on a microscopic theoretical framework. Nuclear ground state is determined using the Relativistic Hartree-Bogoliubov (RHB) model with density-dependent meson-nucleon coupling constants. Momentum dependent terms are also included to improve the density of single-particle states around the Fermi level via an increase of the effective nucleon mass [1]. Transition rates are calculated within the proton-neutron relativistic quasiparticle RPA using the same interaction that was used in the RHB equations. In this way no additional parameters are introduced in the RPA calculation. Weak interaction rates are calculated using the current-current formalism previously employed in the study of other astrophysically significant weak processes [2,3], which systematically includes the contributions of forbidden transitions. This theoretical framework will be utilized to study the contributions of forbidden transitions to the total decay rate in several mass regions. We will compare the calculated half-lives for several isotopic chains with previous calculations and experimental data and discuss possible improvements to the model.(author)

  3. Realistic fission models, new beta-decay half-lives and the r-process in neutron star mergers

    International Nuclear Information System (INIS)

    Shibagaki, S.; Kajino, T.; Chiba, S.; Lorusso, G.; Nishimura, S.; Mathews, G. J.

    2014-01-01

    Almost half of heavy nuclei beyond iron are considered to be produced by rapid neutron capture process (r-process). This process occurs in the neutron-rich environment such as core-collapse supernovae or neutron star mergers, but the main production site is still unknown. In the r-process of neutron star mergers, nuclear fission reactions play an important role. Also beta-decay half-lives of magic nuclei are crucial for the r-process. We have carried out r-process nucleosynthesis calculations based upon new theoretical estimates of fission fragment distributions and new beta-decay half-lives for N=82 nuclei measured at RIBF-RIKEN. We investigate the effect of nuclear fission on abundance patterns in the matter ejected from neutron star mergers with two different fission fragment mass distributions. We also discuss how the new experimental beta-decay half-lives affect the r-process

  4. Indium oxide deposition on glass by aerosol pyrolysis (Pyrosol (R) process)

    International Nuclear Information System (INIS)

    Blandenet, G.; Lagarde, Y.; Spitz, J.

    1975-01-01

    The pyrosol (R) process involves the pyrolysis of an aerosol generated by ultrasonic nebulisation from a solution of organic or inorganic compounds. This technique was used to deposit transparent n-conducting indium oxide films on glass. The electrical and optical properties of these films were studied as a function of the deposition temperature and doping (using tin or fluorine). A deposition temperature of 480 deg C and a Sn/In ratio of about 5% gave the best results. In this case, the transmission in the visible range was 92%, the infrared reflection 84% and the electrical resistivity 1.7x10 -4 ohm.cm [fr

  5. Active-sterile neutrino conversion: consequences for the r-process and supernova neutrino detection

    Science.gov (United States)

    Fetter, J.; McLaughlin, G. C.; Balantekin, A. B.; Fuller, G. M.

    2003-02-01

    We examine active-sterile neutrino conversion in the late time post-core-bounce supernova environment. By including the effect of feedback on the Mikheyev-Smirnov-Wolfenstein (MSW) conversion potential, we obtain a large range of neutrino mixing parameters which produce a favorable environment for the r-process. We look at the signature of this effect in the current generation of neutrino detectors now coming on line. We also investigate the impact of the neutrino-neutrino forward-scattering-induced potential on the MSW conversion.

  6. Burst wait time simulation of CALIBAN reactor at delayed super-critical state

    International Nuclear Information System (INIS)

    Humbert, P.; Authier, N.; Richard, B.; Grivot, P.; Casoli, P.

    2012-01-01

    In the past, the super prompt critical wait time probability distribution was measured on CALIBAN fast burst reactor [4]. Afterwards, these experiments were simulated with a very good agreement by solving the non-extinction probability equation [5]. Recently, the burst wait time probability distribution has been measured at CEA-Valduc on CALIBAN at different delayed super-critical states [6]. However, in the delayed super-critical case the non-extinction probability does not give access to the wait time distribution. In this case it is necessary to compute the time dependent evolution of the full neutron count number probability distribution. In this paper we present the point model deterministic method used to calculate the probability distribution of the wait time before a prescribed count level taking into account prompt neutrons and delayed neutron precursors. This method is based on the solution of the time dependent adjoint Kolmogorov master equations for the number of detections using the generating function methodology [8,9,10] and inverse discrete Fourier transforms. The obtained results are then compared to the measurements and Monte-Carlo calculations based on the algorithm presented in [7]. (authors)

  7. Burst wait time simulation of CALIBAN reactor at delayed super-critical state

    Energy Technology Data Exchange (ETDEWEB)

    Humbert, P. [Commissariat a l' Energie Atomique CEA, Centre de Bruyeres-le-Chatel, 91297 Arpajon (France); Authier, N.; Richard, B.; Grivot, P.; Casoli, P. [Commissariat a l' Energie Atomique CEA, Centre de Valduc, 21120 Is-sur-Tille (France)

    2012-07-01

    In the past, the super prompt critical wait time probability distribution was measured on CALIBAN fast burst reactor [4]. Afterwards, these experiments were simulated with a very good agreement by solving the non-extinction probability equation [5]. Recently, the burst wait time probability distribution has been measured at CEA-Valduc on CALIBAN at different delayed super-critical states [6]. However, in the delayed super-critical case the non-extinction probability does not give access to the wait time distribution. In this case it is necessary to compute the time dependent evolution of the full neutron count number probability distribution. In this paper we present the point model deterministic method used to calculate the probability distribution of the wait time before a prescribed count level taking into account prompt neutrons and delayed neutron precursors. This method is based on the solution of the time dependent adjoint Kolmogorov master equations for the number of detections using the generating function methodology [8,9,10] and inverse discrete Fourier transforms. The obtained results are then compared to the measurements and Monte-Carlo calculations based on the algorithm presented in [7]. (authors)

  8. Patients' perceptions of waiting for bariatric surgery: a qualitative study.

    Science.gov (United States)

    Gregory, Deborah M; Temple Newhook, Julia; Twells, Laurie K

    2013-10-18

    In Canada waiting lists for bariatric surgery are common, with wait times on average > 5 years. The meaning of waiting for bariatric surgery from the patients' perspective must be understood if health care providers are to act as facilitators in promoting satisfaction with care and quality care outcomes. The aims of this study were to explore patients' perceptions of waiting for bariatric surgery, the meaning and experience of waiting, the psychosocial and behavioral impact of waiting for treatment and identify health care provider and health system supportive measures that could potentially improve the waiting experience. Twenty-one women and six men engaged in in-depth interviews that were digitally recorded, transcribed verbatim and analysed using a grounded theory approach to data collection and analysis between June 2011 and April 2012. The data were subjected to re-analysis to identify perceived health care provider and health system barriers to accessing bariatric surgery. Thematic analysis identified inequity as a barrier to accessing bariatric surgery. Three areas of perceived inequity were identified from participants' accounts: socioeconomic inequity, regional inequity, and inequity related to waitlist prioritization. Although excited about their acceptance as candidates for surgery, the waiting period was described as stressful, anxiety provoking, and frustrating. Anger was expressed towards the health care system for the long waiting times. Participants identified the importance of health care provider and health system supports during the waiting period. Recommendations on how to improve the waiting experience included periodic updates from the surgeon's office about their position on the wait list; a counselor who specializes in helping people going through this surgery, dietitian support and further information on what to expect after surgery, among others. Patients' perceptions of accessing and waiting for bariatric surgery are shaped by perceived

  9. What Are We Waiting For Customer Wait Time, Fill Rate, And Marine Corps Equipment Operational Availability

    Science.gov (United States)

    2016-12-01

    directed the use of Customer Wait Time (CWT) as a measure of supply chain performance (Department of Defense [DOD], 2000). CWT is defined as “the total...time elapsed between issuance of a customer order and satisfaction of the order” (United States Marine Corps [USMC], 2014, pp. 2–29). In theory...rate is a widely used metric for setting inventory levels and is also a useful measure of customer satisfaction . In general, high fill-rates can be

  10. The influence of collective neutrino oscillations on a supernova r process

    Science.gov (United States)

    Duan, Huaiyu; Friedland, Alexander; McLaughlin, Gail C.; Surman, Rebecca

    2011-03-01

    Recently, it has been demonstrated that neutrinos in a supernova oscillate collectively. This process occurs much deeper than the conventional matter-induced Mikheyev-Smirnov-Wolfenstein effect and hence may have an impact on nucleosynthesis. In this paper we explore the effects of collective neutrino oscillations on the r-process, using representative late-time neutrino spectra and outflow models. We find that accurate modeling of the collective oscillations is essential for this analysis. As an illustration, the often-used 'single-angle' approximation makes grossly inaccurate predictions for the yields in our setup. With the proper multiangle treatment, the effect of the oscillations is found to be less dramatic, but still significant. Since the oscillation patterns are sensitive to the details of the emitted fluxes and the sign of the neutrino mass hierarchy, so are the r-process yields. The magnitude of the effect also depends sensitively on the astrophysical conditions—in particular on the interplay between the time when nuclei begin to exist in significant numbers and the time when the collective oscillation begins. A more definitive understanding of the astrophysical conditions, and accurate modeling of the collective oscillations for those conditions, is necessary.

  11. Wait watchers: the application of a waiting list active management program in ambulatory care.

    Science.gov (United States)

    de Belvis, Antonio Giulio; Marino, Marta; Avolio, Maria; Pelone, Ferruccio; Basso, Danila; Dei Tos, Gian Antonio; Cinquetti, Sandro; Ricciardi, Walter

    2013-04-01

    This study describes and evaluates the application of a waiting list management program in ambulatory care. Waiting list active management survey (telephone call and further contact); before and after controlled trial. Local Health Trust in Veneto Region (North-East of Italy) in 2008-09. Five hundred and one people on a 554 waiting list for C Class ambulatory care diagnostic and/or clinical investigations (electrocardiography plus cardiology ambulatory consultation, eye ambulatory consultation, carotid vessels Eco-color-Doppler, legs Eco-color-Doppler or colonoscopy, respectively). Active list management program consisting of a telephonic interview on 21 items to evaluate socioeconomic features, self-perceived health status, social support, referral physician, accessibility and patients' satisfaction. A controlled before-and-after study was performed to evaluate anonymously the overall impact on patients' self-perceived quality of care. The rate of patients with deteriorating healthcare conditions; rate of dropout; interviewed degree of satisfaction about the initiative; overall impact on citizens' perceived quality of care. 95.4% patients evaluated the initiative as useful. After the intervention, patients more likely to have been targeted with the program showed a statistically significant increase in self-reported quality of care. Positive impact of the program on some dimensions of ambulatory care quality (health status, satisfaction, willingness to remain in the queue), thus confirming the outstanding value of 'not to leave people alone' and 'not to leave them feeling themselves alone' in healthcare delivery.

  12. The boarding experience from the patient perspective: the wait.

    Science.gov (United States)

    Liu, Shan; Milne, Leslie; Yun, Brian; Walsh, Kathleen

    2015-11-01

    We sought to better understand the experience of being a boarder patient. We conducted a qualitative study between March and August 2012 to examine the experience of boarding in an urban, teaching hospital emergency department (ED). We included boarder patients and selected patients based on a convenience sample. Interviews were semistructured, consisting of eight main open-ended questions. Interviews were transcribed; codes were generated and then organised into categorises and subsequently into one theme. We concluded analysis when we achieved thematic saturation. Our institutional review board approved this study. Our final sample included 18 patients. The average age was 62.3 years. Patients characterised waiting as central to their experience as a boarder patient. One patient stated, "Well if you have to wait for a bed you have to wait for a bed, it's terrible." Three categories exemplified this waiting experience: (1) there was often lack of communication; (2) patients experienced frustration during this waiting period; and yet (3) patients often differentiated the experience of waiting from the care they were receiving. Being a boarder patient was characterised as a waiting experience associated with poor communication and frustration. However, patients may still differentiate their feelings towards the wait from those towards the medical care they are receiving. Our data add more reason to eradicate the practice of ED boarding. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  13. Moderate alcohol consumption and waiting time to pregnancy

    DEFF Research Database (Denmark)

    Juhl, Mette; Andersen, Anne-Marie Nybo; Grønbaek, Morten

    2001-01-01

    BACKGROUND: Recent research indicates that even a moderate consumption of alcohol in women trying to become pregnant is associated with longer waiting time to pregnancy. The findings, though, are based upon few observations. METHODS: Self-reported data on alcohol intake and waiting time to pregna...

  14. Maternity waiting homes in Rural Health Centers of Ethiop: The ...

    African Journals Online (AJOL)

    kim

    1 The Last Ten Kilometers Project, JSI Research & Training Institute, Inc., Addis ... The main aim of this study was to assess the situation of maternity waiting ... experiences and challenges of mothers using waiting homes. ..... education on MWHs were home visits by HEWs ... travel long distances to deliver food, which meant.

  15. Waiting for Merlot: anticipatory consumption of experiential and material purchases.

    Science.gov (United States)

    Kumar, Amit; Killingsworth, Matthew A; Gilovich, Thomas

    2014-10-01

    Experiential purchases (money spent on doing) tend to provide more enduring happiness than material purchases (money spent on having). Although most research comparing these two types of purchases has focused on their downstream hedonic consequences, the present research investigated hedonic differences that occur before consumption. We argue that waiting for experiences tends to be more positive than waiting for possessions. Four studies demonstrate that people derive more happiness from the anticipation of experiential purchases and that waiting for an experience tends to be more pleasurable and exciting than waiting to receive a material good. We found these effects in studies using questionnaires involving a variety of actual planned purchases, in a large-scale experience-sampling study, and in an archival analysis of news stories about people waiting in line to make a purchase. Consumers derive value from anticipation, and that value tends to be greater for experiential than for material purchases. © The Author(s) 2014.

  16. Electron Waiting Times of a Cooper Pair Splitter

    Science.gov (United States)

    Walldorf, Nicklas; Padurariu, Ciprian; Jauho, Antti-Pekka; Flindt, Christian

    2018-02-01

    Electron waiting times are an important concept in the analysis of quantum transport in nanoscale conductors. Here we show that the statistics of electron waiting times can be used to characterize Cooper pair splitters that create spatially separated spin-entangled electrons. A short waiting time between electrons tunneling into different leads is associated with the fast emission of a split Cooper pair, while long waiting times are governed by the slow injection of Cooper pairs from a superconductor. Experimentally, the waiting time distributions can be measured using real-time single-electron detectors in the regime of slow tunneling, where conventional current measurements are demanding. Our work is important for understanding the fundamental transport processes in Cooper pair splitters and the predictions may be verified using current technology.

  17. Electron Waiting Times of a Cooper Pair Splitter

    DEFF Research Database (Denmark)

    Walldorf, Nicklas; Padurariu, Ciprian; Jauho, Antti-Pekka

    2018-01-01

    Electron waiting times are an important concept in the analysis of quantum transport in nanoscale conductors. Here we show that the statistics of electron waiting times can be used to characterize Cooper pair splitters that create spatially separated spin-entangled electrons. A short waiting time...... between electrons tunneling into different leads is associated with the fast emission of a split Cooper pair, while long waiting times are governed by the slow injection of Cooper pairs from a superconductor. Experimentally, the waiting time distributions can be measured using real-time single......-electron detectors in the regime of slow tunneling, where conventional current measurements are demanding. Our work is important for understanding the fundamental transport processes in Cooper pair splitters and the predictions may be verified using current technology....

  18. Enhancing outpatient clinics management software by reducing patients’ waiting time

    Directory of Open Access Journals (Sweden)

    Iman Almomani

    2016-11-01

    Full Text Available Summary: The Kingdom of Saudi Arabia (KSA gives great attention to improving the quality of services provided by health care sectors including outpatient clinics. One of the main drawbacks in outpatient clinics is long waiting time for patients—which affects the level of patient satisfaction and the quality of services. This article addresses this problem by studying the Outpatient Management Software (OMS and proposing solutions to reduce waiting times. Many hospitals around the world apply solutions to overcome the problem of long waiting times in outpatient clinics such as hospitals in the USA, China, Sri Lanka, and Taiwan. These clinics have succeeded in reducing wait times by 15%, 78%, 60% and 50%, respectively. Such solutions depend mainly on adding more human resources or changing some business or management policies. The solutions presented in this article reduce waiting times by enhancing the software used to manage outpatient clinics services. Both quantitative and qualitative methods have been used to understand current OMS and examine level of patient’s satisfaction. Five main problems that may cause high or unmeasured waiting time have been identified: appointment type, ticket numbering, doctor late arrival, early arriving patient and patients’ distribution list. These problems have been mapped to the corresponding OMS components. Solutions to the above problems have been introduced and evaluated analytically or by simulation experiments. Evaluation of the results shows a reduction in patient waiting time. When late doctor arrival issues are solved, this can reduce the clinic service time by up to 20%. However, solutions for early arriving patients reduces 53.3% of vital time, 20% of the clinic time and overall 30.3% of the total waiting time. Finally, well patient-distribution lists make improvements by 54.2%. Improvements introduced to the patients’ waiting time will consequently affect patients’ satisfaction and improve

  19. Access to specialist gastroenterology care in Canada: Comparison of wait times and consensus targets

    Science.gov (United States)

    Leddin, Desmond; Armstrong, David; Barkun, Alan NG; Chen, Ying; Daniels, Sandra; Hollingworth, Roger; Hunt, Richard H; Paterson, William G

    2008-01-01

    consensus targets; 51% to 88% of patients were not seen within the target wait time. Multiple interventions, including adoption of evidence-based management guidelines and provision of economic and human resources, are needed to ensure appropriate access to digestive health care in Canada. Outcomes can be evaluated by the ‘point-of-care’, practice audit methodology used for the present study. PMID:18299735

  20. Ethics in radiology: wait lists queue jumping.

    Science.gov (United States)

    Cunningham, Natalie; Reid, Lynette; MacSwain, Sarah; Clarke, James R

    2013-08-01

    Education in ethics is a requirement for all Royal College residency training programs as laid out in the General Standards of Accreditation for residency programs in Canada. The ethical challenges that face radiologists in clinical practice are often different from those that face other physicians, because the nature of the physician-patient interaction is unlike that of many other specialties. Ethics education for radiologists and radiology residents will benefit from the development of teaching materials and resources that focus on the issues that are specific to the specialty. This article is intended to serve as an educational resource for radiology training programs to facilitate teaching ethics to residents and also as a continuing medical education resource for practicing radiologists. In an environment of limited health care resources, radiologists are frequently asked to expedite imaging studies for patients and, in some respects, act as gatekeepers for specialty care. The issues of wait lists, queue jumping, and balancing the needs of individuals and society are explored from the perspective of a radiologist. Copyright © 2013 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

  1. Parental satisfaction with paediatric care, triage and waiting times.

    Science.gov (United States)

    Fitzpatrick, Nicholas; Breen, Daniel T; Taylor, James; Paul, Eldho; Grosvenor, Robert; Heggie, Katrina; Mahar, Patrick D

    2014-04-01

    The present study aims to determine parental and guardian's perceptions of paediatric emergency care and satisfaction with care, waiting times and triage category in a community ED. A structured questionnaire was provided to parents or guardians of paediatric patients presenting to emergency. The survey evaluated parent perceptions of waiting time, environment/facilities, professionalism and communication skills of staff and overall satisfaction of care. One hundred and thirty-three completed questionnaires were received from parents of paediatric patients. Responses were overall positive with respect to the multiple domains assessed. Parents generally considered waiting times to be appropriate and consistent with triage categories. Overall satisfaction was not significantly different for varying treatment or waiting times. Patients triaged as semi-urgent were of the opinion that waiting times were less appropriate than urgent, less-urgent or non-urgent patients. On the basis of the present study, patient perceptions and overall satisfaction of care does not appear to be primarily influenced by time spent waiting or receiving treatment. Attempts made at the triage process to ensure that semi-urgent patients have reasonable expectations of waiting times might provide an opportunity to improve these patients' expectations and perceptions. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  2. [Influence of waiting time on patient and companion satisfaction].

    Science.gov (United States)

    Fontova-Almató, A; Juvinyà-Canal, D; Suñer-Soler, R

    2015-01-01

    To evaluate patient and companion satisfaction of a hospital Emergency Department and its relationship with waiting time. Prospective, observational study. Hospital de Figueres Emergency Department (Girona, Spain). sociodemographic characteristics, satisfaction level, real and perceived waiting time for triage and being seen by a physician. A total of 285 responses were received from patients and companions. The mean age of the patients and companions (n=257) was 54.6years (SD=18.3). The mean overall satisfaction (n=273) was 7.6 (SD=2.2). Lower perceived waiting time until nurse triage was related to higher overall satisfaction (Spearman rho (ρ)=-0.242, P<.001), and lower perceived waiting time until being seen by physician, with a higher overall satisfaction (ρ=-0.304; P<.001). Users who were informed about estimated waiting time showed higher satisfaction than those who were not informed (P=.001). Perceived waiting time and the information about estimated waiting time determined overall satisfaction. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  3. Cholelithiasis in patients on the kidney transplant waiting list

    Science.gov (United States)

    Brito, André Thiago Scandiuzzi; Azevedo, Luiz Sergio; Nahas, Willian Carlos; Matheus, André Siqueira; Jukemura, José

    2010-01-01

    OBJECTIVES To evaluate the prevalence of cholecystopathy in chronic renal patients awaiting kidney transplants. INTRODUCTION The prevalence and management of cholelithiasis in renal transplant patients is not well established. METHODS A total of 342 chronic renal failure patients on the waiting list for a kidney transplant were studied. Patients were evaluated for the presence of cholelithiasis and related symptoms, previous cholecystectomies and other abdominal surgeries, time on dialysis, and general data (gender, age, number of pregnancies, and body mass index). RESULTS Cholelithiasis was found in 41 out of 342 patients (12%). Twelve of these patients, all symptomatic, had previously undergone cholecystectomies. Five out of 29 patients who had not undergone surgery were symptomatic. Overall, 17 patients (41.5%) were symptomatic. Their mean age was 54 (range 32–74) years old; 61% were female, and their mean body mass index was 25.4. Nineteen (76%) out of 25 women had previously been pregnant, with an average of 3.6 pregnancies per woman. CONCLUSIONS The frequency of cholelithiasis was similar to that reported in the literature for the general population. However, the high frequency of symptomatic patients points toward an indication of routine pre-transplant cholecystectomy to avoid serious post-transplant complications. PMID:20454496

  4. Formation of Globular Clusters with Internal Abundance Spreads in r -Process Elements: Strong Evidence for Prolonged Star Formation

    Energy Technology Data Exchange (ETDEWEB)

    Bekki, Kenji [ICRAR, M468, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009 (Australia); Tsujimoto, Takuji [National Astronomical Observatory of Japan, Mitaka-shi, Tokyo 181-8588 (Japan)

    2017-07-20

    Several globular clusters (GCs) in the Galaxy are observed to show internal abundance spreads in r -process elements (e.g., Eu). We propose a new scenario that explains the origin of these GCs (e.g., M5 and M15). In this scenario, stars with no/little abundance variations first form from a massive molecular cloud (MC). After all of the remaining gas of the MC is expelled by numerous supernovae, gas ejected from asymptotic giant branch stars can be accumulated in the central region of the GC to form a high-density intracluster medium (ICM). Merging of neutron stars then occurs to eject r -process elements, which can be efficiently trapped in and subsequently mixed with the ICM. New stars formed from the ICM can have r -process abundances that are quite different from those of earlier generations of stars within the GC. This scenario can explain both (i) why r -process elements can be trapped within GCs and (ii) why GCs with internal abundance spreads in r -process elements do not show [Fe/H] spreads. Our model shows (i) that a large fraction of Eu-rich stars can be seen in Na-enhanced stellar populations of GCs, as observed in M15, and (ii) why most of the Galactic GCs do not exhibit such internal abundance spreads. Our model demonstrates that the observed internal spreads of r -process elements in GCs provide strong evidence for prolonged star formation (∼10{sup 8} yr).

  5. Waiting list paradox: Danish cancer patients diagnosed fast have higher mortality after diagnosis

    DEFF Research Database (Denmark)

    Tørring, Marie Louise; Frydenberg, Morten; Hansen, Rikke Pilegaard

    on hospital discharge diagnoses for the 2004-2005 period, extracted from population-based healthcare databases in the former County of Aarhus, Denmark, and subsequently validated in the National Danish Cancer Registry. All patients with a first-time diagnosis of colon, rectal, lung, skin, breast, or prostate...... with longer diagnostic interval until the reference point of 30 days. For colon, rectal, skin, and breast cancer mortality seemed to increase with diagnostic interval longer than 30 days. The waiting list paradox is manifest in Denmark. We speculate that medical professionals organise the diagnostic pathway......Studies often show that cancer patients diagnosed more rapidly have higher mortality rates than patients with longer waits in the primary and secondary health care sector. Our aim was to examine whether this paradox is manifest in the Danish health care system. The study was based on data...

  6. Theseus Waits on Lakebed for First Flight

    Science.gov (United States)

    1996-01-01

    The Theseus prototype remotely-piloted aircraft (RPA) waits on the lakebed before its first test flight from NASA's Dryden Flight Research Center, Edwards, California, on May 24, 1996. The Theseus aircraft, built and operated by Aurora Flight Sciences Corporation, Manassas, Virginia, was a unique aircraft flown at NASA's Dryden Flight Research Center, Edwards, California, under a cooperative agreement between NASA and Aurora. Dryden hosted the Theseus program, providing hangar space and range safety for flight testing. Aurora Flight Sciences was responsible for the actual flight testing, vehicle flight safety, and operation of the aircraft. The Theseus remotely piloted aircraft flew its maiden flight on May 24, 1996, at Dryden. During its sixth flight on November 12, 1996, Theseus experienced an in-flight structural failure that resulted in the loss of the aircraft. As of the beginning of the year 2000, Aurora had not rebuilt the aircraft. Theseus was built for NASA under an innovative, $4.9 million fixed-price contract by Aurora Flight Sciences Corporation and its partners, West Virginia University, Morgantown, West Virginia, and Fairmont State College, Fairmont, West Virginia. The twin-engine, unpiloted vehicle had a 140-foot wingspan, and was constructed largely of composite materials. Powered by two 80-horsepower, turbocharged piston engines that drove twin 9-foot-diameter propellers, Theseus was designed to fly autonomously at high altitudes, with takeoff and landing under the active control of a ground-based pilot in a ground control station 'cockpit.' With the potential ability to carry 700 pounds of science instruments to altitudes above 60,000 feet for durations of greater than 24 hours, Theseus was intended to support research in areas such as stratospheric ozone depletion and the atmospheric effects of future high-speed civil transport aircraft engines. Instruments carried aboard Theseus also would be able to validate satellite-based global environmental

  7. Burden of waiting for surveillance CT colonography in patients with screen-detected 6-9 mm polyps

    Energy Technology Data Exchange (ETDEWEB)

    Tutein Nolthenius, Charlotte J. [University of Amsterdam, Department of Radiology, Academic Medical Center, PO Box 22700, Amsterdam (Netherlands); Onze Lieve Vrouwe Gasthuis, Department of Radiology, Amsterdam (Netherlands); Boellaard, Thierry N.; Nio, C.Y.; Bipat, Shandra; Stoker, Jaap [University of Amsterdam, Department of Radiology, Academic Medical Center, PO Box 22700, Amsterdam (Netherlands); Haan, Margriet C. de [Meander Medical Center, Department of Radiology, Amersfoort (Netherlands); Thomeer, Maarten G.J. [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Montauban van Swijndregt, Alexander D. [Onze Lieve Vrouwe Gasthuis, Department of Radiology, Amsterdam (Netherlands); Essink-Bot, Marie-Louise [University of Amsterdam, Public Health, Academic Medical Center, PO Box 22700, Amsterdam (Netherlands); Kuipers, Ernst J. [Erasmus University Medical Center, Gastroenterology and Hepatology, Rotterdam (Netherlands); Erasmus University Medical Center, Internal medicine, Rotterdam (Netherlands); Dekker, Evelien [University of Amsterdam, Gastroenterology and Hepatology, Academic Medical Center, PO Box 22700, Amsterdam (Netherlands)

    2016-11-15

    We assessed the burden of waiting for surveillance CT colonography (CTC) performed in patients having 6-9 mm colorectal polyps on primary screening CTC. Additionally, we compared the burden of primary and surveillance CTC. In an invitational population-based CTC screening trial, 101 persons were diagnosed with <3 polyps 6-9 mm, for which surveillance CTC after 3 years was advised. Validated questionnaires regarding expected and perceived burden (5-point Likert scales) were completed before and after index and surveillance CTC, also including items on burden of waiting for surveillance CTC. McNemar's test was used for comparison after dichotomization. Seventy-eight (77 %) of 101 invitees underwent surveillance CTC, of which 66 (85 %) completed the expected and 62 (79 %) the perceived burden questionnaire. The majority of participants (73 %) reported the experience of waiting for surveillance CTC as 'never' or 'only sometimes' burdensome. There was almost no difference in expected and perceived burden between surveillance and index CTC. Waiting for the results after the procedure was significantly more burdensome for surveillance CTC than for index CTC (23 vs. 8 %; p = 0.012). Waiting for surveillance CTC after primary CTC screening caused little or no burden for surveillance participants. In general, the burden of surveillance and index CTC were comparable. (orig.)

  8. Approaching stationarity: competition between long jumps and long waiting times

    International Nuclear Information System (INIS)

    Dybiec, Bartłomiej

    2010-01-01

    Within the continuous-time random walk (CTRW) scenarios, properties of the overall motion are determined by the waiting time and the jump length distributions. In the decoupled case, with power-law distributed waiting times and jump lengths, the CTRW scenario is asymptotically described by the double (space and time) fractional Fokker–Planck equation. Properties of a system described by such an equation are determined by the subdiffusion parameter and the jump length exponent. Nevertheless, the stationary state is determined solely by the jump length distribution and the potential. The waiting time distribution determines only the rate of convergence to the stationary state. Here, we inspect the competition between long waiting times and long jumps and how this competition is reflected in the way in which a stationary state is reached. In particular, we show that the distance between a time-dependent and a stationary solution changes in time as a double power law

  9. Ultrasound waiting lists: rational queue or extended capacity?

    Science.gov (United States)

    Brasted, Christopher

    2008-06-01

    The features and issues regarding clinical waiting lists in general and general ultrasound waiting lists in particular are reviewed, and operational aspects of providing a general ultrasound service are also discussed. A case study is presented describing a service improvement intervention in a UK NHS hospital's ultrasound department, from which arises requirements for a predictive planning model for an ultrasound waiting list. In the course of this, it becomes apparent that a booking system is a more appropriate way of describing the waiting list than a conventional queue. Distinctive features are identified from the literature and the case study as the basis for a predictive model, and a discrete event simulation model is presented which incorporates the distinctive features.

  10. Moderate alcohol consumption and waiting time to pregnancy

    DEFF Research Database (Denmark)

    Juhl, Mette; Andersen, Anne-Marie Nybo; Grønbæk, Morten

    2001-01-01

    BACKGROUND: Recent research indicates that even a moderate consumption of alcohol in women trying to become pregnant is associated with longer waiting time to pregnancy. The findings, though, are based upon few observations. METHODS: Self-reported data on alcohol intake and waiting time...... to pregnancy (0-2, 3-5, 6-12 and >12 months) was used for 39 612 pregnant women, recruited to the Danish National Birth Cohort within the first 24 weeks of pregnancy from 1997 to 2000. Main outcome measures were odds ratios (OR) for a prolonged waiting time to pregnancy according to alcohol intake. RESULTS......: In nulliparous women neither moderate nor high alcohol intake was related with longer waiting time to pregnancy compared with a low intake. In parous women, a modest association was seen only among those with an intake of >14 drinks per week (subfecundity OR 1.3; 95% confidence interval 1.0-1.7). Women who...

  11. Mean Waiting Time and Patients' Satisfaction in GOPD, Federal ...

    African Journals Online (AJOL)

    Mean Waiting Time and Patients' Satisfaction in GOPD, Federal Medical Centre, Owerri. ... Journal Home > Vol 4, No 2 (2013) > ... dis-satisfaction as noted from this study should be addressed by the staff and management of the hospital.

  12. Waiting to Drive (A Minute of Health with CDC)

    Centers for Disease Control (CDC) Podcasts

    Over the past 10 years, the number of fatal motor-vehicle crashes involving teenage drivers has declined by more than 50 percent. This podcast discusses the trend of teens waiting until they are older to drive.

  13. Heart Surgery Waiting Time: Assessing the Effectiveness of an Action

    OpenAIRE

    Badakhshan, Abbas; Arab, Mohammad; Gholipour, Mahin; Behnampour, Naser; Saleki, Saeid

    2015-01-01

    Background: Waiting time is an index assessing patient satisfaction, managerial effectiveness and horizontal equity in providing health care. Although heart surgery centers establishment is attractive for politicians. They are always faced with the question of to what extent they solve patient’s problems. Objectives: The objective of this study was to evaluate factors influencing waiting time in patients of heart surgery centers, and to make recommendations for health-care policy-makers for r...

  14. Analysing passenger arrivals rates and waiting time at bus stops

    OpenAIRE

    Kaparias, I.; Rossetti, C.; Trozzi, V.

    2015-01-01

    The present study investigates the rather under-explored topic of passenger waiting times at public transport facilities. Using data collected from part of London’s bus network by means of physical counts, measurements and observations, and complemented by on-site passenger interviews, the waiting behaviour is analysed for a number of bus stops served by different numbers of lines. The analysis employs a wide range of statistical methods and tools, and concentrates on three aspects: passenger...

  15. Galactic r-process enrichment by neutron star mergers in cosmological simulations of a Milky Way-mass galaxy

    Science.gov (United States)

    van de Voort, Freeke; Quataert, Eliot; Hopkins, Philip F.; Kereš, Dušan; Faucher-Giguère, Claude-André

    2015-02-01

    We quantify the stellar abundances of neutron-rich r-process nuclei in cosmological zoom-in simulations of a Milky Way-mass galaxy from the Feedback In Realistic Environments project. The galaxy is enriched with r-process elements by binary neutron star (NS) mergers and with iron and other metals by supernovae. These calculations include key hydrodynamic mixing processes not present in standard semi-analytic chemical evolution models, such as galactic winds and hydrodynamic flows associated with structure formation. We explore a range of models for the rate and delay time of NS mergers, intended to roughly bracket the wide range of models consistent with current observational constraints. We show that NS mergers can produce [r-process/Fe] abundance ratios and scatter that appear reasonably consistent with observational constraints. At low metallicity, [Fe/H] ≲ -2, we predict there is a wide range of stellar r-process abundance ratios, with both supersolar and subsolar abundances. Low-metallicity stars or stars that are outliers in their r-process abundance ratios are, on average, formed at high redshift and located at large galactocentric radius. Because NS mergers are rare, our results are not fully converged with respect to resolution, particularly at low metallicity. However, the uncertain rate and delay time distribution of NS mergers introduce an uncertainty in the r-process abundances comparable to that due to finite numerical resolution. Overall, our results are consistent with NS mergers being the source of most of the r-process nuclei in the Universe.

  16. Towards decision support for waiting lists: an operations management view.

    Science.gov (United States)

    Vissers, J M; Van Der Bij, J D; Kusters, R J

    2001-06-01

    This paper considers the phenomenon of waiting lists in a healthcare setting, which is characterised by limitations on the national expenditure, to explore the potentials of an operations management perspective. A reference framework for waiting list management is described, distinguishing different levels of planning in healthcare--national, regional, hospital and process--that each contributes to the existence of waiting lists through managerial decision making. In addition, different underlying mechanisms in demand and supply are distinguished, which together explain the development of waiting lists. It is our contention that within this framework a series of situation specific models should be designed to support communication and decision making. This is illustrated by the modelling of the demand for cataract treatment in a regional setting in the south-eastern part of the Netherlands. An input-output model was developed to support decisions regarding waiting lists. The model projects the demand for treatment at a regional level and makes it possible to evaluate waiting list impacts for different scenarios to meet this demand.

  17. Heuristics for no-wait flow shop scheduling problem

    Directory of Open Access Journals (Sweden)

    Kewal Krishan Nailwal

    2016-09-01

    Full Text Available No-wait flow shop scheduling refers to continuous flow of jobs through different machines. The job once started should have the continuous processing through the machines without wait. This situation occurs when there is a lack of an intermediate storage between the processing of jobs on two consecutive machines. The problem of no-wait with the objective of minimizing makespan in flow shop scheduling is NP-hard; therefore the heuristic algorithms are the key to solve the problem with optimal solution or to approach nearer to optimal solution in simple manner. The paper describes two heuristics, one constructive and an improvement heuristic algorithm obtained by modifying the constructive one for sequencing n-jobs through m-machines in a flow shop under no-wait constraint with the objective of minimizing makespan. The efficiency of the proposed heuristic algorithms is tested on 120 Taillard’s benchmark problems found in the literature against the NEH under no-wait and the MNEH heuristic for no-wait flow shop problem. The improvement heuristic outperforms all heuristics on the Taillard’s instances by improving the results of NEH by 27.85%, MNEH by 22.56% and that of the proposed constructive heuristic algorithm by 24.68%. To explain the computational process of the proposed algorithm, numerical illustrations are also given in the paper. Statistical tests of significance are done in order to draw the conclusions.

  18. The effects of immigration on NHS waiting times.

    Science.gov (United States)

    Giuntella, Osea; Nicodemo, Catia; Vargas-Silva, Carlos

    2018-03-01

    This paper analyzes the effects of immigration on waiting times for the National Health Service (NHS) in England. Linking administrative records from Hospital Episode Statistics (2003-2012) with immigration data drawn from the UK Labour Force Survey, we find that immigration reduced waiting times for outpatient referrals and did not have significant effects on waiting times in accident and emergency departments (A&E) and elective care. The reduction in outpatient waiting times can be explained by the fact that immigration increases natives' internal mobility and that immigrants tend to be healthier than natives who move to different areas. Finally, we find evidence that immigration increased waiting times for outpatient referrals in more deprived areas outside of London. The increase in average waiting times in more deprived areas is concentrated in the years immediately following the 2004 EU enlargement and disappears in the medium term (e.g., 3-4 years). Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

  19. Experimentally Determining β-Decay Intensities for 103,104Nb to Improve R-process Calculations

    Science.gov (United States)

    Gombas, J.; Deyoung, P. D.; Spyrou, A.; Dombos, A. C.; Lyons, S.; SuN Collaboration

    2017-09-01

    The rapid neutron capture process (r-process) is responsible for the formation of nuclei heavier than iron. This process is theorized to occur in supernovas and/or neutron star mergers. R-process calculations require the accurate knowledge of a significant amount of nuclear properties, the majority of which are not known experimentally. Nuclear masses, β-decay properties and neutron-capture reactions are all input ingredients into r-process models. This present study focuses on the β decay of 103Nb and 104Nb. The β decay of 103Nb and 104Nb, two nuclei found in the r-process, were observed at the NSCL using the Summing NaI (SuN) detector. An unstable beam implanted inside SuN. The γ rays were measured in coincidence with the emitted electrons. The β-decay intensity function was then extracted. The experimentally determined functions for 103Nb and 104Nb will be compared to predictions made by the Quasi Random Phase Approximation (QRPA) model. These theoretical calculations are used in astrophysical models of the r-process. This comparison will lead to a better understanding of the nuclear structure for 103Nb and 104Nb. A more dependable prediction of the formation of heavier nuclei birthed from supernovas or neutron star mergers can then be made. This material is based upon work supported by the National Science Foundation under Grant No. PHY-1613188 and PHY-1306074, and by the Hope College Department of Physics Guess Research Fund.

  20. Production of the entire range of r-process nuclides by black hole accretion disc outflows from neutron star mergers

    Science.gov (United States)

    Wu, Meng-Ru; Fernández, Rodrigo; Martínez-Pinedo, Gabriel; Metzger, Brian D.

    2016-12-01

    We consider r-process nucleosynthesis in outflows from black hole accretion discs formed in double neutron star and neutron star-black hole mergers. These outflows, powered by angular momentum transport processes and nuclear recombination, represent an important - and in some cases dominant - contribution to the total mass ejected by the merger. Here we calculate the nucleosynthesis yields from disc outflows using thermodynamic trajectories from hydrodynamic simulations, coupled to a nuclear reaction network. We find that outflows produce a robust abundance pattern around the second r-process peak (mass number A ˜ 130), independent of model parameters, with significant production of A spike at A = 132 that is absent in the Solar system r-process distribution. The spike arises from convection in the disc and depends on the treatment of nuclear heating in the simulations. We conclude that disc outflows provide an important - and perhaps dominant - contribution to the r-process yields of compact binary mergers, and hence must be included when assessing the contribution of these systems to the inventory of r-process elements in the Galaxy.

  1. Heart Surgery Waiting Time: Assessing the Effectiveness of an Action.

    Science.gov (United States)

    Badakhshan, Abbas; Arab, Mohammad; Gholipour, Mahin; Behnampour, Naser; Saleki, Saeid

    2015-08-01

    Waiting time is an index assessing patient satisfaction, managerial effectiveness and horizontal equity in providing health care. Although heart surgery centers establishment is attractive for politicians. They are always faced with the question of to what extent they solve patient's problems. The objective of this study was to evaluate factors influencing waiting time in patients of heart surgery centers, and to make recommendations for health-care policy-makers for reducing waiting time and increasing the quality of services from this perspective. This cross-sectional study was performed in 2013. After searching articles on PubMed, Elsevier, Google Scholar, Ovid, Magiran, IranMedex, and SID, a list of several criteria, which relate to waiting time, was provided. Afterwards, the data on waiting time were collected by a researcher-structured checklist from 156 hospitalized patients. The data were analyzed by SPSS 16. The Kolmogorov Smirnov and Shapiro tests were used for determination of normality. Due to the non-normal distribution, non-parametric tests, such as Kruskal-Wallis and Mann-Whitney were chosen for reporting significance. Parametric tests also used reporting medians. Among the studied variables, just economic status had a significant relation with waiting time (P = 0.37). Fifty percent of participants had diabetes, whereas this estimate was 43.58% for high blood pressure. As the cause of delay, 28.2% of patients reported financial problems, 18.6% personal problem and 13.5% a delay in providing equipment by the hospital. It seems the studied hospital should review its waiting time arrangements and detach them, as far as possible, from subjective and personal (specialists) decisions. On the other hand, ministries of health and insurance companies should consider more financial support. It is also recommend that hospitals should arrange preoperational psychiatric consultation for increasing patients' emotionally readiness.

  2. Respiratory viral RNA on toys in pediatric office waiting rooms.

    Science.gov (United States)

    Pappas, Diane E; Hendley, J Owen; Schwartz, Richard H

    2010-02-01

    Toys in pediatric office waiting rooms may be fomites for transmission of viruses. Eighteen samples were taken from office objects on 3 occasions. Samples were tested for presence of picornavirus (either rhinovirus or enterovirus) on all 3 sample days; in addition, January samples were tested for respiratory syncytial virus and March samples were tested for influenza A and B. In addition, 15 samples were obtained from the sick waiting room before and after cleaning. Polymerase chain reaction was used to detect picornavirus, respiratory syncytial virus, and influenza A or B virus. Finally, 20 samples were obtained from the fingers of a researcher after handling different toys in the sick waiting room, and samples were then obtained from all the same toys; all samples were tested for picornavirus by polymerase chain reaction. Viral RNA was detected on 11 of 52 (21%) of toys sampled. Ten of the positives were picornavirus; 1 was influenza B virus. Three (30%) of 10 toys from the new toy bag, 6 of 30 (20%) in the sick child waiting room, and 2 of 12 (17%) in the well child waiting room were positive. Six (40%) of 15 toys in the sick waiting room were positive for picornaviral RNA before cleaning; after cleaning, 4 (27%) of 15 were positive in spite of the fact that RNA was removed from 4 of 6 of the original positives. Three (15%) of 20 toys in the sick waiting room were positive for picornaviral RNA, but RNA was not transferred to the fingers of the investigator who handled these toys. About 20% of the objects in a pediatric office may be contaminated with respiratory viral RNA, most commonly picornavirus RNA. Cleaning with a disinfectant cloth was only modestly effective in removing the viral RNA from the surfaces of toys, but transfer of picornaviral RNA from toys to fingers was inefficient.

  3. Effect of emergency physician burnout on patient waiting times.

    Science.gov (United States)

    De Stefano, Carla; Philippon, Anne-Laure; Krastinova, Evguenia; Hausfater, Pierre; Riou, Bruno; Adnet, Frederic; Freund, Yonathan

    2018-04-01

    Burnout is common in emergency physicians. This syndrome may negatively affect patient care and alter work productivity. We seek to assess whether burnout of emergency physicians impacts waiting times in the emergency department. Prospective study in an academic ED. All patients who visited the main ED for a 4-month period in 2016 were included. Target waiting times are assigned by triage nurse to patients on arrival depending on their severity. The primary endpoint was an exceeded target waiting time for ED patients. All emergency physicians were surveyed by a psychologist to assess their level of burnout using the Maslach Burnout Inventory. We defined the level of burnout of the day in the ED as the mean burnout level of the physicians working that day (8:30 to the 8:30 the next day). A logistic regression model was performed to assess whether burnout level of the day was independently associated with prolonged waiting times, along with previously reported predictors. Target waiting time was exceeded in 7524 patients (59%). Twenty-six emergency physicians were surveyed. Median burnout score was 35 [Interquartile (24-49)]. A burnout level of the day higher than 35 was independently associated with an exceeded target waiting time (adjusted odds ratio 1.54, 95% confidence interval 1.39-1.70), together with previously reported predictors (i.e., day of the week, time of the day, trauma, age and daily census). Burnout of emergency physicians was independently associated with a prolonged waiting time for patients visiting the ED.

  4. NEW RARE EARTH ELEMENT ABUNDANCE DISTRIBUTIONS FOR THE SUN AND FIVE r-PROCESS-RICH VERY METAL-POOR STARS

    International Nuclear Information System (INIS)

    Sneden, Christopher; Lawler, James E.; Den Hartog, Elizabeth A.; Cowan, John J.; Ivans, Inese I.

    2009-01-01

    We have derived new abundances of the rare earth elements Pr, Dy, Tm, Yb, and Lu for the solar photosphere and for five very metal-poor, neutron-capture r-process-rich giant stars. The photospheric values for all five elements are in good agreement with meteoritic abundances. For the low-metallicity sample, these abundances have been combined with new Ce abundances from a companion paper, and reconsideration of a few other elements in individual stars, to produce internally consistent Ba, rare earth, and Hf (56 ≤ Z ≤ 72) element distributions. These have been used in a critical comparison between stellar and solar r-process abundance mixes.

  5. An exploration of the basis for patient complaints about the oldness of magazines in practice waiting rooms: cohort study.

    Science.gov (United States)

    Arroll, Bruce; Alrutz, Stowe; Moyes, Simon

    2014-12-11

    To explore the basis for patient complaints about the oldness of most magazines in practice waiting rooms. Cohort study. Waiting room of a general practice in Auckland, New Zealand. 87 magazines stacked into three mixed piles and placed in the waiting room: this included non-gossipy magazines (Time magazine, the Economist, Australian Women's Weekly, National Geographic, BBC History) and gossipy ones (not identified for fear of litigation). Gossipy was defined as having five or more photographs of celebrities on the front cover and most gossipy as having up to 10 such images. The magazines were marked with a unique number on the back cover, placed in three piles in the waiting room, and monitored twice weekly. Disappearance of magazines less than 2 months old versus magazines 3-12 months old, the overall rate of loss of magazines, and the rate of loss of gossipy versus non-gossipy magazines. 47 of the 82 magazines with a visible date on the front cover were aged less than 2 months. 28 of these 47 (60%) magazines and 10 of the 35 (29%) older magazines disappeared (P=0.002). After 31 days, 41 of the 87 (47%, 95% confidence interval 37% to 58%) magazines had disappeared. None of the 19 non-gossipy magazines (the Economist and Time magazine) had disappeared compared with 26 of the 27 (96%) gossipy magazines (Pmagazines and none of the non-gossipy magazines [corrected] had disappeared by 31 days. The study was terminated at this point. General practice waiting rooms contain mainly old magazines. This phenomenon relates to the disappearance of the magazines rather than to the supply of old ones. Gossipy magazines were more likely to disappear than non-gossipy ones. On the grounds of cost we advise practices to supply old copies of non-gossipy magazines. A waiting room science curriculum is urgently needed. © Arroll et al 2014.

  6. Waiting Lists for Radiation Therapy: A Case Study

    Directory of Open Access Journals (Sweden)

    Singer Peter A

    2001-04-01

    Full Text Available Abstract Background Why waiting lists arise and how to address them remains unclear, and an improved understanding of these waiting list "dynamics" could lead to better management. The purpose of this study is to understand how the current shortage in radiation therapy in Ontario developed; the implications of prolonged waits; who is held accountable for managing such delays; and short, intermediate, and long-term solutions. Methods A case study of the radiation therapy shortage in 1998-99 at Princess Margaret Hospital, Toronto, Ontario, Canada. Relevant documents were collected; semi-structured, face-to-face interviews with ten administrators, health care workers, and patients were conducted, audio-taped and transcribed; and relevant meetings were observed. Results The radiation therapy shortage arose from a complex interplay of factors including: rising cancer incidence rates; broadening indications for radiation therapy; human resources management issues; government funding decisions; and responsiveness to previous planning recommendations. Implications of delays include poorer cancer control rates; patient suffering; and strained doctor-patient relationships. An incompatible relationship exists between moral responsibility, borne by government, and legal liability, borne by physicians. Short-term solutions include re-referral to centers with available resources; long-term solutions include training and recruiting health care workers, improving workload standards, increasing compensation, and making changes to the funding formula. Conclusion Human resource planning plays a critical role in the causes and solutions of waiting lists. Waiting lists have harsh implications for patients. Accountability relationships require realignment.

  7. The role of fission on neutron star mergers and its impact on the r-process peaks

    International Nuclear Information System (INIS)

    Eichler, M.; Thielemann, F.-K.; Arcones, A.; Langanke, K.; Martinez-Pinedo, G.; Kelic, A.; Korobkin, O.; Rosswog, S.; Marketin, T.; Panov, I.; Rauscher, T.; Winteler, C.; Zinner, N. T.

    2016-01-01

    The comparison between observational abundance features and those obtained from nucleosynthesis predictions of stellar evolution and/or explosion simulations can scrutinize two aspects: (a) the conditions in the astrophysical production site and (b) the quality of the nuclear physics input utilized. Here we test the abundance features of r-process nucleosynthesis calculations using four different fission fragment distribution models. Furthermore, we explore the origin of a shift in the third r-process peak position in comparison with the solar r-process abundances which has been noticed in a number of merger nucleosynthesis predictions. We show that this shift occurs during the r-process freeze-out when neutron captures and β-decays compete and an (n,γ)-(γ,n) equilibrium is not maintained anymore. During this phase neutrons originate mainly from fission of material above A = 240. We also investigate the role of β-decay half-lives from recent theoretical advances, which lead either to a smaller amount of fissioning nuclei during freeze-out or a faster (and thus earlier) release of fission neutrons, which can (partially) prevent this shift and has an impact on the second and rare-earth peak as well.

  8. The role of fission on neutron star mergers and its impact on the r-process peaks

    Energy Technology Data Exchange (ETDEWEB)

    Eichler, M., E-mail: marius.eichler@unibas.ch; Thielemann, F.-K. [Department of Physics, University of Basel, Klingelbergstrasse 82, CH-4055 Basel (Switzerland); Arcones, A.; Langanke, K.; Martinez-Pinedo, G. [Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstrasse 2, D-64289 Darmstadt (Germany); GSI Helmholtzzentrum fr Schwerionenforschung GmbH, Planckstrasse 1, D-64291 Darmstadt (Germany); Kelic, A. [GSI Helmholtzzentrum fr Schwerionenforschung GmbH, Planckstrasse 1, D-64291 Darmstadt (Germany); Korobkin, O.; Rosswog, S. [The Oskar Klein Centre, Department of Astronomy, AlbaNova, Stockholm University, SE-10691 Stockholm (Sweden); Marketin, T. [Department of Physics, Faculty of Science, University of Zagreb, 10000 Zagreb (Croatia); Panov, I. [SSC RF ITEP of NRC “Kurchatov Institute”, Bolshaya Cheremushkinskaya 25, 117218 Moscow (Russian Federation); Department of Physics, University of Basel, Klingelbergstrasse 82, CH-4055 Basel (Switzerland); Rauscher, T. [Centre for Astrophysics Research, School of Physics, Astronomy and Mathematics, University of Hertfordshire, Hatfield AL10 9AB (United Kingdom); Department of Physics, University of Basel, Klingelbergstrasse 82, CH-4055 Basel (Switzerland); Winteler, C. [Institut Energie am Bau, Fachhochschule Nordwestschweiz, St. Jakobs-Strasse 84, 4132 Muttenz (Switzerland); Zinner, N. T. [Department of Physics and Astronomy, Aarhus University, Ny Munkegade, bygn. 1520, DK-8000 Aarhus C (Denmark)

    2016-06-21

    The comparison between observational abundance features and those obtained from nucleosynthesis predictions of stellar evolution and/or explosion simulations can scrutinize two aspects: (a) the conditions in the astrophysical production site and (b) the quality of the nuclear physics input utilized. Here we test the abundance features of r-process nucleosynthesis calculations using four different fission fragment distribution models. Furthermore, we explore the origin of a shift in the third r-process peak position in comparison with the solar r-process abundances which has been noticed in a number of merger nucleosynthesis predictions. We show that this shift occurs during the r-process freeze-out when neutron captures and β-decays compete and an (n,γ)-(γ,n) equilibrium is not maintained anymore. During this phase neutrons originate mainly from fission of material above A = 240. We also investigate the role of β-decay half-lives from recent theoretical advances, which lead either to a smaller amount of fissioning nuclei during freeze-out or a faster (and thus earlier) release of fission neutrons, which can (partially) prevent this shift and has an impact on the second and rare-earth peak as well.

  9. Waiting for Art: The Experience of Real Time in Sculpture

    Directory of Open Access Journals (Sweden)

    Elizabeth Buhe

    2011-05-01

    Full Text Available Why and how does some contemporary art make us wait, and why does the beholder choose to stay? This study seeks to answer this question by exploring what happens to the viewer while waiting in front of a “time sculpture,” a term coined here to mean a three-dimensional artwork that is dynamic over a set period of time. Through an analysis of select works by artists Anish Kapoor, Amelia Whitelaw, Michael Sailstorfer, and Roman Signer, the article posits that while in front of these time sculptures, the viewer experiences an anxiety of waiting and temporal confusion that glues him to the spot. Ultimately, by drawing upon Henri Bergson’s concept of duration, the essay suggests that the viewership of time sculpture allows for a heightened state of perception. Normal 0 false false false EN-US X-NONE X-NONE

  10. Children's preferences concerning ambiance of dental waiting rooms.

    Science.gov (United States)

    Panda, A; Garg, I; Shah, M

    2015-02-01

    Despite many advances in paediatric dentistry, the greatest challenge for any paediatric dentist is to remove the anxiety related to a dental visit and have a child patient to accept dental treatment readily. Minor changes made in the waiting room design can have a major effect on the way any child perceives the upcoming dental experience. This study was carried out to determine children's preferences regarding the dental waiting area so as to improve their waiting experience and reduce their preoperative anxiety before a dental appointment. This was a cross-sectional descriptive study using survey methodology. A questionnaire designed to evaluate children's preferences regarding the waiting room was distributed to new paediatric patients, aged between 6 and 11 years of age, attending an outpatient dental facility and was completed by 212 children (127 males, 85 females). The analyses were carried out on cross-tables using Phi (for 2×2 tables) or Cramer's V (for larger than 2×2 tables) to assess responses to the questionnaire items across age groups and gender. A majority of children preferred music and the ability to play in a waiting room. They also preferred natural light and walls with pictures. They preferred looking at an aquarium or a television and sitting on beanbags and chairs and also preferred plants and oral hygiene posters Repetious. The results obtained from this study may help the dental team decide on an appropriate design of their paediatric waiting room so as to make children comfortable in the dental environment and improve delivery of health care.

  11. Development of an Information Model for Kidney Transplant Wait List.

    Science.gov (United States)

    Bircan, Hüseyin Yüce; Özçelik, Ümit; Uysal, Nida; Demirağ, Alp; Haberal, Mehmet

    2015-11-01

    Deceased-donor kidney transplant is unique among surgical procedures that are an urgent procedure performed in an elective population. It has not been possible to accurately determine when a given patient will be called for transplant. Patients on the active transplant list can be called for a transplant at any time. As a result, every effort must be made to optimize their health according to best practices and published clinical practice guidelines. Once the patient is placed on the transplant wait list after undergoing an initial extensive evaluation, continued surveillance is required. Therefore, we developed a kidney transplant wait list surveillance software program that alerts organ transplant coordinator on time regarding which patients need a work-up. The new designed software has a database of our waiting patients with their completed and pending controls. The software also has built-in functions to warn the responsible staff with an E-mail. If one of the controls of a recipient delayed, the software sends an automated E-mail to the staff regarding the patients delayed controls. The software is a Web application that works on any platform with a Web browser and Internet connection and allows access by multiple users. The software has been developed with NET platform. The database is SQL server. The software has the following functions: patient communication info, search, alert list, alert E-mail, control entry, and system management. As of January 2014, a total of 21 000 patients were registered on the National Kidney Transplant wait list in Turkey and the kidney transplant wait list had been expanding by 2000 to 3000 patients each year. Therefore computerized wait list programs are crucial to help to transplant centers to keep their patients up-to-date on time.

  12. r-Process nucleosynthesis from three-dimensional jet-driven core-collapse supernovae with magnetic misalignments

    Science.gov (United States)

    Halevi, Goni; Mösta, Philipp

    2018-06-01

    We investigate r-process nucleosynthesis in three-dimensional general relativistic magnetohydrodynamic simulations of jet-driven supernovae resulting from rapidly rotating, strongly magnetized core-collapse. We explore the effect of misaligning the pre-collapse magnetic field with respect to the rotation axis by performing four simulations: one aligned model and models with 15°, 30°, and 45° misalignments. The simulations we present employ a microphysical finite-temperature equation of state and a leakage scheme that captures the overall energetics and lepton number exchange due to post-bounce neutrino emission and absorption. We track the thermodynamic properties of the ejected material with Lagrangian tracer particles and analyse its composition with the nuclear reaction network SKYNET. By using different neutrino luminosities in post-processing the tracer data with SKYNET, we constrain the impact of uncertainties in neutrino luminosities. We find that, for the aligned model considered here, the use of an approximate leakage scheme results in neutrino luminosity uncertainties corresponding to a factor of 100-1000 uncertainty in the abundance of third peak r-process elements. Our results show that for misalignments of 30° or less, r-process elements are robustly produced as long as neutrino luminosities are reasonably low (≲ 5 × 1052 erg s-1). For a more extreme misalignment of 45°, we find the production of r-process elements beyond the second peak significantly reduced. We conclude that robust r-process nucleosynthesis in magnetorotational supernovae requires a progenitor stellar core with a large poloidal magnetic field component that is at least moderately (within ˜30°) aligned with the rotation axis.

  13. THE ROLE OF FISSION IN NEUTRON STAR MERGERS AND ITS IMPACT ON THE r-PROCESS PEAKS

    International Nuclear Information System (INIS)

    Eichler, M.; Panov, I.; Rauscher, T.; Thielemann, F.-K.; Arcones, A.; Langanke, K.; Martinez-Pinedo, G.; Kelic, A.; Korobkin, O.; Rosswog, S.; Marketin, T.; Winteler, C.; Zinner, N. T.

    2015-01-01

    Comparing observational abundance features with nucleosynthesis predictions of stellar evolution or explosion simulations, we can scrutinize two aspects: (a) the conditions in the astrophysical production site and (b) the quality of the nuclear physics input utilized. We test the abundance features of r-process nucleosynthesis calculations for the dynamical ejecta of neutron star merger simulations based on three different nuclear mass models: The Finite Range Droplet Model, the (quenched version of the) Extended Thomas Fermi Model with Strutinsky Integral, and the Hartree–Fock–Bogoliubov mass model. We make use of corresponding fission barrier heights and compare the impact of four different fission fragment distribution models on the final r-process abundance distribution. In particular, we explore the abundance distribution in the second r-process peak and the rare-earth sub-peak as a function of mass models and fission fragment distributions, as well as the origin of a shift in the third r-process peak position. The latter has been noticed in a number of merger nucleosynthesis predictions. We show that the shift occurs during the r-process freeze-out when neutron captures and β-decays compete and an (n,γ)–(γ,n) equilibrium is no longer maintained. During this phase neutrons originate mainly from fission of material above A = 240. We also investigate the role of β-decay half-lives from recent theoretical advances, which lead either to a smaller amount of fissioning nuclei during freeze-out or a faster (and thus earlier) release of fission neutrons, which can (partially) prevent this shift and has an impact on the second and rare-earth peak as well

  14. THE ROLE OF FISSION IN NEUTRON STAR MERGERS AND ITS IMPACT ON THE r-PROCESS PEAKS

    Energy Technology Data Exchange (ETDEWEB)

    Eichler, M.; Panov, I.; Rauscher, T.; Thielemann, F.-K. [Department of Physics, University of Basel, Klingelbergstrasse 82, 4056 Basel (Switzerland); Arcones, A.; Langanke, K.; Martinez-Pinedo, G. [Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstrasse 2, D-64289 Darmstadt (Germany); Kelic, A. [GSI Helmholtzzentrum für Schwerionenforschung GmbH, Planckstrasse 1, D-64291 Darmstadt (Germany); Korobkin, O.; Rosswog, S. [The Oskar Klein Centre, Department of Astronomy, AlbaNova, Stockholm University, SE-106 91 Stockholm (Sweden); Marketin, T. [Department of Physics, Faculty of Science, University of Zagreb, 10000 Zagreb (Croatia); Winteler, C. [Institut Energie am Bau, Fachhochschule Nordwestschweiz, St. Jakobs-Strasse 84, 4132 Muttenz (Switzerland); Zinner, N. T., E-mail: marius.eichler@unibas.ch [Department of Physics and Astronomy, Aarhus University, Ny Munkegade, bygn. 1520, DK-8000 Aarhus C (Denmark)

    2015-07-20

    Comparing observational abundance features with nucleosynthesis predictions of stellar evolution or explosion simulations, we can scrutinize two aspects: (a) the conditions in the astrophysical production site and (b) the quality of the nuclear physics input utilized. We test the abundance features of r-process nucleosynthesis calculations for the dynamical ejecta of neutron star merger simulations based on three different nuclear mass models: The Finite Range Droplet Model, the (quenched version of the) Extended Thomas Fermi Model with Strutinsky Integral, and the Hartree–Fock–Bogoliubov mass model. We make use of corresponding fission barrier heights and compare the impact of four different fission fragment distribution models on the final r-process abundance distribution. In particular, we explore the abundance distribution in the second r-process peak and the rare-earth sub-peak as a function of mass models and fission fragment distributions, as well as the origin of a shift in the third r-process peak position. The latter has been noticed in a number of merger nucleosynthesis predictions. We show that the shift occurs during the r-process freeze-out when neutron captures and β-decays compete and an (n,γ)–(γ,n) equilibrium is no longer maintained. During this phase neutrons originate mainly from fission of material above A = 240. We also investigate the role of β-decay half-lives from recent theoretical advances, which lead either to a smaller amount of fissioning nuclei during freeze-out or a faster (and thus earlier) release of fission neutrons, which can (partially) prevent this shift and has an impact on the second and rare-earth peak as well.

  15. Pricing in M/M/1 queues when cost of waiting in queue differs from cost of waiting in service

    Directory of Open Access Journals (Sweden)

    Görkem Sarıyer

    2016-11-01

    Full Text Available Service providers can adjust the entrance price to the state of the demand in real life service systems where the customers' decision to receive the service, is based on this price, state of demand and other system parameters. We analyzed service provider's short and long term pricing problems in unobservable M/M/1 queues having the rational customers, where, for customers, the unit cost of waiting in the queue is higher than unit cost of waiting in the service. We showed that waiting in the queue has a clear negative effect on customers’ utilities, hence the service provider's price values. We also showed that, in the short term, monopolistic pricing is optimal for congested systems with high server utilization levels, whereas in the long term, market capturing pricing is more profitable.

  16. Reducing wait time in a hospital pharmacy to promote customer service.

    Science.gov (United States)

    Slowiak, Julie M; Huitema, Bradley E; Dickinson, Alyce M

    2008-01-01

    The purpose of this study was to compare the effects of 2 different interventions on wait times at a hospital outpatient pharmacy: (1) giving feedback to employees about customer satisfaction with wait times and (2) giving a combined intervention package that included giving more specific feedback about actual wait times and goal setting for wait time reduction in addition to the customer satisfaction feedback. The relationship between customer satisfaction ratings and wait times was examined to determine whether wait times affected customer service satisfaction. Participants were 10 employees (4 pharmacists and 6 technicians) of an outpatient pharmacy. Wait times and customer satisfaction ratings were collected for "waiting customers." An ABCBA' within-subjects design was used to assess the effects of the interventions on both wait time and customer satisfaction, where A was the baseline (no feedback and no goal setting); B was the customer satisfaction feedback; C was the customer satisfaction feedback, the wait time feedback, and the goal setting for wait time reduction; and A' was a follow-up condition that was similar to the original baseline condition. Wait times were reduced by approximately 20%, and there was concomitant increased shift in levels of customer satisfaction, as indicated by the correlation between these variables (r = -0.57 and P customer's wait time. Data from this study may provide useful preliminary benchmarking data for standard pharmacy wait times.

  17. Reachability analysis to design zero-wait entry guidance

    NARCIS (Netherlands)

    Gonzalez-Puerta, Alejandro; Mooij, E.; Valles, Celia Yabar

    2018-01-01

    This paper presents a novel reentry guidance architecture that aims to improve cur- rent mission safety by enabling zero-wait orbital aborts. To do so, an on-board trajectory planner based on Adaptive Multivariate Pseudospectral Interpolation (AMPI) is devel- oped. This planner generates

  18. EVALUTION OF THE SINGLE INTERCITY FREIGHT TRANSPORTATION WAITING TIME

    Directory of Open Access Journals (Sweden)

    N. Ponomariova

    2015-07-01

    Full Text Available The example of vechicle operation on the pendulum intercity route during single freightages processing is considered. Two approaches to the definition of the single freightage waiting time by the carrier are proposed. These approaches allow to take into account the probability of the single freightage obtaining by the carrier during the different load level of the transport enterprise capacity.

  19. Waiting for the Leaf; Warten auf den Leaf

    Energy Technology Data Exchange (ETDEWEB)

    Wilms, Jan

    2012-01-15

    Nissan will be the first manufacturer to launch an electric vehicle of the VW Golf category in the German market. With a mileage of about 170 km and a roomy passenger compartment, the Leaf promises much comfort. In the US market, it was launched two years ago. Was it worth while waiting for?.

  20. Waiting to Drive (A Minute of Health with CDC)

    Centers for Disease Control (CDC) Podcasts

    2015-04-09

    Over the past 10 years, the number of fatal motor-vehicle crashes involving teenage drivers has declined by more than 50 percent. This podcast discusses the trend of teens waiting until they are older to drive.  Created: 4/9/2015 by MMWR.   Date Released: 4/9/2015.

  1. Self-Stabilization of Wait-Free Shared Memory Objects

    NARCIS (Netherlands)

    Hoepman, J.H.; Papatriantafilou, Marina; Tsigas, Philippas

    2002-01-01

    This paper proposes a general definition of self-stabilizing wait-free shared memory objects. The definition ensures that, even in the face of processor failures, every execution after a transient memory failure is linearizable except for an a priori bounded number of actions. Shared registers have

  2. Potential impact of enhanced practice efficiency on endoscopy waiting times.

    LENUS (Irish Health Repository)

    Harewood, G C

    2009-06-01

    With the growing demand on endoscopy services, optimising practice efficiency has assumed increasing importance. Prior research has identified practice changes, which increase the efficiency in endoscopy. In this study, the potential impact of these practice changes on the current and projected future endoscopy waiting times at our institution was assessed.

  3. Waiting Time Dynamics in Two-Dimensional Infrared Spectroscopy

    NARCIS (Netherlands)

    Jansen, Thomas L. C.; Knoester, Jasper

    We review recent work on the waiting time dynamics of coherent two-dimensional infrared (2DIR) spectroscopy. This dynamics can reveal chemical and physical processes that take place on the femto- and picosecond time scale, which is faster than the time scale that may be probed by, for example,

  4. Why wait? : Organizing integrated processes in cancer care

    NARCIS (Netherlands)

    Leeftink, Anne Greetje

    2017-01-01

    The access to cancer diagnostics and cancer treatment is not the same for all types of cancer patients. Furthermore, the resources involved in these processes are costly and scarce. Long access and waiting times to diagnostics and treatment can cause increased anxiety of patients. The goal of this

  5. Determinants of Patient Waiting Time in the General Outpatient ...

    African Journals Online (AJOL)

    obtaining services and keeping patients waiting unnecessarily can be a cause of stress for both .... Simple random sampling was done for the first two patients to get the starting ... record clerks (12% [9/76]), and jumping of queue by patients.

  6. Quality Improvement Cycles that Reduced Waiting Times at ...

    African Journals Online (AJOL)

    It was decided to undertake quality improvement (QI) cycles to analyse and improve the situation, using waiting time as a measure of improvement. Methods: A QI team was chosen to conduct two QI cycles. The allocated time for QI cycle 1 was from May to August 2006 and for QI cycle 2 from September to December 2006.

  7. Blood pressure self-measurement in the obstetric waiting room

    DEFF Research Database (Denmark)

    Wagner, Stefan; Kamper, Christina H.; Toftegaard, Thomas Skjødeberg

    2013-01-01

    a reliable blood pressure reading. Results: We found that the patients did not adhere to given instructions when performing blood pressure self-measurement in the waiting room. None of the 81 patients adhered to all six inves- tigated recommendations, while around a quarter adhered to five out of six...

  8. Maternity waiting homes: A panacea for maternal/neonatal ...

    African Journals Online (AJOL)

    women to inadequately equipped delivery settings 4,5. Eritrea has made some ... Maternity waiting homes were introduced in Eritrea in 2007 as a strategy to mitigate .... 24(4):472-8. 5. Chandramohan D, Cutts F, Millard P The effect of stay in.

  9. Waiting Time Increases Risk of Attrition in Gambling Disorder Treatment

    DEFF Research Database (Denmark)

    Linnet, Jakob; Pedersen, Anders Sune

    2014-01-01

    Attrition is a well known problem in psychotherapeutic treatment. Patients with addiction have high attrition rates, and it is therefore important to identify factors that can improve completion rates in addiction. Here, we investigated the influence of waiting time as a predictor of treatment...

  10. Waiting in the queue on Hotelling’s Main Street

    NARCIS (Netherlands)

    Peters, H.J.M.; Schröder, M.J.W.; Vermeulen, A.J.

    2015-01-01

    We consider a variant of Hotelling’s location model that was proposed by Kohlberg (1983): when choosing a firm, consumers take travel time and also (expected) waiting time, which again depends on the number of consumers choosing that firm, into consideration. If we assume that firms are symmetric,

  11. No-Wait Job Shop Scheduling, a Constraint Propagation Approach

    NARCIS (Netherlands)

    Lennartz, P.M.

    2006-01-01

    Multi-machine scheduling problems have earned themselves a reputation of intractability. In this thesis we try to solve a special kind of these problems, the so-called no-wait job shop problems. In an instance of this problem-class we are given a number of operations that are to be executed on a

  12. U.S. tells CERN to wait for support

    CERN Multimedia

    Mervis, J

    1995-01-01

    The US has put off CERN's request for a $300 million contribution to help build the Large Hadron Collider. Department of Energy officials asserted that such a decision must wait until after the budget is finalized. House Science Committee Chairman Robert Walker also claimed it was too early to make a decision.

  13. Waiting Time Policies in the Health Care Sector. What Works?

    DEFF Research Database (Denmark)

    Christiansen, Terkel; Bech, Mickael

    2013-01-01

    times. In addition, a range of other measures may indirectly have affected waiting times, such as a general increase in spending on health care, the general practitioners’ role as gate-keepers, increased use of activity-based hospital reimbursement, increasing use of private heath insurance and private...

  14. Did Not Wait Patient Management Strategy (DNW PMS) Study.

    LENUS (Irish Health Repository)

    O'Keeffe, Fran

    2011-06-14

    Objectives This study was undertaken to assess the usefulness of senior emergency medicine specialists\\' review of all \\'did not wait\\' (DNW) patients\\' triage notes and the recall of at-risk patients. Methods A prospective study of all DNW patients was performed from 1 January to 31 December 2008. Following a daily review of charts of those who failed to wait to be seen, those patients considered to be at risk of adverse outcome were contacted by the liaison team and advised to return. Data were gathered on all DNW patients on the Oracle database and interrogated using the Diver solution. Results 2872 (6.3%) of 45 959 patients did not wait to be seen. 107 (3.7%) were recalled on the basis of senior emergency medicine doctor review of the patients\\' triage notes. Variables found to be associated with increased likelihood of being recalled included triage category (p<0.001), male sex (p<0.004) and certain clinical presentations. The presenting complaints associated with being recalled were chest pain (p<0.001) and alcohol\\/drug overdose (p=0.001). 9.4% of DNW patients required admission following recall. Conclusion The systematic senior doctor review of triage notes led to 3.7% of patients who failed to wait being recalled. 9.4% of those recalled required acute admission. The daily review of DNW patients\\' triage notes and the recalling of at-risk patients is a valuable addition to our risk management strategy.

  15. Did Not Wait Patient Management Strategy (DNW PMS) Study.

    LENUS (Irish Health Repository)

    2012-02-01

    Objectives This study was undertaken to assess the usefulness of senior emergency medicine specialists\\' review of all \\'did not wait\\' (DNW) patients\\' triage notes and the recall of at-risk patients. Methods A prospective study of all DNW patients was performed from 1 January to 31 December 2008. Following a daily review of charts of those who failed to wait to be seen, those patients considered to be at risk of adverse outcome were contacted by the liaison team and advised to return. Data were gathered on all DNW patients on the Oracle database and interrogated using the Diver solution. Results 2872 (6.3%) of 45 959 patients did not wait to be seen. 107 (3.7%) were recalled on the basis of senior emergency medicine doctor review of the patients\\' triage notes. Variables found to be associated with increased likelihood of being recalled included triage category (p<0.001), male sex (p<0.004) and certain clinical presentations. The presenting complaints associated with being recalled were chest pain (p<0.001) and alcohol\\/drug overdose (p=0.001). 9.4% of DNW patients required admission following recall. Conclusion The systematic senior doctor review of triage notes led to 3.7% of patients who failed to wait being recalled. 9.4% of those recalled required acute admission. The daily review of DNW patients\\' triage notes and the recalling of at-risk patients is a valuable addition to our risk management strategy.

  16. Reduction of admit wait times: the effect of a leadership-based program.

    Science.gov (United States)

    Patel, Pankaj B; Combs, Mary A; Vinson, David R

    2014-03-01

    Prolonged admit wait times in the emergency department (ED) for patients who require hospitalization lead to increased boarding time in the ED, a significant cause of ED congestion. This is associated with decreased quality of care, higher morbidity and mortality, decreased patient satisfaction, increased costs for care, ambulance diversion, higher numbers of patients who leave without being seen (LWBS), and delayed care with longer lengths of stay (LOS) for other ED patients. The objective was to assess the effect of a leadership-based program to expedite hospital admissions from the ED. This before-and-after observational study was undertaken from 2006 through 2011 at one community hospital ED. A team of ED and hospital leaders implemented a program to reduce admit wait times, using a computerized hospital-wide tracking system to monitor inpatient and ED bed status. The team collaboratively and consistently moved ED patients to their inpatient beds within an established goal of 60 minutes after an admission decision was reached. Top leadership actively intervened in real time by contacting staff whenever delays occurred to expedite immediate solutions to achieve the 60-minute goal. The primary outcome measures were the percentage of ED patients who were admitted to inpatient beds within 60 minutes from the time the beds were requested and ED boarding time. LOS, patient satisfaction, LWBS rate, and ambulance diversion hours were also measured. After ED census, hospital admission rates, and ED bed capacity were controlled for using a multivariable linear regression analysis, the admit wait time reduction program contributed to an increase in patients being admitted to the hospital within 60 minutes by 16 percentage points (95% confidence intervals [CI] = 10 to 22 points; p leadership-based program to reduce admit wait times and boarding times was associated with a significant increase in the percentage of patients admitted to the hospital within 60 minutes and a

  17. Precision mass measurements on neutron-rich Zn isotopes and their consequences on the astrophysical r-process

    Energy Technology Data Exchange (ETDEWEB)

    Baruah, Sudarshan

    2008-07-15

    The rapid neutron-capture or the r-process is responsible for the origin of about half of the neutron-rich atomic nuclei in the universe heavier than iron. For the calculation of the abundances of those nuclei, atomic masses are required as one of the input parameters with very high precision. In the present work, the masses of the neutron rich Zn isotopes (A=71 to 81) lying in the r-process path have been measured in the ISOLTRAP experiment at ISOLDE/CERN. The mass of {sup 81}Zn has been measured directly for the rst time. The half-lives of the nuclides ranged from 46.5 h ({sup 72}Zn) down to 290 ms ({sup 81}Zn). In case of all the nuclides, the relative mass uncertainty ({delta}m=m) achieved was in the order of 10{sup -8} corresponding to a 100-fold improvement in precision over previous measurements. (orig.)

  18. Precision mass measurements on neutron-rich Zn isotopes and their consequences on the astrophysical r-process

    International Nuclear Information System (INIS)

    Baruah, Sudarshan

    2008-07-01

    The rapid neutron-capture or the r-process is responsible for the origin of about half of the neutron-rich atomic nuclei in the universe heavier than iron. For the calculation of the abundances of those nuclei, atomic masses are required as one of the input parameters with very high precision. In the present work, the masses of the neutron rich Zn isotopes (A=71 to 81) lying in the r-process path have been measured in the ISOLTRAP experiment at ISOLDE/CERN. The mass of 81 Zn has been measured directly for the rst time. The half-lives of the nuclides ranged from 46.5 h ( 72 Zn) down to 290 ms ( 81 Zn). In case of all the nuclides, the relative mass uncertainty (Δm=m) achieved was in the order of 10 -8 corresponding to a 100-fold improvement in precision over previous measurements. (orig.)

  19. r-Process Nucleosynthesis in the Early Universe Through Fast Mergers of Compact Binaries in Triple Systems

    Science.gov (United States)

    Bonetti, Matteo; Perego, Albino; Capelo, Pedro R.; Dotti, Massimo; Miller, M. Coleman

    2018-05-01

    Surface abundance observations of halo stars hint at the occurrence of r-process nucleosynthesis at low metallicity ([Fe/H] scale of the inner compact object binaries. Our results are highly sensitive to the assumed initial distribution of the inner binary semi-major axes. Distributions with mostly wide compact object binaries are most affected by the third object, resulting in a strong increase (by more than a factor of 2) in the fraction of fast coalescences. If instead the distribution preferentially populates very close compact binaries, general relativistic precession prevents the third body from increasing the inner binary eccentricity to very high values. In this last case, the fraction of coalescing binaries is increased much less by tertiaries, but the fraction of binaries that would coalesce within 108 yr even without a third object is already high. Our results provide additional support to the compact-binary merger scenario for r-process nucleosynthesis.

  20. Worth the Wait? Using Past Patterns to Determine Wait Periods for E-Books Released after Print

    Science.gov (United States)

    Kohn, Karen

    2018-01-01

    This paper asks if there is an optimal wait period for e-books that balances libraries' desire to acquire books soon after their publication with the frequent desire to purchase books electronically whenever feasible. Analyzing 13,043 titles that Temple University Libraries received on its e-preferred approval plan in 2014-15, the author looks at…

  1. Capture reactions into borromean two-proton systems at rp-waiting points

    DEFF Research Database (Denmark)

    Hove, D.; Jensen, A. S.; Fynbo, H. O. U.

    2016-01-01

    of the radiative capture reactions can be determined. We present numerical results for $E1$ and $E2$ photon emission, and discuss occurrence preferences in general as well as relative sizes of these most likely processes. Finally, we present narrow estimated intervals for the proton capture rates relevant...

  2. Canadian Consensus on Medically Acceptable Wait Times for Digestive Health Care

    Directory of Open Access Journals (Sweden)

    William G Paterson

    2006-01-01

    Full Text Available BACKGROUND: Delays in access to health care in Canada have been reported, but standardized systems to manage and monitor wait lists and wait times, and benchmarks for appropriate wait times, are lacking. The objective of the present consensus was to develop evidence- and expertise-based recommendations for medically appropriate maximal wait times for consultation and procedures by a digestive disease specialist.

  3. The everyday of people waiting for kidney transplantation

    Directory of Open Access Journals (Sweden)

    Micheli Rezende Ferreira Cruz

    2016-01-01

    Full Text Available Objective: to understand the everyday of people experiencing the waiting list for kidney transplantation. Methods: this is a qualitative research, based on Heideggerian phenomenology. 14 deponents participated in hemodialysis and registered on the waiting list for kidney transplantation. Phenomenological interview with the research question: How is the experience awaiting the kidney transplant? Color marking technique for analyzing demarcating lines that show similarity, of these, emerged the essential structures that enabled the units of meaning. Results: changing lifestyles, imposing a routine and rigidity of treatment signaling everyday stress and exhaustion of hemodialysis being. Emerging from the modes of gossip, curiosity, and bureaucracy, unfolding-inauthentic and impersonal regarding their care. Conclusion: hemodialysis dependence and awaiting kidney transplantation transfer care for family/professional caregivers. To understand the everyday marked by impositions and restrictions, the reflection about how professional health interaction/being-care becomes important.

  4. Improving Patients Experience in Peadiatric Emergency Waiting Room.

    Science.gov (United States)

    Ehrler, Frederic; Siebert, Johan; Wipfli, Rolf; Duret, Cyrille; Gervaix, Alain; Lovis, Christian

    2016-01-01

    When visiting the emergency department, the perception of the time spent in the waiting room before the beginning of the care, may influence patients' experience. Based on models of service evaluation, highlighting the importance of informing people about their waiting process and their place in the queue, we have developed an innovative information screen aiming at improving perception of time by patients. Following an iterative process, a group of experts including computer scientists, ergonomists and caregivers designed a solution adapted to the pediatric context. The solution includes a screen displaying five lanes representing triage levels. Patients are represented by individual avatars, drawn sequentially in the appropriate line. The interface has been designed using gamification principle, aiming at increasing acceptance, lowering learning curve and improving satisfaction. Questionnaire based evaluation results revealed high satisfaction from the 278 respondents even if the informative content was not always completely clear.

  5. Renewal processes based on generalized Mittag-Leffler waiting times

    Science.gov (United States)

    Cahoy, Dexter O.; Polito, Federico

    2013-03-01

    The fractional Poisson process has recently attracted experts from several fields of study. Its natural generalization of the ordinary Poisson process made the model more appealing for real-world applications. In this paper, we generalized the standard and fractional Poisson processes through the waiting time distribution, and showed their relations to an integral operator with a generalized Mittag-Leffler function in the kernel. The waiting times of the proposed renewal processes have the generalized Mittag-Leffler and stretched-squashed Mittag-Leffler distributions. Note that the generalizations naturally provide greater flexibility in modeling real-life renewal processes. Algorithms to simulate sample paths and to estimate the model parameters are derived. Note also that these procedures are necessary to make these models more usable in practice. State probabilities and other qualitative or quantitative features of the models are also discussed.

  6. Mandatory weight loss during the wait for bariatric surgery.

    Science.gov (United States)

    Glenn, Nicole M; Raine, Kim D; Spence, John C

    2015-01-01

    Mandatory presurgical, behavior-induced weight loss, although not standard, is a relatively common practice among bariatric surgical clinics. We explore the patient's experience of this practice using phenomenology. We gathered experiential accounts from 7 individuals waiting to have the procedure at a large publically funded clinic in western Canada. In writing this article, we focused on four phenomenological themes: "just nod your head and carry on"-silencing through the ideal; waiting and weighing-promoting weight consciousness to the weight conscious; paying for surgical approval through weight loss; and presurgical weight loss and questioning the need for weight loss surgery altogether. We contrast the experiential findings with the clinical literature to question the impact and possible (unintended or unexpected) effects the practice might have, particularly on patients' lives. We situate this article within a larger discussion about the possible contribution of experiential knowledge to clinical guidelines, practices, and pedagogies. © The Author(s) 2014.

  7. How Tolerable is Delay? Consumers' Evaluations of Internet Web Sites After Waiting

    NARCIS (Netherlands)

    Dellaert, B.G.C.; Kahn, B.

    1998-01-01

    How consumers’ waiting times affect their retrospective evaluations of Internet Web Sites is investigated in four computer-based experiments. Results show that waiting can but does not always negatively affect evaluations of Web Sites. Results also show that the potential negative effects of waiting

  8. Nine centuries waiting: The experiences of Iranians surrogacy commissioning mothers

    OpenAIRE

    Zandi, Mitra; Vanaki, Zohreh; Shiva, Marziyeh; Mohammadi, Eesa

    2014-01-01

    Background: There are a few studies about commissioning mothers’ understanding from the surrogacy during 9 months of waiting for delivery in Iran and other countries. This study was conducted with an aim to explore and explain the nature of concerns (experiences) of commissioning mothers. Materials and Methods: A qualitative design with a conventional content analysis approach was used to gather and analyze the experiences of commissioning mothers. They were selected from Royan Research Centr...

  9. An Elementary Derivation of Mean Wait Time in Polling Systems

    OpenAIRE

    Cady, Field

    2012-01-01

    Polling systems are a well-established subject in queueing theory. However, their formal treatments generally rely heavily on relatively sophisticated theoretical tools, such as moment generating functions and Laplace transforms, and solutions often require the solution of large systems of equations. We show that, if you are willing to only have the average waiting of a system time rather than higher moments, it can found through an elementary derivation based only on algebra and some well-kn...

  10. Incorporating waiting time in competitive location models: Formulations and heuristics

    OpenAIRE

    Silva, Francisco; Serra, Daniel

    2008-01-01

    In this paper we propose a metaheuristic to solve a new version of the Maximum Capture Problem. In the original MCP, market capture is obtained by lower traveling distances or lower traveling time, in this new version not only the traveling time but also the waiting time will affect the market share. This problem is hard to solve using standard optimization techniques. Metaheuristics are shown to offer accurate results within acceptable computing times.

  11. Probability-Based Determination Methods for Service Waiting in Service-Oriented Computing Environments

    Science.gov (United States)

    Zeng, Sen; Huang, Shuangxi; Liu, Yang

    Cooperative business processes (CBP)-based service-oriented enterprise networks (SOEN) are emerging with the significant advances of enterprise integration and service-oriented architecture. The performance prediction and optimization for CBP-based SOEN is very complex. To meet these challenges, one of the key points is to try to reduce an abstract service’s waiting number of its physical services. This paper introduces a probability-based determination method (PBDM) of an abstract service’ waiting number, M l , and time span, τ i , for its physical services. The determination of M i and τ i is according to the physical services’ arriving rule and their overall performance’s distribution functions. In PBDM, the arriving probability of the physical services with the best overall performance value is a pre-defined reliability. PBDM has made use of the information of the physical services’ arriving rule and performance distribution functions thoroughly, which will improve the computational efficiency for the scheme design and performance optimization of the collaborative business processes in service-oriented computing environments.

  12. Use of maternity waiting home in rural Zambia.

    Science.gov (United States)

    van Lonkhuijzen, Luc; Stegeman, Margreet; Nyirongo, Rebecca; van Roosmalen, Jos

    2003-04-01

    This study was conducted to assess the results from the use of a maternity waiting home, a health facility to which women with high risk pregnancies are referred during the last weeks of pregnancy in rural Zambia. It compared the risk status and pregnancy outcome in women staying as waiters with those women who give birth in hospital after direct admission (non-waiters). Forty seven per-cent of the non-waiters (n = 292) had no maternal risk factors and 85% had no antenatal risk factors as compared to 17% and 78% among the waiters (n = 218). Eighty six per cent of waiters had spontaneous vaginal vertex delivery as compared to 95% of non-waiters. Although the differences in risk status were statistically significant, no differences were found in birth weight and maternal and perinatal mortality. The similar obstetric outcome among waiters with more high risk pregnancies and non-waiters could be interpreted as a possible outcome of the maternity waiting home. When dependent on a proper functioning referral system, such waiting homes can reduce perinatal mortality.

  13. At the Tipping Point

    Energy Technology Data Exchange (ETDEWEB)

    Wiley, H. S.

    2011-02-28

    There comes a time in every field of science when things suddenly change. While it might not be immediately apparent that things are different, a tipping point has occurred. Biology is now at such a point. The reason is the introduction of high-throughput genomics-based technologies. I am not talking about the consequences of the sequencing of the human genome (and every other genome within reach). The change is due to new technologies that generate an enormous amount of data about the molecular composition of cells. These include proteomics, transcriptional profiling by sequencing, and the ability to globally measure microRNAs and post-translational modifications of proteins. These mountains of digital data can be mapped to a common frame of reference: the organism’s genome. With the new high-throughput technologies, we can generate tens of thousands of data points from each sample. Data are now measured in terabytes and the time necessary to analyze data can now require years. Obviously, we can’t wait to interpret the data fully before the next experiment. In fact, we might never be able to even look at all of it, much less understand it. This volume of data requires sophisticated computational and statistical methods for its analysis and is forcing biologists to approach data interpretation as a collaborative venture.

  14. The neutron long counter NERO for studies of β-delayed neutron emission in the r-process

    International Nuclear Information System (INIS)

    Pereira, J.; Hosmer, P.; Lorusso, G.; Santi, P.; Couture, A.; Daly, J.; Del Santo, M.; Elliot, T.

    2010-01-01

    The neutron long counter NERO was built at the National Superconducting Cyclotron Laboratory (NSCL), Michigan State University, for measuring β-delayed neutron-emission probabilities. The detector was designed to work in conjunction with a β-delay implantation station, so that β decays and β-delayed neutrons emitted from implanted nuclei can be measured simultaneously. The high efficiency of about 40%, for the range of energies of interest, along with the small background, are crucial for measuring β-delayed neutron emission branchings for neutron-rich r-process nuclei produced as low intensity fragmentation beams in in-flight separator facilities.

  15. Reducing pharmacy wait time to promote customer service: a follow-up study.

    Science.gov (United States)

    Slowiak, Julie M; Huitema, Bradley E

    2015-01-01

    The present study had 3 objectives: (1) to evaluate the effects of 2 different interventions (feedback regarding customer satisfaction with wait time and combined feedback and goal setting) on wait time in a hospital outpatient pharmacy; (2) to assess the extent to which the previously applied interventions maintained their effects; and (3) to evaluate the differences between the effects of the original study and those of the present follow-up study. Participants were 10 employees (4 pharmacists and 6 technicians) of an outpatient pharmacy. Wait times and customer satisfaction ratings were collected for "waiting customers." An ABCB within-subjects design was used to assess the effects of the interventions on both wait time and customer satisfaction, where A was the baseline (no feedback and no goal setting); B was the customer satisfaction feedback; and C was the customer satisfaction feedback, the wait time feedback, and the goal setting for wait time reduction. Wait time decreased after baseline when the combined intervention was introduced, and wait time increased with the reintroduction of satisfaction feedback (alone). The results of the replication study confirm the pattern of the results of the original study and demonstrate high sensitivity of levels of customer satisfaction with wait time. The most impressive result of the replication is the nearly 2-year maintenance of lower wait time between the end of the original study and the beginning (baseline) of the replication.

  16. COMPACT STELLAR BINARY ASSEMBLY IN THE FIRST NUCLEAR STAR CLUSTERS AND r-PROCESS SYNTHESIS IN THE EARLY UNIVERSE

    International Nuclear Information System (INIS)

    Ramirez-Ruiz, Enrico; MacLeod, Morgan; Trenti, Michele; Roberts, Luke F.; Lee, William H.; Saladino-Rosas, Martha I.

    2015-01-01

    Investigations of elemental abundances in the ancient and most metal deficient stars are extremely important because they serve as tests of variable nucleosynthesis pathways and can provide critical inferences of the type of stars that lived and died before them. The presence of r-process elements in a handful of carbon-enhanced metal-poor (CEMP-r) stars, which are assumed to be closely connected to the chemical yield from the first stars, is hard to reconcile with standard neutron star mergers. Here we show that the production rate of dynamically assembled compact binaries in high-z nuclear star clusters can attain a sufficient high value to be a potential viable source of heavy r-process material in CEMP-r stars. The predicted frequency of such events in the early Galaxy, much lower than the frequency of Type II supernovae but with significantly higher mass ejected per event, can naturally lead to a high level of scatter of Eu as observed in CEMP-r stars

  17. COMPACT STELLAR BINARY ASSEMBLY IN THE FIRST NUCLEAR STAR CLUSTERS AND r-PROCESS SYNTHESIS IN THE EARLY UNIVERSE

    Energy Technology Data Exchange (ETDEWEB)

    Ramirez-Ruiz, Enrico; MacLeod, Morgan [Department of Astronomy and Astrophysics, University of California, Santa Cruz, CA 95064 (United States); Trenti, Michele [Kavli Institute for Cosmology and Institute of Astronomy, University of Cambridge, Madingley Road, Cambridge CB3 0HA (United Kingdom); Roberts, Luke F. [TAPIR, California Institute of Technology, Pasadena, California 91125 (United States); Lee, William H.; Saladino-Rosas, Martha I. [Instituto de Astronomía, Universidad Nacional Autónoma de México, México DF 04510, México (Mexico)

    2015-04-01

    Investigations of elemental abundances in the ancient and most metal deficient stars are extremely important because they serve as tests of variable nucleosynthesis pathways and can provide critical inferences of the type of stars that lived and died before them. The presence of r-process elements in a handful of carbon-enhanced metal-poor (CEMP-r) stars, which are assumed to be closely connected to the chemical yield from the first stars, is hard to reconcile with standard neutron star mergers. Here we show that the production rate of dynamically assembled compact binaries in high-z nuclear star clusters can attain a sufficient high value to be a potential viable source of heavy r-process material in CEMP-r stars. The predicted frequency of such events in the early Galaxy, much lower than the frequency of Type II supernovae but with significantly higher mass ejected per event, can naturally lead to a high level of scatter of Eu as observed in CEMP-r stars.

  18. Assessment of saddle-point-mass predictions for astrophysical applications

    Energy Technology Data Exchange (ETDEWEB)

    Kelic, A.; Schmidt, K.H.

    2005-07-01

    Using available experimental data on fission barriers and ground-state masses, a detailed study on the predictions of different models concerning the isospin dependence of saddle-point masses is performed. Evidence is found that several macroscopic models yield unrealistic saddle-point masses for very neutron-rich nuclei, which are relevant for the r-process nucleosynthesis. (orig.)

  19. Lean-driven improvements slash wait times, drive up patient satisfaction scores.

    Science.gov (United States)

    2012-07-01

    Administrators at LifePoint Hospitals, based in Brentwood, TN, used lean manufacturing techniques to slash wait times by as much as 30 minutes and achieve double-digit increases in patient satisfaction scores in the EDs at three hospitals. In each case, front-line workers took the lead on identifying opportunities for improvement and redesigning the patient-flow process. As a result of the new efficiencies, patient volume is up by about 25% at all three hospitals. At each hospital, the improvement process began with Kaizen, a lean process that involves bringing personnel together to flow-chart the current system, identify problem areas, and redesign the process. Improvement teams found big opportunities for improvement at the front end of the flow process. Key to the approach was having a plan up front to deal with non-compliance. To sustain improvements, administrators gather and disseminate key metrics on a daily basis.

  20. Tipping Point

    Medline Plus

    Full Text Available ... en español Blog About OnSafety CPSC Stands for Safety The Tipping Point Home > 60 Seconds of Safety (Videos) > The Tipping Point The Tipping Point by ... danger death electrical fall furniture head injury product safety television tipover tv Watch the video in Adobe ...

  1. Computation and evaluation of scheduled waiting time for railway networks

    DEFF Research Database (Denmark)

    Landex, Alex

    2010-01-01

    Timetables are affected by scheduled waiting time (SWT) that prolongs the travel times for trains and thereby passengers. SWT occurs when a train hinders another train to run with the wanted speed. The SWT affects both the trains and the passengers in the trains. The passengers may be further...... affected due to longer transfer times to other trains. SWT can be estimated analytically for a given timetable or by simulation of timetables and/or plans of operation. The simulation of SWT has the benefit that it is possible to examine the entire network. This makes it possible to improve the future...

  2. Mobile Technology Waiting for the 3G Rush

    Institute of Scientific and Technical Information of China (English)

    HAYET SELLAMI

    2006-01-01

    @@ China is potentially the biggest third generation (3G) mobile market in the world, and everyone is eager to grab a piece of the pie. Foreign carriers are still not allowed to apply for licences since China's decision regarding licensing and adoption of 3G mobile services is still pending, but the waiting list is long. Both Chinese officials and industry executives have stated that they want 3G in place in time for the August 2008 Olympic Games held in Beijing. This tight deadline leaves no room for failure.

  3. Guided Online or Face-to-Face Cognitive Behavioral Treatment for Insomnia: A Randomized Wait-List Controlled Trial.

    Science.gov (United States)

    Lancee, Jaap; van Straten, Annemieke; Morina, Nexhmedin; Kaldo, Viktor; Kamphuis, Jan H

    2016-01-01

    To compare the efficacy of guided online and individual face-to-face cognitive behavioral treatment for insomnia (CBT-I) to a wait-list condition. A randomized controlled trial comparing three conditions: guided online; face-to-face; wait-list. Posttest measurements were administered to all conditions, along with 3- and 6-mo follow-up assessments to the online and face-to-face conditions. Ninety media-recruited participants meeting the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for insomnia were randomly allocated to either guided online CBT-I (n = 30), individual face-to-face CBT-I (n = 30), or wait-list (n = 30). At post-assessment, the online (Cohen d = 1.2) and face-to-face (Cohen d = 2.3) intervention groups showed significantly larger treatment effects than the wait-list group on insomnia severity (insomnia severity index). Large treatment effects were also found for the sleep diary estimates (except for total sleep time), and anxiety and depression measures (for depression only in the face-to-face condition). Face-to-face treatment yielded a statistically larger treatment effect (Cohen d = 0.9) on insomnia severity than the online condition at all time points. In addition, a moderate differential effect size favoring face-to-face treatment emerged at the 3- and 6-mo follow-up on all sleep diary estimates. Face-to-face treatment further outperformed online treatment on depression and anxiety outcomes. These data show superior performance of face-to-face treatment relative to online treatment. Yet, our results also suggest that online treatment may offer a potentially cost-effective alternative to and complement face-to-face treatment. Clinicaltrials.gov, NCT01955850. A commentary on this article appears in this issue on page 13. © 2016 Associated Professional Sleep Societies, LLC.

  4. The British Columbia Nephrologists' Access Study (BCNAS) - a prospective, health services interventional study to develop waiting time benchmarks and reduce wait times for out-patient nephrology consultations.

    Science.gov (United States)

    Schachter, Michael E; Romann, Alexandra; Djurdev, Ognjenka; Levin, Adeera; Beaulieu, Monica

    2013-08-29

    Early referral and management of high-risk chronic kidney disease may prevent or delay the need for dialysis. Automatic eGFR reporting has increased demand for out-patient nephrology consultations and in some cases, prolonged queues. In Canada, a national task force suggested the development of waiting time targets, which has not been done for nephrology. We sought to describe waiting time for outpatient nephrology consultations in British Columbia (BC). Data collection occurred in 2 phases: 1) Baseline Description (Jan 18-28, 2010) and 2) Post Waiting Time Benchmark-Introduction (Jan 16-27, 2012). Waiting time was defined as the interval from receipt of referral letters to assessment. Using a modified Delphi process, Nephrologists and Family Physicians (FP) developed waiting time targets for commonly referred conditions through meetings and surveys. Rules were developed to weigh-in nephrologists', FPs', and patients' perspectives in order to generate waiting time benchmarks. Targets consider comorbidities, eGFR, BP and albuminuria. Referred conditions were assigned a priority score between 1-4. BC nephrologists were encouraged to centrally triage referrals to see the first available nephrologist. Waiting time benchmarks were simultaneously introduced to guide patient scheduling. A post-intervention waiting time evaluation was then repeated. In 2010 and 2012, 43/52 (83%) and 46/57 (81%) of BC nephrologists participated. Waiting time decreased from 98(IQR44,157) to 64(IQR21,120) days from 2010 to 2012 (p = management associated with improved access to nephrologists in BC. Improvements in waiting time was most marked for the highest priority patients, which suggests that benchmarks had an influence on triaging behavior. Further research is needed to determine whether this effect is sustainable.

  5. Urgency coding as a dynamic tool in management of waiting lists for psychogeriatric nursing home care in The Netherlands

    NARCIS (Netherlands)

    Meiland, F. J. M.; Danse, J. A. C.; Wendte, J. F.; Gunning-Schepers, L. J.; Klazinga, N. S.

    2002-01-01

    Criteria are used to prioritise patients on waiting lists for health care services. This is also true for waiting lists for admission to psychogeriatric nursing homes. A patient's position on these latter waiting lists is determined by (changes in) urgency and waiting time. The present article

  6. RAVE J203843.2-002333: The First Highly R-process-enhanced Star Identified in the RAVE Survey

    Science.gov (United States)

    Placco, Vinicius M.; Holmbeck, Erika M.; Frebel, Anna; Beers, Timothy C.; Surman, Rebecca A.; Ji, Alexander P.; Ezzeddine, Rana; Points, Sean D.; Kaleida, Catherine C.; Hansen, Terese T.; Sakari, Charli M.; Casey, Andrew R.

    2017-07-01

    We report the discovery of RAVE J203843.2-002333, a bright (V = 12.73), very metal-poor ([{Fe}/{{H}}] = -2.91), r-process-enhanced ([{Eu}/{Fe}] = +1.64 and [{Ba}/{Eu}] = -0.81) star selected from the RAVE survey. This star was identified as a metal-poor candidate based on its medium-resolution (R ˜ 1600) spectrum obtained with the KPNO/Mayall Telescope, and followed up with high-resolution (R ˜ 66,000) spectroscopy with the Magellan/Clay Telescope, allowing for the determination of elemental abundances for 24 neutron-capture elements, including thorium and uranium. RAVE J2038-0023 is only the fourth metal-poor star with a clearly measured U abundance. The derived chemical abundance pattern exhibits good agreement with those of other known highly r-process-enhanced stars, and evidence suggests that it is not an actinide-boost star. Age estimates were calculated using U/X abundance ratios, yielding a mean age of 13.0 ± 1.1 Gyr. Based on observations gathered with the 6.5 m Magellan Telescopes located at Las Campanas Observatory, Chile; Kitt Peak National Observatory, National Optical Astronomy Observatory (NOAO Prop. ID: 14B-0231; PI: Placco), which is operated by the Association of Universities for Research in Astronomy (AURA) under cooperative agreement with the National Science Foundation. The authors are honored to be permitted to conduct astronomical research on Iolkam Du’ag (Kitt Peak), a mountain with particular significance to the Tohono O’odham.

  7. Patient deaths blamed on long waits at the Phoenix VA

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2014-04-01

    Full Text Available No abstract available. Article truncated at 150 words. This morning the lead article in the Arizona Republic was a report blaming as many as 40 deaths at the Phoenix VA on long waits (1. Yesterday, Rep. Jeff Miller, the chairman of the House Committee on Veterans Affairs, held a hearing titled “A Continued Assessment of Delays in VA Medical Care and Preventable Veteran Deaths.” “It appears as though there could be as many as 40 veterans whose deaths could be related to delays in care,” Miller announced to a stunned audience. The committee has spent months investigating patient-care scandals and allegations at VA facilities in Pittsburgh, Atlanta, Miami and other cities. said that dozens of VA hospital patients in Phoenix may have died while awaiting medical care. He went on to say that staff investigators have evidence that the Phoenix VA Health Care System keeps two sets of records to conceal prolonged waits that patients must endure for ...

  8. No-Wait Flexible Flow Shop Scheduling with Due Windows

    Directory of Open Access Journals (Sweden)

    Rong-Hwa Huang

    2015-01-01

    Full Text Available To improve capacity and reduce processing time, the flow shop with multiprocessors (FSMP system is commonly used in glass, steel, and semiconductor production. No-wait FSMP is a modern production system that responds to periods when zero work is required in process production. The production process must be continuous and uninterrupted. Setup time must also be considered. Just-in-time (JIT production is very popular in industry, and timely delivery is important to customer satisfaction. Therefore, it is essential to consider the time window constraint, which is also very complex. This study focuses on a no-wait FSMP problem with time window constraint. An improved ant colony optimization (ACO, known as ant colony optimization with flexible update (ACOFU, is developed to solve the problem. The results demonstrate that ACOFU is more effective and robust than ACO when applied to small-scale problems. ACOFU has superior solution capacity and robustness when applied to large-scale problems. Therefore, this study concludes that the proposed algorithm ACOFU performs excellently when applied to the scheduling problem discussed in this study.

  9. Pooled Open Blocks Shorten Wait Times for Nonelective Surgical Cases.

    Science.gov (United States)

    Zenteno, Ana C; Carnes, Tim; Levi, Retsef; Daily, Bethany J; Price, Devon; Moss, Susan C; Dunn, Peter F

    2015-07-01

    Assess the impact of the implementation of a data-driven scheduling strategy that aimed to improve the access to care of nonelective surgical patients at Massachusetts General Hospital (MGH). Between July 2009 and June 2010, MGH experienced increasing throughput challenges in its perioperative environment: approximately 30% of the nonelective patients were waiting more than the prescribed amount of time to get to surgery, hampering access to care and aggravating the lack of inpatient beds. This work describes the design and implementation of an "open block" strategy: operating room (OR) blocks were reserved for nonelective patients during regular working hours (prime time) and their management centralized. Discrete event simulation showed that 5 rooms would decrease the percentage of delayed patients from 30% to 2%, assuming that OR availability was the only reason for preoperative delay. Implementation began in January 2012. We compare metrics for June through December of 2012 against the same months of 2011. The average preoperative wait time of all nonelective surgical patients decreased by 25.5% (P reason for delay. Rigorous metrics were developed to evaluate its performance. Strong managerial leadership was crucial to enact the new practices and turn them into organizational change.

  10. Nine centuries waiting: The experiences of Iranians surrogacy commissioning mothers.

    Science.gov (United States)

    Zandi, Mitra; Vanaki, Zohreh; Shiva, Marziyeh; Mohammadi, Eesa

    2014-05-01

    There are a few studies about commissioning mothers' understanding from the surrogacy during 9 months of waiting for delivery in Iran and other countries. This study was conducted with an aim to explore and explain the nature of concerns (experiences) of commissioning mothers. A qualitative design with a conventional content analysis approach was used to gather and analyze the experiences of commissioning mothers. They were selected from Royan Research Centre and other infertility centers in Iran. After purposive sampling for the selection of the participants, unstructured interviews were held for data collection. Twenty-four unstructured interviews were conducted with 12 commissioning mothers, 2 surrogate mothers, and 2 infertility center social workers who directly and continuously dealt with these mothers. TWO MAIN THEMES EMERGED FROM THE DATA ANALYSIS: 1. cultural dilemma (consisting of three subthemes: Social taboo, concerns about disclosure to others and the child, concerns about altering maternal and child's identity, and 2. uncertain waiting (consisting of three subthemes: Concerns about health of fetus and surrogate, concerns about an unfamiliar surrogate, and concerns about lack of preparation for maternal role). The study reveals the importance of maternal emotional care in this group and introduces a new arena for nurses' activity. These findings help the mothers by nurses' activities in health care clinics and anywhere they deliver nursing care.

  11. Nine centuries waiting: The experiences of Iranians surrogacy commissioning mothers

    Science.gov (United States)

    Zandi, Mitra; Vanaki, Zohreh; Shiva, Marziyeh; Mohammadi, Eesa

    2014-01-01

    Background: There are a few studies about commissioning mothers’ understanding from the surrogacy during 9 months of waiting for delivery in Iran and other countries. This study was conducted with an aim to explore and explain the nature of concerns (experiences) of commissioning mothers. Materials and Methods: A qualitative design with a conventional content analysis approach was used to gather and analyze the experiences of commissioning mothers. They were selected from Royan Research Centre and other infertility centers in Iran. After purposive sampling for the selection of the participants, unstructured interviews were held for data collection. Twenty-four unstructured interviews were conducted with 12 commissioning mothers, 2 surrogate mothers, and 2 infertility center social workers who directly and continuously dealt with these mothers. Results: Two main themes emerged from the data analysis: 1. cultural dilemma (consisting of three subthemes: Social taboo, concerns about disclosure to others and the child, concerns about altering maternal and child's identity, and 2. uncertain waiting (consisting of three subthemes: Concerns about health of fetus and surrogate, concerns about an unfamiliar surrogate, and concerns about lack of preparation for maternal role). Conclusions: The study reveals the importance of maternal emotional care in this group and introduces a new arena for nurses’ activity. These findings help the mothers by nurses’ activities in health care clinics and anywhere they deliver nursing care. PMID:24949058

  12. Healthcare Use for Pain in Women Waiting for Gynaecological Surgery

    Directory of Open Access Journals (Sweden)

    Sarah Walker

    2016-01-01

    Full Text Available Background. Pain while waiting for surgery may increase healthcare utilization (HCU preoperatively. Objective. Examine the association between preoperative pain and HCU in the year prior to gynecological surgery. Methods. 590 women waiting for surgery in a Canadian tertiary care centre were asked to report on HCU in the year before surgery. Pain was assessed using the Brief Pain Inventory. Results. 33% reported moderate to severe pain intensity and interference in the week before surgery. Sixty-one percent (n=360 reported a total of 2026 healthcare visits, with 21% (n=126 reporting six or more visits in the year before surgery. After controlling for covariates, women with moderate to severe (>3/10 pain intensity/interference reported higher odds of overall HCU (≥3 pain-related visits to family doctor or specialist in the past year or ≥1 to emergency/walk-in clinic compared to women with no or mild pain. Lower body mass index (BMI < 30 versus ≥30 and anxiety and/or depression were associated with emergency department or walk-in visits but not visits to family doctors or specialists. Conclusions. There is a high burden of pain in women awaiting gynecological surgery. Decisions about resource allocation should consider the impact of pain on individuals and the healthcare system.

  13. Magazines in waiting areas of hospital: a forgotten microbial reservoir?

    Science.gov (United States)

    Adé, Mathias; Burger, Sandrine; Cuntzmann, Anaelle; Exinger, Julien; Meunier, Olivier

    2017-12-01

    The hospital environment is a potential source of microbial contamination. Thus, the magazines in hospital's waiting rooms are handled by patients and visitors whose health and hygiene conditions can vary widely. In this context, we had measured the microbial load on the surface of magazines. Fifteen magazines from 5 waiting rooms of hospital are sampled by agar prints at the areas taken in hand. The agar plates are incubated at 30̊C for 72h. The colonies are counted and identified by MALDI-TOF mass spectrometry (Vitek ® -MS). The extraction efficiency of bacteria by the agar print method on the magazines is calculated. All the samples highlight a varied bacterial flora: 32CFU/agar in mean. Isolated bacteria come principally from the skin flora (>60%), but we also isolate potentially pathogenic micro-organisme like S. aureus, E. faecalis, A. viridans and Aspergillus sp. as well as oropharyngeal flora bacteria like A. iwolfii and M. osloensis and fecal like B. stercoris. Some species rarely described in hospital are also isolated such as P. yeei or K. sedentarius. The extraction efficiency of the sampling method on a magazine is 36%. Our study, which is the first to be interested in the bacterial contamination of magazines in hospital, could make them consider as microbial reservoir to be controlled, especially for the most fragile patients. New bacterial identification techniques as the MALDI-TOF allow to reveal the presence of rarely described and often underestimated species.

  14. The effect of waiting times on demand and supply for elective surgery: Evidence from Italy.

    Science.gov (United States)

    Riganti, Andrea; Siciliani, Luigi; Fiorio, Carlo V

    2017-09-01

    Waiting times are a major policy concern in publicly funded health systems across OECD countries. Economists have argued that, in the presence of excess demand, waiting times act as nonmonetary prices to bring demand for and supply of health care in equilibrium. Using administrative data disaggregated by region and surgical procedure over 2010-2014 in Italy, we estimate demand and supply elasticities with respect to waiting times. We employ linear regression models with first differences and instrumental variables to deal with endogeneity of waiting times. We find that demand is inelastic to waiting times while supply is more elastic. Estimates of demand elasticity are between -0.15 to -0.24. Our results have implications on the effectiveness of policies aimed at increasing supply and their ability to reduce waiting times. Copyright © 2017 John Wiley & Sons, Ltd.

  15. Waiting time disparities in breast cancer diagnosis and treatment: a population-based study in France.

    Science.gov (United States)

    Molinié, F; Leux, C; Delafosse, P; Ayrault-Piault, S; Arveux, P; Woronoff, A S; Guizard, A V; Velten, M; Ganry, O; Bara, S; Daubisse-Marliac, L; Tretarre, B

    2013-10-01

    Waiting times are key indicators of a health's system performance, but are not routinely available in France. We studied waiting times for diagnosis and treatment according to patients' characteristics, tumours' characteristics and medical management options in a sample of 1494 breast cancers recorded in population-based registries. The median waiting time from the first imaging detection to the treatment initiation was 34 days. Older age, co-morbidity, smaller size of tumour, detection by organised screening, biopsy, increasing number of specimens removed, multidisciplinary consulting meetings and surgery as initial treatment were related to increased waiting times in multivariate models. Many of these factors were related to good practices guidelines. However, the strong influence of organised screening programme and the disparity of waiting times according to geographical areas were of concern. Better scheduling of diagnostic tests and treatment propositions should improve waiting times in the management of breast cancer in France. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Should I stay or should I go? Hospital emergency department waiting times and demand.

    Science.gov (United States)

    Sivey, Peter

    2018-03-01

    In the absence of the price mechanism, hospital emergency departments rely on waiting times, alongside prioritisation mechanisms, to restrain demand and clear the market. This paper estimates by how much the number of treatments demanded is reduced by a higher waiting time. I use variation in waiting times for low-urgency patients caused by rare and resource-intensive high-urgency patients to estimate the relationship. I find that when waiting times are higher, more low-urgency patients are deterred from treatment and leave the hospital during the waiting period without being treated. The waiting time elasticity of demand for low-urgency patients is approximately -0.25 and is highest for the lowest-urgency patients. Copyright © 2017 John Wiley & Sons, Ltd.

  17. Poster - 26: Electronic Waiting Room Management for a busy Cancer Centre

    Energy Technology Data Exchange (ETDEWEB)

    Kildea, John; Hijal, Tarek [McGill University Health Center (Canada)

    2016-08-15

    We describe an electronic waiting room management system that we have developed and deployed in our cancer centre. Our system connects with our electronic medical records systems, gathers data for a machine learning algorithm to predict future patient waiting times, and is integrated with a mobile phone app. The system has been in operation for over nine months and has led to reduced lines, calmer waiting rooms and overwhelming patient and staff satisfaction.

  18. Poster - 26: Electronic Waiting Room Management for a busy Cancer Centre

    International Nuclear Information System (INIS)

    Kildea, John; Hijal, Tarek

    2016-01-01

    We describe an electronic waiting room management system that we have developed and deployed in our cancer centre. Our system connects with our electronic medical records systems, gathers data for a machine learning algorithm to predict future patient waiting times, and is integrated with a mobile phone app. The system has been in operation for over nine months and has led to reduced lines, calmer waiting rooms and overwhelming patient and staff satisfaction.

  19. Fixed Points

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 5; Issue 5. Fixed Points - From Russia with Love - A Primer of Fixed Point Theory. A K Vijaykumar. Book Review Volume 5 Issue 5 May 2000 pp 101-102. Fulltext. Click here to view fulltext PDF. Permanent link:

  20. Tipping Point

    Medline Plus

    Full Text Available ... OnSafety CPSC Stands for Safety The Tipping Point Home > 60 Seconds of Safety (Videos) > The Tipping Point ... 24 hours a day. For young children whose home is a playground, it’s the best way to ...

  1. Tipping Point

    Medline Plus

    Full Text Available ... 60 Seconds of Safety (Videos) > The Tipping Point The Tipping Point by CPSC Blogger September 22, 2009 appliance child Childproofing CPSC danger death electrical fall furniture head injury product safety television tipover tv Watch the video in Adobe Flash ...

  2. Predictive event modelling in multicenter clinical trials with waiting time to response.

    Science.gov (United States)

    Anisimov, Vladimir V

    2011-01-01

    A new analytic statistical technique for predictive event modeling in ongoing multicenter clinical trials with waiting time to response is developed. It allows for the predictive mean and predictive bounds for the number of events to be constructed over time, accounting for the newly recruited patients and patients already at risk in the trial, and for different recruitment scenarios. For modeling patient recruitment, an advanced Poisson-gamma model is used, which accounts for the variation in recruitment over time, the variation in recruitment rates between different centers and the opening or closing of some centers in the future. A few models for event appearance allowing for 'recurrence', 'death' and 'lost-to-follow-up' events and using finite Markov chains in continuous time are considered. To predict the number of future events over time for an ongoing trial at some interim time, the parameters of the recruitment and event models are estimated using current data and then the predictive recruitment rates in each center are adjusted using individual data and Bayesian re-estimation. For a typical scenario (continue to recruit during some time interval, then stop recruitment and wait until a particular number of events happens), the closed-form expressions for the predictive mean and predictive bounds of the number of events at any future time point are derived under the assumptions of Markovian behavior of the event progression. The technique is efficiently applied to modeling different scenarios for some ongoing oncology trials. Case studies are considered. Copyright © 2011 John Wiley & Sons, Ltd.

  3. The acceptability of waiting times for elective general surgery and the appropriateness of prioritising patients

    Directory of Open Access Journals (Sweden)

    Knol Dirk L

    2007-02-01

    Full Text Available Abstract Background Problematic waiting lists in public health care threaten the equity and timeliness of care provision in several countries. This study assesses different stakeholders' views on the acceptability of waiting lists in health care, their preferences for priority care of patients, and their judgements on acceptable waiting times for surgical patients. Methods A questionnaire survey was conducted among 257 former patients (82 with varicose veins, 86 with inguinal hernia, and 89 with gallstones, 101 surgeons, 95 occupational physicians, and 65 GPs. Judgements on acceptable waiting times were assessed using vignettes of patients with varicose veins, inguinal hernia, and gallstones. Results Participants endorsed the prioritisation of patients based on clinical need, but not on ability to benefit. The groups had significantly different opinions (p Acceptable waiting times ranged between 2 and 25 weeks depending on the type of disorder (p Conclusion The explicit prioritisation of patients seems an accepted means for reducing the overall burden from waiting lists. The disagreement about appropriate prioritisation criteria and the need for uniformity, however, raises concern about equity when implementing prioritisation in daily practice. Single factor waiting time thresholds seem insufficient for securing timely care provision in the presence of long waiting lists as they do not account for the different consequences of waiting between patients.

  4. Norwegian Priority Setting in Practice – an Analysis of Waiting Time Patterns Across Medical Disciplines

    Directory of Open Access Journals (Sweden)

    Jurgita Januleviciute Gangstøe

    2016-06-01

    Full Text Available Background: Different strategies for addressing the challenge of prioritizing elective patients efficiently and fairly have been introduced in Norway. In the time period studied, there were three possible outcomes for elective patients that had been through the process of priority setting: (i high priority with assigned individual maximum waiting time; (ii low priority without a maximum waiting time; and (iii refusal (not in need for specialized services. We study variation in priority status and waiting time of the first two groups across different medical disciplines. Methods: Data was extracted from the Norwegian Patient Register (NPR and contains information on elective referrals to 41 hospitals in the Western Norway Regional Health Authority in 2010. The hospital practice across different specialties was measured by patient priority status and waiting times. The distributions of assigned maximum waiting times and the actual ones were analyzed using standard Kernel density estimation. The perspective of the planning process was studied by measuring the time interval between the actual start of healthcare and the maximum waiting time. Results: Considerable variation was found across medical specialties concerning proportion of priority patients and their maximum waiting times. The degree of differentiation in terms of maximum waiting times also varied by medical discipline. We found that the actual waiting time was very close to the assigned maximum waiting time. Furthermore, there was no clear correspondence between the actual waiting time for patients and their priority status. Conclusion: Variations across medical disciplines are often interpreted as differences in clinical judgment and capacity. Alternatively they primarily reflect differences in patient characteristics, patient case-mix, as well as capacity. One hypothesis for further research is that the introduction of maximum waiting times may have contributed to push the actual

  5. Large-scale evaluation of β -decay rates of r -process nuclei with the inclusion of first-forbidden transitions

    Science.gov (United States)

    Marketin, T.; Huther, L.; Martínez-Pinedo, G.

    2016-02-01

    Background: r -process nucleosynthesis models rely, by necessity, on nuclear structure models for input. Particularly important are β -decay half-lives of neutron-rich nuclei. At present only a single systematic calculation exists that provides values for all relevant nuclei making it difficult to test the sensitivity of nucleosynthesis models to this input. Additionally, even though there are indications that their contribution may be significant, the impact of first-forbidden transitions on decay rates has not been systematically studied within a consistent model. Purpose: Our goal is to provide a table of β -decay half-lives and β -delayed neutron emission probabilities, including first-forbidden transitions, calculated within a fully self-consistent microscopic theoretical framework. The results are used in an r -process nucleosynthesis calculation to asses the sensitivity of heavy element nucleosynthesis to weak interaction reaction rates. Method: We use a fully self-consistent covariant density functional theory (CDFT) framework. The ground state of all nuclei is calculated with the relativistic Hartree-Bogoliubov (RHB) model, and excited states are obtained within the proton-neutron relativistic quasiparticle random phase approximation (p n -RQRPA). Results: The β -decay half-lives, β -delayed neutron emission probabilities, and the average number of emitted neutrons have been calculated for 5409 nuclei in the neutron-rich region of the nuclear chart. We observe a significant contribution of the first-forbidden transitions to the total decay rate in nuclei far from the valley of stability. The experimental half-lives are in general well reproduced for even-even, odd-A , and odd-odd nuclei, in particular for short-lived nuclei. The resulting data table is included with the article as Supplemental Material. Conclusions: In certain regions of the nuclear chart, first-forbidden transitions constitute a large fraction of the total decay rate and must be

  6. Enabling narrative pedagogy: inviting, waiting, and letting be.

    Science.gov (United States)

    Ironside, Pamela M

    2014-01-01

    This article describes how teachers enable Narrative Pedagogy in their courses by explicating the Concernful Practice Inviting: Waiting and Letting Be. Narrative Pedagogy, a research-based, phenomenological approach to teaching and learning, extends conventional pedagogies and offers nursing faculty an alternative way of transforming their schools and courses. Using hermeneutic phenomenology, interview data collected over a 10-year period were analyzed by coding practical examples of teachers' efforts to enact Narrative Pedagogy. When Narrative Pedagogy is enacted, teachers and students focus on thinking and learning together about nursing phenomena and seek new understandings about how they may provide care in the myriad situations they encounter. Although the Concernful Practices co-occur, explicating inviting experiences can assist new teachers, and those seeking to extend their pedagogical literacy, by providing new understandings of how Narrative Pedagogy can be enacted.

  7. Empowered citizen 'health hackers' who are not waiting.

    Science.gov (United States)

    Omer, Timothy

    2016-08-17

    Due to the easier access to information, the availability of low cost technologies and the involvement of well educated, passionate patients, a group of citizen 'Health Hackers', who are building their own medical systems to help them overcome the unmet needs of their conditions, is emerging. This has recently been the case in the type 1 diabetes community, under the movement #WeAreNotWaiting, with innovative use of current medical devices hacked to access data and Open-Source code producing solutions ranging from remote monitoring of diabetic children to producing an Artificial Pancreas System to automate the management and monitoring of a patient's condition. Timothy Omer is working with the community to utilise the technology already in his pocket to build a mobile- and smartwatch-based Artificial Pancreas System.

  8. Success Run Waiting Times and Fuss-Catalan Numbers

    Directory of Open Access Journals (Sweden)

    S. J. Dilworth

    2015-01-01

    Full Text Available We present power series expressions for all the roots of the auxiliary equation of the recurrence relation for the distribution of the waiting time for the first run of k consecutive successes in a sequence of independent Bernoulli trials, that is, the geometric distribution of order k. We show that the series coefficients are Fuss-Catalan numbers and write the roots in terms of the generating function of the Fuss-Catalan numbers. Our main result is a new exact expression for the distribution, which is more concise than previously published formulas. Our work extends the analysis by Feller, who gave asymptotic results. We obtain quantitative improvements of the error estimates obtained by Feller.

  9. Determining prescription durations based on the parametric waiting time distribution

    DEFF Research Database (Denmark)

    Støvring, Henrik; Pottegård, Anton; Hallas, Jesper

    2016-01-01

    two-component mixture model for the waiting time distribution (WTD). The distribution component for prevalent users estimates the forward recurrence density (FRD), which is related to the distribution of time between subsequent prescription redemptions, the inter-arrival density (IAD), for users...... in continued treatment. We exploited this to estimate percentiles of the IAD by inversion of the estimated FRD and defined the duration of a prescription as the time within which 80% of current users will have presented themselves again. Statistical properties were examined in simulation studies......-Normal). When the IAD consisted of a mixture of two Log-Normal distributions, but was analyzed with a single Log-Normal distribution, relative bias did not exceed 9%. Using a Log-Normal FRD, we estimated prescription durations of 117, 91, 137, and 118 days for NSAIDs, warfarin, bendroflumethiazide...

  10. Waiting Time Distributions for Pattern Occurrence in a Constrained Sequence

    Directory of Open Access Journals (Sweden)

    Valeri Stefanov

    2007-01-01

    Full Text Available A binary sequence of zeros and ones is called a (d,k-sequence if it does not contain runs of zeros of length either less than d or greater than k, where d and k are arbitrary, but fixed, non-negative integers and d < k. Such sequences find an abundance of applications in communications, in particular for magnetic and optical recording. Occasionally, one requires that (d,k-sequences do not contain a specific pattern w. Therefore, distribution results concerning pattern occurrence in (d,k-sequences are of interest. In this paper we study the distribution of the waiting time until the r th occurrence of a pattern w in a random (d,k-sequence generated by a Markov source. Numerical examples are also provided.

  11. Built spaces and features associated with user satisfaction in maternity waiting homes in Malawi.

    Science.gov (United States)

    McIntosh, Nathalie; Gruits, Patricia; Oppel, Eva; Shao, Amie

    2018-07-01

    To assess satisfaction with maternity waiting home built spaces and features in women who are at risk for underutilizing maternity waiting homes (i.e. residential facilities that temporarily house near-term pregnant mothers close to healthcare facilities that provide obstetrical care). Specifically we wanted to answer the questions: (1) Are built spaces and features associated with maternity waiting home user satisfaction? (2) Can built spaces and features designed to improve hygiene, comfort, privacy and function improve maternity waiting home user satisfaction? And (3) Which built spaces and features are most important for maternity waiting home user satisfaction? A cross-sectional study comparing satisfaction with standard and non-standard maternity waiting home designs. Between December 2016 and February 2017 we surveyed expectant mothers at two maternity waiting homes that differed in their design of built spaces and features. We used bivariate analyses to assess if built spaces and features were associated with satisfaction. We compared ratings of built spaces and features between the two maternity waiting homes using chi-squares and t-tests to assess if design features to improve hygiene, comfort, privacy and function were associated with higher satisfaction. We used exploratory robust regression analysis to examine the relationship between built spaces and features and maternity waiting home satisfaction. Two maternity waiting homes in Malawi, one that incorporated non-standardized design features to improve hygiene, comfort, privacy, and function (Kasungu maternity waiting home) and the other that had a standard maternity waiting home design (Dowa maternity waiting home). 322 expectant mothers at risk for underutilizing maternity waiting homes (i.e. first-time mothers and those with no pregnancy risk factors) who had stayed at the Kasungu or Dowa maternity waiting homes. There were significant differences in ratings of built spaces and features between the

  12. Dew Point

    OpenAIRE

    Goldsmith, Shelly

    1999-01-01

    Dew Point was a solo exhibition originating at PriceWaterhouseCoopers Headquarters Gallery, London, UK and toured to the Centre de Documentacio i Museu Textil, Terrassa, Spain and Gallery Aoyama, Tokyo, Japan.

  13. Tipping Point

    Medline Plus

    Full Text Available ... Point by CPSC Blogger September 22, 2009 appliance child Childproofing CPSC danger death electrical fall furniture head injury product safety television tipover tv Watch the video in Adobe Flash ...

  14. Tipping Point

    Science.gov (United States)

    ... Point by CPSC Blogger September 22, 2009 appliance child Childproofing CPSC danger death electrical fall furniture head injury product safety television tipover tv Watch the video in Adobe Flash ...

  15. Tipping Point

    Medline Plus

    Full Text Available ... Point by CPSC Blogger September 22, 2009 appliance child Childproofing CPSC danger death electrical fall furniture head ... see news reports about horrible accidents involving young children and furniture, appliance and tv tip-overs. The ...

  16. Tipping Point

    Medline Plus

    Full Text Available ... Point by CPSC Blogger September 22, 2009 appliance child Childproofing CPSC danger death electrical fall furniture head ... TV falls with about the same force as child falling from the third story of a building. ...

  17. Tipping Point

    Medline Plus

    Full Text Available ... Tipping Point by CPSC Blogger September 22, 2009 appliance child Childproofing CPSC danger death electrical fall furniture ... about horrible accidents involving young children and furniture, appliance and tv tip-overs. The force of a ...

  18. Patient Satisfaction Is Associated With Time With Provider But Not Clinic Wait Time Among Orthopedic Patients.

    Science.gov (United States)

    Patterson, Brendan M; Eskildsen, Scott M; Clement, R Carter; Lin, Feng-Chang; Olcott, Christopher W; Del Gaizo, Daniel J; Tennant, Joshua N

    2017-01-01

    Clinic wait time is considered an important predictor of patient satisfaction. The goal of this study was to determine whether patient satisfaction among orthopedic patients is associated with clinic wait time and time with the provider. The authors prospectively enrolled 182 patients at their outpatient orthopedic clinic. Clinic wait time was defined as the time between patient check-in and being seen by the surgeon. Time spent with the provider was defined as the total time the patient spent in the examination room with the surgeon. The Consumer Assessment of Healthcare Providers and Systems survey was used to measure patient satisfaction. Factors associated with increased patient satisfaction included patient age and increased time with the surgeon (P=.024 and P=.037, respectively), but not clinic wait time (P=.625). Perceived wait time was subject to a high level of error, and most patients did not accurately report whether they had been waiting longer than 15 minutes to see a provider until they had waited at least 60 minutes (P=.007). If the results of the current study are generalizable, time with the surgeon is associated with patient satisfaction in orthopedic clinics, but wait time is not. Further, the study findings showed that patients in this setting did not have an accurate perception of actual wait time, with many patients underestimating the time they waited to see a provider. Thus, a potential strategy for improving patient satisfaction is to spend more time with each patient, even at the expense of increased wait time. [Orthopedics. 2017; 40(1):43-48.]. Copyright 2016, SLACK Incorporated.

  19. A Study of the r-Process Path Nuclides,$^{137,138,139}$Sb using the Enhanced Selectivity of Resonance Ionization Laser Ionization

    CERN Multimedia

    Walters, W

    2002-01-01

    The particular features of the r-process abundances with 100 < A < 150 have demonstrated the close connection between knowledge of nuclear structure and decay along the r-process path and the astrophysical environement in which these elements are produced. Key to this connection has been the measurement of data for nuclides (mostly even-N nuclides) that lie in the actual r-process path. Such data are of direct use in r-process calculations and they also serve to refine and test the predictive power of nuclear models where little or no data now exist. In this experiment we seek to use the newly developed ionization scheme for the Resonance Ionization Laser Ion Source (RILIS) to achieve selective ionization of neutron-rich antimony isotopes in order to measure the decay properties of r-process path nuclides $^{137,138,139}$Sb. These properties include the half-lives, delayed neutron branches, and daughter $\\gamma$-rays. The new nuclear structure data for the daughter Te nuclides is also of considerable in...

  20. Impact of waiting on the perception of service quality in nuclear medicine

    NARCIS (Netherlands)

    De Man, S; Vlerick, P; Gemmel, P; De Bondt, P; Matthys, D; Dierckx, RA

    Background This is the first study examining the link between waiting and various dimensions of perceived service quality in nuclear medicine. Methods We tested the impact of selected waiting experience variables on the evaluation of service quality, measured using the Servqual tool, of 406 patients

  1. Reasons for dropping out from a waiting list for in vitro fertilization

    NARCIS (Netherlands)

    van Dongen, Angelique J. C. M.; Verhagen, Tamara E. M.; Dumoulin, John C. M.; Land, Jolande A.; Evers, Johannes L. H.

    2010-01-01

    Objective: To determine the incidence of couples dropping out of the in vitro fertilization (IVF) waiting list and to describe the couples' reasons. Design: Prospective cohort study. Setting: Fertility center in an academic hospital. Patient(s): 674 women placed consecutively on the IVF waiting list

  2. 24 CFR 982.203 - Special admission (non-waiting list): Assistance targeted by HUD.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Special admission (non-waiting list... Admission to Tenant-Based Program § 982.203 Special admission (non-waiting list): Assistance targeted by HUD... family residing in a multifamily rental housing project when HUD sells, forecloses or demolishes the...

  3. Waiting Endurance Time Estimation of Electric Two-Wheelers at Signalized Intersections

    Directory of Open Access Journals (Sweden)

    Mei Huan

    2014-01-01

    Full Text Available The paper proposed a model for estimating waiting endurance times of electric two-wheelers at signalized intersections using survival analysis method. Waiting duration times were collected by video cameras and they were assigned as censored and uncensored data to distinguish between normal crossing and red-light running behavior. A Cox proportional hazard model was introduced, and variables revealing personal characteristics and traffic conditions were defined as covariates to describe the effects of internal and external factors. Empirical results show that riders do not want to wait too long to cross intersections. As signal waiting time increases, electric two-wheelers get impatient and violate the traffic signal. There are 12.8% of electric two-wheelers with negligible wait time. 25.0% of electric two-wheelers are generally nonrisk takers who can obey the traffic rules after waiting for 100 seconds. Half of electric two-wheelers cannot endure 49.0 seconds or longer at red-light phase. Red phase time, motor vehicle volume, and conformity behavior have important effects on riders’ waiting times. Waiting endurance times would decrease with the longer red-phase time, the lower traffic volume, or the bigger number of other riders who run against the red light. The proposed model may be applicable in the design, management and control of signalized intersections in other developing cities.

  4. Waiting endurance time estimation of electric two-wheelers at signalized intersections.

    Science.gov (United States)

    Huan, Mei; Yang, Xiao-bao

    2014-01-01

    The paper proposed a model for estimating waiting endurance times of electric two-wheelers at signalized intersections using survival analysis method. Waiting duration times were collected by video cameras and they were assigned as censored and uncensored data to distinguish between normal crossing and red-light running behavior. A Cox proportional hazard model was introduced, and variables revealing personal characteristics and traffic conditions were defined as covariates to describe the effects of internal and external factors. Empirical results show that riders do not want to wait too long to cross intersections. As signal waiting time increases, electric two-wheelers get impatient and violate the traffic signal. There are 12.8% of electric two-wheelers with negligible wait time. 25.0% of electric two-wheelers are generally nonrisk takers who can obey the traffic rules after waiting for 100 seconds. Half of electric two-wheelers cannot endure 49.0 seconds or longer at red-light phase. Red phase time, motor vehicle volume, and conformity behavior have important effects on riders' waiting times. Waiting endurance times would decrease with the longer red-phase time, the lower traffic volume, or the bigger number of other riders who run against the red light. The proposed model may be applicable in the design, management and control of signalized intersections in other developing cities.

  5. Optimising radiation outcomes, scheduling patient waiting lists for maximum population tumour control

    International Nuclear Information System (INIS)

    Ebert, M.A.; Jennings, L.; Kearvell, R.; Bydder, S.

    2011-01-01

    Full text: Delays in the commencement of radiotherapy, possibly due to resource constraints, are known to impact on control-related outcomes. We sought an objective solution for patient prioritisation based on tumour control probability (TCP). With a utilitarian objective for maximising TCP in a population of M patients, with patient i waiting a time between diagnosis and treatment of Ti and a mean wait time of TMean, the optimisation problem is as shown. A linear-quadratic/Poissonian model for cell survival/TCP was considered including cell doubling during the wait time. Solutions to several distributions of patient population characteristics were examined together with the expected change in TCP for the population and individuals. An analytical solution to the optimisation problem was found which gives the optimal wait time for each patient as a function of the distribution of radiobiological characteristics in the population. This solution does not allow a negativity constraint on an individual's optimised waiting time so a waiting list simulation was developed to enforce that. Optimal wait time distributions were calculated for situations where patients are allocated distinct diagnostic groups (sharing radiobiological parameters) and for a (log-normal) distribution of doubling times in the population. In order to meet the utilitarian objective, the optimal solutions require patients with rapid cell doubling times to be accelerated up the waiting list at the expense of those with slowly proliferating tumours. The net population benefit however is comparable to or greater then the expected benefit from beam intensity modulation or dose escalation.

  6. Waiting Time from Diagnosis to Treatment has no Impact on Survival in Patients with Esophageal Cancer

    NARCIS (Netherlands)

    Visser, E.; Leeftink, Anne Greetje; van Rossum, P.S.N.; Siesling, Sabine; van Hillegersberg, R.; Ruurda, J.P.

    2016-01-01

    Background Waiting time from diagnosis to treatment has emerged as an important quality indicator in cancer care. This study was designed to determine the impact of waiting time on long-term outcome of patients with esophageal cancer who are treated with neoadjuvant therapy followed by surgery or

  7. Waiting times for prostate cancer diagnosis in KwaZulu-Natal, South ...

    African Journals Online (AJOL)

    prostate cancer (an elevated prostate-specific antigen level or abnormal findings on digital rectal examination) wait to have a prostate biopsy. Objectives. To improve the overall efficiency of the prostate biopsy service offered at St Aidan's Regional Hospital, Durban, SA, by quantifying the burden of disease and waiting times ...

  8. The use of the waiting list in a fair selection of patients for nursing home care

    NARCIS (Netherlands)

    Meiland, F. J.; Danse, J. A.; Hoos, A. M.; Wendte, J. F.; Gunning-Schepers, L. J.

    1996-01-01

    When health care resources are scarce, waiting lists may be used as a distribution measure in order to enhance the fair allocation of resources through selection of patients. In this study, the structure and use of a waiting list for a fair selection of patients for nursing home admission was

  9. How tolerable is delay? : Consumers' evaluations of internet web sites after waiting

    NARCIS (Netherlands)

    B.G.C. Dellaert (Benedict); B.E. Kahn

    1998-01-01

    textabstractHow consumer's waiting times affect their retrospective evaluations of Internet Web Sites is investigated in four computer-based experiments. Results show that waiting can but does not always negatively affect evaluations of Web Sites. Results also show that the potential negative

  10. Reading of Waiting, Time and Social Change in S. N. A. Agoro's ...

    African Journals Online (AJOL)

    It is against this backdrop that we attempt to explore the depiction and treatment of waiting, time and social change in the dramatic universe of existentialism created by some playwrights who have not been given scholarly attention. The study shall therefore undertake a dialectical consideration of the concept of waiting and ...

  11. Space, place and (waiting) time: reflections on health policy and politics.

    Science.gov (United States)

    Sheard, Sally

    2018-02-19

    Health systems have repeatedly addressed concerns about efficiency and equity by employing trans-national comparisons to draw out the strengths and weaknesses of specific policy initiatives. This paper demonstrates the potential for explicit historical analysis of waiting times for hospital treatment to add value to spatial comparative methodologies. Waiting times and the size of the lists of waiting patients have become key operational indicators. In the United Kingdom, as National Health Service (NHS) financial pressures intensified from the 1970s, waiting times have become a topic for regular public and political debate. Various explanations for waiting times include the following: hospital consultants manipulate NHS waiting lists to maintain their private practice; there is under-investment in the NHS; and available (and adequate) resources are being used inefficiently. Other countries have also experienced ongoing tensions between the public and private delivery of universal health care in which national and trans-national comparisons of waiting times have been regularly used. The paper discusses the development of key UK policies, and provides a limited Canadian comparative perspective, to explore wider issues, including whether 'waiting crises' were consciously used by policymakers, especially those brought into government to implement new economic and managerial strategies, to diminish the autonomy and authority of the medical professional in the hospital environment.

  12. Minimizing makespan for a no-wait flowshop using genetic algorithm

    Indian Academy of Sciences (India)

    This paper explains minimization of makespan or total completion time .... lead to a natural reduction of the no-wait flow shop problem to the travelling sales- ... FCH can also be applied in real time scheduling and rescheduling for no-wait flow.

  13. Effects of Wait Time When Communicating with Children Who Have Sensory and Additional Disabilities

    Science.gov (United States)

    Johnson, Nicole; Parker, Amy T.

    2013-01-01

    Introduction: This study utilized wait-time procedures to determine if they are effective in helping children with deafblindness or multiple disabilities that include a visual impairment communicate in their home. Methods: A single subject with an alternating treatment design was used for the study. Zero- to one-second wait time was utilized…

  14. The Impact of Patient-to-Patient Interaction in Health Facility Waiting Rooms on Their Perception of Health Professionals.

    Science.gov (United States)

    Willis, William Kent; Ozturk, Ahmet Ozzie; Chandra, Ashish

    2015-01-01

    Patients have to wait in waiting rooms prior to seeing the physician. But there are few studies that demonstrate what they are actually doing in the waiting room. This exploratory study was designed to investigate the types of discussions that patients in the waiting room typically engage in with other patients and how the conversations affected their opinion on general reputation of the clinic, injections/blocks as treatment procedures, waiting time, time spent with the caregiver, overall patient satisfaction, and the pain medication usage policy. The study demonstrates that patient interaction in the waiting room has a positive effect on patient opinion of the pain clinic and the caregivers.

  15. Toys are a potential source of cross-infection in general practitioners' waiting rooms.

    Science.gov (United States)

    Merriman, Eileen; Corwin, Paul; Ikram, Rosemary

    2002-01-01

    The waiting rooms of general practitioners' surgeries usually have toys provided for children. The level of contamination of these toys and the effectiveness of toy decontamination was investigated in this study. Hard toys from general practitioners' waiting rooms had relatively low levels of contamination, with only 13.5% of toys showing any coliform counts. There were no hard toys with heavy contamination by coliforms or other bacteria. Soft toys were far more likely to be contaminated, with 20% of toys showing moderate to heavy coliform contamination and 90% showing moderate to heavy bacterial contamination. Many waiting-room toys are not cleaned routinely. Soft toys are hard to disinfect and tend to rapidly become recontaminated after cleaning. Conversely, hard toys can be cleaned and disinfected easily. Soft toys in general practitioners' waiting rooms pose an infectious risk and it is therefore recommended that soft toys are unsuitable for doctors' waiting rooms. PMID:11885823

  16. Research on the waiting time of passengers and escalator energy consumption at the railway station

    Energy Technology Data Exchange (ETDEWEB)

    Ma, Wei-wu; Liu, Xiao-yan; Li, Liqing; Shi, Xiangnan; Zhou, Chenn Q. [School of Energy Science and Engineering, Central South University, Changsha 410083 (China)

    2009-12-15

    Based on the Little Formula and the classical queuing model of multi-channel M vertical stroke D vertical stroke n, the relation of the average queue length, the maximum waiting time and the escalator service intensity were identified and the waiting time simulation model was established. With the passenger delivery data at A railway station in China and the probability distribution model of waiting time, a detailed analysis was made on the escalator allocation, power and energy consumption on holidays, ordinary working days and the largest-passengers-volume days; meanwhile, the fixed and variable energy consumption were compared and studied when the waiting time are 5, 10 and 30 s. The result shows that the waiting time settings affect the allocation and the energy consumption of the escalators and the fixed energy consumption takes 70%. (author)

  17. A RFID-based JIT Application for Least Waiting Time for Dynamic Smart Diet Customers

    Directory of Open Access Journals (Sweden)

    Chen Long-Fei

    2017-01-01

    Full Text Available Waiting in queue is part of everyone’s life. A day may include several different waiting in queue. Waiting in line is always a bit of phenomena for a prosperous restaurant at dinner time. How to manage the queues and keep their feet into customers is the operating challenge facing everyone manager. In addition, rising energy costs and growing demand for protection of the environment call for a shorter waiting queue. Thus, we devise a dynamic smart diet App manager to reduce customer waiting time through radio frequency identification (RFID and just in time (JIT principle to reduce inventory of restaurant food materials, thereby increasing customer satisfaction and loyalty, and improving revenue and social responsibility.

  18. [Waiting time for the first colposcopic examination in women with abnormal Papanicolaou test].

    Science.gov (United States)

    Nascimento, Maria Isabel do; Rabelo, Irene Machado Moraes Alvarenga; Cardoso, Fabrício Seabra Polidoro; Musse, Ricardo Neif Vieira

    2015-08-01

    To evaluate the waiting times before obtaining the first colposcopic examination for women with abnormal Papanicolaou smears. Retrospective cohort study conducted on patients who required a colposcopic examination to clarify an abnormal pap test, between 2002 January and 2008 August, in a metropolitan region of Brazil. The waiting times were defined as: Total Waiting Time (interval between the date of the pap test result and the date of the first colposcopic examination); Partial A Waiting Time (interval between the date of the pap test result and the date of referral); Partial B Waiting Time (interval between the date of referral and the date of the first colposcopic examination). Means, medians, relative and absolute frequencies were calculated. The Kruskal-Wallis test and Pearson's chi-square test were used to determine statistical significance. A total of 1,544 women with mean of age of 34 years (SD=12.6 years) were analyzed. Most of them had access to colposcopic examination within 30 days (65.8%) or 60 days (92.8%) from referral. Mean Total Waiting Time, Partial A Waiting Time, and Partial B Waiting Time were 94.5 days (SD=96.8 days), 67.8 days (SD=95.3 days) and 29.2 days (SD=35.1 days), respectively. A large part of the women studied had access to colposcopic examination within 60 days after referral, but Total waiting time was long. Measures to reduce the waiting time for obtaining the first colposcopic examination can help to improve the quality of care in the context of cervical cancer control in the region, and ought to be addressed at the phase between the date of the pap test results and the date of referral to the teaching hospital.

  19. Impact of pulmonary rehabilitation on quality of life and functional capacity in patients on waiting lists for lung transplantation

    Directory of Open Access Journals (Sweden)

    Juliessa Florian

    2013-06-01

    Full Text Available OBJECTIVE: To investigate the impact of a pulmonary rehabilitation program on the functional capacity and on the quality of life of patients on waiting lists for lung transplantation. METHODS: Patients on lung transplant waiting lists were referred to a pulmonary rehabilitation program consisting of 36 sessions. Before and after the program, participating patients were evaluated with the six-minute walk test and the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36. The pulmonary rehabilitation program involved muscle strengthening exercises, aerobic training, clinical evaluation, psychiatric evaluation, nutritional counseling, social assistance, and educational lectures. RESULTS: Of the 112 patients initially referred to the program, 58 completed it. The mean age of the participants was 46 ± 14 years, and females accounted for 52%. Of those 58 patients, 37 (47% had pulmonary fibrosis, 13 (22% had pulmonary emphysema, and 18 (31% had other types of advanced lung disease. The six-minute walk distance was significantly greater after the program than before (439 ± 114 m vs. 367 ± 136 m, p = 0.001, the mean increase being 72 m. There were significant point increases in the scores on the following SF-36 domains: physical functioning, up 22 (p = 0.001, role-physical, up 10 (p = 0.045; vitality, up 10 (p < 0.001; social functioning, up 15 (p = 0.001; and mental health, up 8 (p = 0.001. CONCLUSIONS: Pulmonary rehabilitation had a positive impact on exercise capacity and quality of life in patients on lung transplant waiting lists.

  20. If you 'watch and wait', prostate cancer may progress dramatically

    International Nuclear Information System (INIS)

    Allison, R. R.; Schulsinger, A.; Vongtama, V.; Grant, P.; Shin, K. H.; Huben, R.

    1996-01-01

    Objective: Observation has been proposed as an option for localized prostate cancer. However, most series reporting on 'watch and wait include patients treated by TUR or hormones which may affect results. We retrospectively reviewed the natural history of truly untreated prostate cancer and report the outcome for these patients. Materials and Methods: From 1976 to 1992, 34 patients of median age 70 yrs (range 56-88) with biopsy proven localized adenocarcinoma of the prostate refused therapy. All had negative bone scan and none underwent TUR or hormone treatment. No patient was lost to follow-up (median 76 months). Failure patterns and survival were analyzed. Results: At diagnosis 27 patients had palpable nodules (T 2 ) of which 13 were well differentiated and 14 moderately differentiated. Seven had moderately differentiated T 3 lesions. Mild prostatitis was reported in 16 T 2 and 6 T 3 patients. Within 36 months, local progression requiring therapy occurred in all T 3 , all T 2 moderate and (5(13)) T 2 well differentiated patients. Systemic progression occurred in (6(7)) T 3 , (9(14)) T 2 (mod) and (3(13)) T 2 (well) patients. Overall 59% are alive, 26% succumbed to prostate carcinoma and 15% to other causes. Conclusion: Observation results in a high rate of local progression requiring intervention (77%) and excessive systemic disease development (52%) for patients with clinically palpable disease. Perhaps this strategy is viable for earlier stage lesions detected by PSA but it must be tested in a rigorous fashion before accepted

  1. Patient satisfaction with clinicians in colorectal 2-week wait clinics.

    Science.gov (United States)

    Cock, Karen; Kent, Bridie

    2017-03-23

    To determine if patient satisfaction is affected by the clinician (nurse or doctor), conducting the colorectal 2-week wait (2ww) clinics. A prospective non-randomised comparative cohort study of 339 consecutive patients (divided by blind allocation into nurse-led (n=216) and doctor-led (n=123) cohorts) conducted over a 3-month period. Patient satisfaction in both cohorts was assessed by an adapted version of the Grogan et al validated patient satisfaction questionnaire. The questionnaire was piloted first and was found to have high internal reliability (Cronbach's alpha=0.91). The study had a response rate of 78% (n=258/331) and overall satisfaction scores showed 85% (n=149/175) of patients in the nurse-led cohort and 65% (n=54/83) of patients in the doctor-led cohort strongly agreed that they were satisfied with the care they received. Mean overall satisfaction scores in the two cohorts revealed that the nurse-led cohort achieved significantly more 'strongly agree' responses than the doctor-led cohort (ppatient satisfaction was affected by the clinician conducting the 2ww clinic, in that the nurse-led cohort displayed significantly higher patient satisfaction. However, there are areas that merit further research.

  2. Alberta farm couple waits 35 years for oilpatch clean up

    International Nuclear Information System (INIS)

    Anon

    2003-01-01

    Story of an Alberta farm couple is told, whose farm has been polluted by a nearby oil lease and salt water from the time they purchased the property in 1968, rendering it unusable for farming. Owners of the well first argued that cleaning it up was not their responsibility, and later claiming that they could not afford the cost. After the company went into receivership, the farmer applied to the province's surface rights' advocate, but could not do better than a $3,000 annual award retroactive to 1999, which he rejected. After much legal wrangling as to the ownership of the wells, the receiver, KPMG, turned the wells over to the Alberta Energy and Utilities Board (EUB) in 2002. Finally, in 2003 the EUB promised to ask the industry-funded Orphan Wells Program to permanently abandon the wells and in preparation for reclaiming the land to undertake the necessary tests to determine the scope of the work that needs to be done and the associated costs. It appears that after 35 years of waiting the farm couple will receive justice after all

  3. Models of emergency departments for reducing patient waiting times.

    Directory of Open Access Journals (Sweden)

    Marek Laskowski

    Full Text Available In this paper, we apply both agent-based models and queuing models to investigate patient access and patient flow through emergency departments. The objective of this work is to gain insights into the comparative contributions and limitations of these complementary techniques, in their ability to contribute empirical input into healthcare policy and practice guidelines. The models were developed independently, with a view to compare their suitability to emergency department simulation. The current models implement relatively simple general scenarios, and rely on a combination of simulated and real data to simulate patient flow in a single emergency department or in multiple interacting emergency departments. In addition, several concepts from telecommunications engineering are translated into this modeling context. The framework of multiple-priority queue systems and the genetic programming paradigm of evolutionary machine learning are applied as a means of forecasting patient wait times and as a means of evolving healthcare policy, respectively. The models' utility lies in their ability to provide qualitative insights into the relative sensitivities and impacts of model input parameters, to illuminate scenarios worthy of more complex investigation, and to iteratively validate the models as they continue to be refined and extended. The paper discusses future efforts to refine, extend, and validate the models with more data and real data relative to physical (spatial-topographical and social inputs (staffing, patient care models, etc.. Real data obtained through proximity location and tracking system technologies is one example discussed.

  4. The Psychosocial Influences of Waiting Periods on Patients Undergoing Endoscopic Submucosal Dissection.

    Science.gov (United States)

    Nagao, Noriko; Tsuchiya, Aya; Ando, Sae; Arita, Mizue; Toyonaga, Takashi; Miyawaki, Ikuko

    This study aimed to clarify psychosocial influences of waiting periods on patients undergoing endoscopic submucosal dissection for cancer at an advanced medical care facility in Japan. Subjects were consenting patients hospitalized from 2009 to 2010. Qualitative and quantitative data were gathered about patients' characteristics, disease and stage, and waiting period. Qualitative content analysis was used to analyze free statements and interview data. Subjects included 154 patients with an average wait period of 46.28 days for admission. Qualitative analysis revealed the following wait period perceptions. For calmness, results indicated (1) no anxiety, (2) relief based on doctors' positive judgment, (3) whatever happens/no choice, and (4) trust in doctor. For uneasiness, perceptions included (1) the sooner, the better/eagerly waiting, (2) anxiety and concern, and (3) emotional instability. Four waiting period coping types were identified: (1) making phone inquiries, (2) busy and forgot about the medical procedure, (3) relief from anxiety, and (4) unable to function well in daily life. Patients need to be educated about cancer progression and provided an estimated wait time. They also require more information about how to manage daily life such as monitoring factors from the nursing domain including physical condition, digestive symptoms, diet, and exercise.

  5. Informing Healthcare Waiting Area Design Using Transparency Attributes: A Comparative Preference Study.

    Science.gov (United States)

    Jiang, Shan; Powers, Matthew; Allison, David; Vincent, Ellen

    2017-07-01

    This study aimed to explore people's visual preference for waiting areas in general hospital environments designed with transparency attributes that fully integrate nature. Waiting can be a tedious and frustrating experience among people seeking healthcare treatments and negatively affect their perception of the quality of care. Positive distractions and supportive designs have gained increasing attraction to improve people's waiting experience. Nature, which has shown therapeutic effects according to a growing amount of evidence, could be a distinguished positive distraction in waiting areas. Additionally, the theory of transparency was operationalized to indicate a spatial continuity between the external nature and the built interiors in general healthcare waiting area design. A survey method was adopted in the study. Twenty-one images of general healthcare waiting areas depicting three design typologies were preselected following a strict procedure, including designs with (a) no window views, (b) limited window views to nature, and (c) transparent spaces with maximum natural views. Ninety-five student participants rated the images based on their visual preference using a Likert-type scale. The results showed that transparent waiting areas were significantly preferred. A significant positive relationship existed between the level of transparency and people's preference scores. The factor analysis indicated additional supportive features that may affect people's preferences, including daylight, perceived warmth, noninstitutional furniture arrangement, visual orientation, and the use of natural materials for interior design. However, these tentative results need to be furthered tested with the real patient population as the next step of this study.

  6. Survey of Access to GastroEnterology in Canada: The SAGE wait times program

    Science.gov (United States)

    Leddin, Desmond; Bridges, Ronald J; Morgan, David G; Fallone, Carlo; Render, Craig; Plourde, Victor; Gray, Jim; Switzer, Connie; McHattie, Jim; Singh, Harminder; Walli, Eric; Murray, Iain; Nestel, Anthony; Sinclair, Paul; Chen, Ying; Irvine, E Jan

    2010-01-01

    BACKGROUND: Assessment of current wait times for specialist health services in Canada is a key method that can assist government and health care providers to plan wisely for future health needs. These data are not readily available. A method to capture wait time data at the time of consultation or procedure has been developed, which should be applicable to other specialist groups and also allows for assessment of wait time trends over intervals of years. METHODS: In November 2008, gastroenterologists across Canada were asked to complete a questionnaire (online or by fax) that included personal demographics and data from one week on at least five consecutive new consultations and five consecutive procedure patients who had not previously undergone a procedure for the same indication. Wait times were collected for 18 primary indications and results were then compared with similar survey data collected in 2005. RESULTS: The longest wait times observed were for screening colonoscopy (201 days) and surveillance of previous colon cancer or polyps (272 days). The shortest wait times were for cancer-likely based on imaging or physical examination (82 days), severe or rapidly progressing dysphagia or odynophagia (83 days), documented iron-deficiency anemia (90 days) and dyspepsia with alarm symptoms (99 days). Compared with 2005 data, total wait times in 2008 were lengthened overall (127 days versus 155 days; Pgastroenterology services continue to exceed consensus conference recommended targets and have significantly worsened since 2005. PMID:20186352

  7. Public views on a wait time management initiative: a matter of communication.

    Science.gov (United States)

    Bruni, Rebecca A; Laupacis, Andreas; Levinson, Wendy; Martin, Douglas K

    2010-08-05

    Many countries have tried to reduce waiting times for health care through formal wait time reduction strategies. Our paper describes views of members of the public about a wait time management initiative--the Ontario Wait Time Strategy (OWTS) (Canada). Scholars and governmental reports have advocated for increased public involvement in wait time management. We provide empirically derived recommendations for public engagement in a wait time management initiative. Two qualitative studies: 1) an analysis of all emails sent by the public to the (OWTS) email address; and 2) in-depth interviews with members of the Ontario public. Email correspondents and interview participants supported the intent of the OWTS. However they wanted more information about the Strategy and its actions. Interview participants did not feel they were sufficiently made aware of the Strategy and email correspondents requested additional information beyond what was offered on the Strategy's website. Moreover, the email correspondents believed that some of the information that was provided on the Strategy's website and through the media was inaccurate, misleading, and even dishonest. Interview participants strongly supported public involvement in the OWTS priority setting. Findings suggest the public wanted increased communication from and with the OWTS. Effective communication can facilitate successful public engagement, and in turn fair and legitimate priority setting. Based on the study's findings we developed concrete recommendations for improving public involvement in wait time management.

  8. Public views on a wait time management initiative: a matter of communication

    Directory of Open Access Journals (Sweden)

    Laupacis Andreas

    2010-08-01

    Full Text Available Abstract Background Many countries have tried to reduce waiting times for health care through formal wait time reduction strategies. Our paper describes views of members of the public about a wait time management initiative - the Ontario Wait Time Strategy (OWTS (Canada. Scholars and governmental reports have advocated for increased public involvement in wait time management. We provide empirically derived recommendations for public engagement in a wait time management initiative. Methods Two qualitative studies: 1 an analysis of all emails sent by the public to the (OWTS email address; and 2 in-depth interviews with members of the Ontario public. Results Email correspondents and interview participants supported the intent of the OWTS. However they wanted more information about the Strategy and its actions. Interview participants did not feel they were sufficiently made aware of the Strategy and email correspondents requested additional information beyond what was offered on the Strategy's website. Moreover, the email correspondents believed that some of the information that was provided on the Strategy's website and through the media was inaccurate, misleading, and even dishonest. Interview participants strongly supported public involvement in the OWTS priority setting. Conclusions Findings suggest the public wanted increased communication from and with the OWTS. Effective communication can facilitate successful public engagement, and in turn fair and legitimate priority setting. Based on the study's findings we developed concrete recommendations for improving public involvement in wait time management.

  9. Waiting time for cataract surgery and its influence on patient attitudes.

    Science.gov (United States)

    Chan, Frank Wan-kin; Fan, Alex Hoi; Wong, Fiona Yan-yan; Lam, Philip Tsze-ho; Yeoh, Eng-kiong; Yam, Carrie Ho-kwan; Griffiths, Sian; Lam, Dennis Shun-chiu; Congdon, Nathan

    2009-08-01

    To characterize willingness to pay for private operations and preferred waiting time among patients awaiting cataract surgery in Hong Kong. This was a cross-sectional survey. Subjects randomly selected from cataract surgical waiting lists in Hong Kong (n = 467) underwent a telephone interview based on a structured, validated questionnaire. Data were collected on private insurance coverage, preferred waiting time, amount willing to pay for surgery, and self-reported visual function and health status. Among 300 subjects completing the interview, 144 (48.2%) were 76 years of age or older, 177 (59%) were women, and mean time waiting for surgery was 17 +/- 15 months. Among 220 subjects (73.3%) willing to pay anything for surgery, the mean amount was US$552 +/- 443. With adjustment for age, education, and monthly household income, subjects willing to pay anything were less willing to wait 12 months for surgery (OR = 4.34; P = 0.002), more likely to know someone having had cataract surgery (OR = 2.20; P = 0.03), and more likely to use their own savings to pay for the surgery (OR = 2.21; P = 0.04). Subjects considering private cataract surgery, knowing people who have had cataract surgery, using nongovernment sources to pay for surgery, and having lower visual function were willing to pay more. Many patients wait significant periods for cataract surgery in Hong Kong, and are willing to pay substantial amounts for private operations. These results may have implications for other countries with cataract waiting lists.

  10. Indication criteria for cataract extraction and gender differences in waiting time.

    Science.gov (United States)

    Smirthwaite, Goldina; Lundström, Mats; Albrecht, Susanne; Swahnberg, Katarina

    2014-08-01

    The purpose of this study was to investigate national indication criteria tool for cataract extraction (NIKE), a clinical tool for establishing levels of indications for cataract surgery, in relation to gender differences in waiting times for cataract extraction (CE). Data were collected by The Swedish National Cataract Register (NCR). Eye clinics report to NCR voluntarily and on regular basis (98% coverage). Comparisons regarding gender difference in waiting times were performed between NIKE-categorized and non-NIKE-categorized patients, as well as between different indication groups within the NIKE-system. All calculations were performed in spss version 20. Multivariate analyses were carried out using logistic regression, and single variable analyses were carried out by Student's t-test or chi square as appropriate. Gender, age, visual acuity and NIKE-categorization were associated with waiting time. Female patients had a longer waiting time to CE than male, both within and outside the NIKE-system. Gender difference in waiting time was somewhat larger among patients who had not been categorized by NIKE. In the non-NIKE-categorized group, women waited 0.20 months longer than men. In the group which was NIKE-categorized, women waited 0.18 months longer than men. It is reasonable to assume that prioritizing patients by means of NIKE helps to reduce the gender differences in waiting time. Gender differences in waiting time have decreased as NIKE was introduced and there may be a variety of explanations for this. However, with the chosen study design, we could not distinguish between effects related to NIKE and those due to other factors which occurred during the study period. © 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  11. Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping

    Directory of Open Access Journals (Sweden)

    Tara Sampalli

    2015-07-01

    Full Text Available Background Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely – an adaptation of Value Stream Mapping (VSM to meet the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding. Methods Over an 18-month time period, staff applied a patient-centric approach that included LEAN methodology of VSM to improve wait times to care. Our framework of evaluation was grounded in the needs and perspectives of patients and individuals waiting to receive care. Patient centric views were obtained through surveys such as Patient Assessment of Chronic Illness Care (PACIC and process engineering based questions. In addition, LEAN methodology, VSM was added to identify non-value added processes contributing to wait times. Results The care team successfully reduced wait times to 2 months in 2014 with no wait times for care anticipated in 2015. Increased patient engagement and satisfaction are also outcomes of this innovative initiative. In addition, successful transformations and implementation have resulted in resource efficiencies without increase in costs. Patients have shown significant improvements in functional health following Integrated Chronic Care Service (ICCS intervention. The methodology will be applied to other chronic disease management areas in Capital Health and the province. Conclusion Wait times to care in the management of multimoribidities and other complex conditions can add a significant burden not only on the affected individuals but also on the healthcare system. In this study, a novel and modified LEAN methodology has been applied to embed the voice of the patient in care delivery processes and to reduce wait times to care in the management of complex chronic conditions.

  12. General practice cooperatives: long waiting times for home visits due to long distances?

    Science.gov (United States)

    Giesen, Paul; van Lin, Nieke; Mokkink, Henk; van den Bosch, Wil; Grol, Richard

    2007-02-12

    The introduction of large-scale out-of-hours GP cooperatives has led to questions about increased distances between the GP cooperatives and the homes of patients and the increasing waiting times for home visits in urgent cases. We studied the relationship between the patient's waiting time for a home visit and the distance to the GP cooperative. Further, we investigated if other factors (traffic intensity, home visit intensity, time of day, and degree of urgency) influenced waiting times. Cross-sectional study at four GP cooperatives. We used variance analysis to calculate waiting times for various categories of traffic intensity, home visit intensity, time of day, and degree of urgency. We used multiple logistic regression analysis to calculate to what degree these factors affected the ability to meet targets in urgent cases. The average waiting time for 5827 consultations was 30.5 min. Traffic intensity, home visit intensity, time of day and urgency of the complaint all seemed to affect waiting times significantly. A total of 88.7% of all patients were seen within 1 hour. In the case of life-threatening complaints (U1), 68.8% of the patients were seen within 15 min, and 95.6% of those with acute complaints (U2) were seen within 1 hour. For patients with life-threatening complaints (U1) the percentage of visits that met the time target of 15 minutes decreased from 86.5% (less than 2.5 km) to 16.7% (equals or more than 20 km). Although home visits waiting times increase with increasing distance from the GP cooperative, it appears that traffic intensity, home visit intensity, and urgency also influence waiting times. For patients with life-threatening complaints waiting times increase sharply with the distance.

  13. Adjusting patients streaming initiated by a wait time threshold in emergency department for minimizing opportunity cost.

    Science.gov (United States)

    Kim, Byungjoon B J; Delbridge, Theodore R; Kendrick, Dawn B

    2017-07-10

    Purpose Two different systems for streaming patients were considered to improve efficiency measures such as waiting times (WTs) and length of stay (LOS) for a current emergency department (ED). A typical fast track area (FTA) and a fast track with a wait time threshold (FTW) were designed and compared effectiveness measures from the perspective of total opportunity cost of all patients' WTs in the ED. The paper aims to discuss these issues. Design/methodology/approach This retrospective case study used computerized ED patient arrival to discharge time logs (between July 1, 2009 and June 30, 2010) to build computer simulation models for the FTA and fast track with wait time threshold systems. Various wait time thresholds were applied to stream different acuity-level patients. National average wait time for each acuity level was considered as a threshold to stream patients. Findings The fast track with a wait time threshold (FTW) showed a statistically significant shorter total wait time than the current system or a typical FTA system. The patient streaming management would improve the service quality of the ED as well as patients' opportunity costs by reducing the total LOS in the ED. Research limitations/implications The results of this study were based on computer simulation models with some assumptions such as no transfer times between processes, an arrival distribution of patients, and no deviation of flow pattern. Practical implications When the streaming of patient flow can be managed based on the wait time before being seen by a physician, it is possible for patients to see a physician within a tolerable wait time, which would result in less crowded in the ED. Originality/value A new streaming scheme of patients' flow may improve the performance of fast track system.

  14. Setting wait times to achieve targeted left-without-being-seen rates.

    Science.gov (United States)

    Lucas, Jared; Batt, Robert J; Soremekun, Olanrewaju A

    2014-04-01

    Although several studies have demonstrated that wait time is a key factor that drives high leave-without-being-seen (LWBS) rates, limited data on ideal wait times and impact on LWBS rates exist. We studied the LWBS rates by triage class and target wait times required to achieve various LWBS rates. We conducted a 3-year retrospective analysis of patients presenting to an urban, tertiary, academic, adult emergency department (ED). We divided the 3-year study period into 504 discrete periods by year, day of the week, and hour of the day. Patients of same triage level arriving in the same bin were exposed to similar ED conditions. For each bin, we calculate the mean actual wait time and the proportion of patients that abandoned. We performed a regression analysis on the abandonment proportion on the mean wait time using weighted least squares regression. A total of 143,698 patients were included for analysis during the study period. The R(2) value was highest for Emergency Severity Index (ESI) 3 (R(2) = 0.88), suggesting that wait time is the major factor driving LWBS of ESI 3 patients. Assuming that ESI 2 patients wait less than 10 minutes, our sensitivity analysis shows that the target wait times for ESI 3 and ESI 4/5 patients should be less than 45 and 60 minutes, respectively, to achieve an overall LWBS rate of less than 2%. Achieving target LWBS rates requires analysis to understand the abandonment behavior and redesigning operations to achieve the target wait times. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Effects of LLLT on the periarthritis of the shoulder: a clinical study on different treatments with corticosteroid injections or a wait-and-see policy

    Science.gov (United States)

    Tam, Giuseppe

    2005-11-01

    The aim of this study was to compare the efficacy of three types of treatments in the periarthritis of the shoulder: corticosteroid injections, Low Level Laser Therapy (LLLT) or wait-and-see-policy. BACKGROUND DATA: Low level laser irradiation is a treatment method widely used in medical science. Many disorders, such as osteoarthritis and musculoskeletal conditions with pain, have been treated with LLLT. METHODS: Patients, suffering from periarthritis of the shoulder of at least 6 weeks' duration, were recruited by family doctors. We randomly allocated eligible patients to 6 weeks of treatment n. 20 (33%) with corticosteroid injection, n. 21 (35%) with LLLT and with wait-and-see policy n.19 (31%). We applied a number of 12 sessions with infrared Diode Laser Ga-As (904 nm), 60 W maximum power, peak power per pulse 27 W, pulse frequency 1280 Hz, average point region 2-8 J; dose/point = 3-4 J; total energy density 24 J/cm2. Outcome measures included general improvement, severity of the main complaint, pain, shoulder disability, and patient satisfaction. Severity of shoulder complaints, abduction and elevation of the arm, and the pressure pain threshold were assessed. The principal analysis was done on an intention treatment basis. We assessed all outcomes at 3,6, 12, 26, 52 weeks. RESULTS: We randomly assigned 60 patients. At 6 weeks, corticosteroid injections were significantly better than all other therapy options for all outcome measures. Success rates were 90% (18) compared with 52% (11) for LLLT and 35% (7) for wait-and-see policy. Long-term differences between injections and LLLT were significantly in favour of LLLT. Success rate at 52 weeks were 14 (70%) for injections, 19 (90.5%) for LLLT, and 16 (84%) for wait-and-see policy. LLLT had better results than a wait-and-see policy, but differences were not significant ( p disadvantages of the treatment options for the periarthritis of the shoulder. The decision to treat with LLLT or to adopt a wait-and-see policy

  16. The R-Process Alliance: 2MASS J09544277+5246414, the Most Actinide-enhanced R-II Star Known

    Science.gov (United States)

    Holmbeck, Erika M.; Beers, Timothy C.; Roederer, Ian U.; Placco, Vinicius M.; Hansen, Terese T.; Sakari, Charli M.; Sneden, Christopher; Liu, Chao; Lee, Young Sun; Cowan, John J.; Frebel, Anna

    2018-06-01

    We report the discovery of a new actinide-boost star, 2MASS J09544277+5246414, originally identified as a very bright (V = 10.1), extremely metal-poor ([Fe/H] = ‑2.99) K giant in the LAMOST survey, and found to be highly r-process-enhanced (r-II; [Eu/Fe] = +1.28]), during the snapshot phase of the R-Process Alliance (RPA). Based on a high signal-to-noise ratio (S/N), high-resolution spectrum obtained with the Harlan J. Smith 2.7 m telescope, this star is the first confirmed actinide-boost star found by RPA efforts. With an enhancement of [Th/Eu] = +0.37, 2MASS J09544277+5246414 is also the most actinide-enhanced r-II star yet discovered, and only the sixth metal-poor star with a measured uranium abundance ([U/Fe] = +1.40). Using the Th/U chronometer, we estimate an age of 13.0 ± 4.7 Gyr for this star. The unambiguous actinide-boost signature of this extremely metal-poor star, combined with additional r-process-enhanced and actinide-boost stars identified by the RPA, will provide strong constraints on the nature and origin of the r-process at early times.

  17. The Influence of Ambient Scent and Music on Patients' Anxiety in a Waiting Room of a Plastic Surgeon

    NARCIS (Netherlands)

    Fenko, Anna; Loock, Caroline

    2014-01-01

    OBJECTIVE: This study investigates the influence of ambient scent and music, and their combination, on patients' anxiety in a waiting room of a plastic surgeon. BACKGROUND: Waiting for an appointment with a plastic surgeon can increase a patient's anxiety. It is important to make the waiting time

  18. Sci-Fri AM: Quality, Safety, and Professional Issues 04: Predicting waiting times in Radiation Oncology using machine learning

    International Nuclear Information System (INIS)

    Joseph, Ackeem; Herrera, David; Hijal, Tarek; Hendren, Laurie; Leung, Alvin; Wainberg, Justin; Sawaf, Marya; Maxim, Gorshkov; Maglieri, Robert; Keshavarz, Mehryar; Kildea, John

    2016-01-01

    We describe a method for predicting waiting times in radiation oncology. Machine learning is a powerful predictive modelling tool that benefits from large, potentially complex, datasets. The essence of machine learning is to predict future outcomes by learning from previous experience. The patient waiting experience remains one of the most vexing challenges facing healthcare. Waiting time uncertainty can cause patients, who are already sick and in pain, to worry about when they will receive the care they need. In radiation oncology, patients typically experience three types of waiting: Waiting at home for their treatment plan to be prepared Waiting in the waiting room for daily radiotherapy Waiting in the waiting room to see a physician in consultation or follow-up These waiting periods are difficult for staff to predict and only rough estimates are typically provided, based on personal experience. In the present era of electronic health records, waiting times need not be so uncertain. At our centre, we have incorporated the electronic treatment records of all previously-treated patients into our machine learning model. We found that the Random Forest Regression model provides the best predictions for daily radiotherapy treatment waiting times (type 2). Using this model, we achieved a median residual (actual minus predicted value) of 0.25 minutes and a standard deviation residual of 6.5 minutes. The main features that generated the best fit model (from most to least significant) are: Allocated time, median past duration, fraction number and the number of treatment fields.

  19. Sci-Fri AM: Quality, Safety, and Professional Issues 04: Predicting waiting times in Radiation Oncology using machine learning

    Energy Technology Data Exchange (ETDEWEB)

    Joseph, Ackeem; Herrera, David; Hijal, Tarek; Hendren, Laurie; Leung, Alvin; Wainberg, Justin; Sawaf, Marya; Maxim, Gorshkov; Maglieri, Robert; Keshavarz, Mehryar; Kildea, John [McGill University Health Centre (Canada)

    2016-08-15

    We describe a method for predicting waiting times in radiation oncology. Machine learning is a powerful predictive modelling tool that benefits from large, potentially complex, datasets. The essence of machine learning is to predict future outcomes by learning from previous experience. The patient waiting experience remains one of the most vexing challenges facing healthcare. Waiting time uncertainty can cause patients, who are already sick and in pain, to worry about when they will receive the care they need. In radiation oncology, patients typically experience three types of waiting: Waiting at home for their treatment plan to be prepared Waiting in the waiting room for daily radiotherapy Waiting in the waiting room to see a physician in consultation or follow-up These waiting periods are difficult for staff to predict and only rough estimates are typically provided, based on personal experience. In the present era of electronic health records, waiting times need not be so uncertain. At our centre, we have incorporated the electronic treatment records of all previously-treated patients into our machine learning model. We found that the Random Forest Regression model provides the best predictions for daily radiotherapy treatment waiting times (type 2). Using this model, we achieved a median residual (actual minus predicted value) of 0.25 minutes and a standard deviation residual of 6.5 minutes. The main features that generated the best fit model (from most to least significant) are: Allocated time, median past duration, fraction number and the number of treatment fields.

  20. Mobile Fences: J.M. Coetzee’s Waiting for the Barbarians

    Directory of Open Access Journals (Sweden)

    Eleonora Pizzinat

    2011-05-01

    Full Text Available Fences usually enclose and separate, but they are also places of exchange neither inside nor outside. This concept is well represented in J.M. Coetzee’s Waiting for the Barbarians, because not only this novel is setted on the border between an undefined Empire and the barbarians’ lands, but it also plays with various declinations of the idea of limit and boundary. Through a reading which intends to highlight every kind of frame in the novel, it will emerge that no border is fixed and conclusive. Namely, in this book every real or metaphoric fence is called into question: the distinction between the duality of “us and them” is actually determined by the Empire’s walls which separate the inside from the outside in an arbitrary way; the magistrate (with the empathy he feels for the barbarian girl is inevitably caught in a double bind; and, according to Emmanuel Lévinas’ philosophy, the desire to understand otherness reveals its predatory intentions from a post-colonial point of view. It is not possible to delineate an ultimate bordeline, and it will emerge that instead of a binary logic there is a more fruitful way of thinking, a way based on frames, paradoxes and literary texts which cannot be read as flat mirroring devices.

  1. The effectiveness of service delivery initiatives at improving patients' waiting times in clinical radiology departments: a systematic review.

    Science.gov (United States)

    Olisemeke, B; Chen, Y F; Hemming, K; Girling, A

    2014-12-01

    We reviewed the literature for the impact of service delivery initiatives (SDIs) on patients' waiting times within radiology departments. We searched MEDLINE, EMBASE, CINAHL, INSPEC and The Cochrane Library for relevant articles published between 1995 and February, 2013. The Cochrane EPOC risk of bias tool was used to assess the risk of bias on studies that met specified design criteria. Fifty-seven studies met the inclusion criteria. The types of SDI implemented included extended scope practice (ESP, three studies), quality management (12 studies), productivity-enhancing technologies (PETs, 29 studies), multiple interventions (11 studies), outsourcing and pay-for-performance (one study each). The uncontrolled pre- and post-intervention and the post-intervention designs were used in 54 (95%) of the studies. The reporting quality was poor: many of the studies did not test and/or report the statistical significance of their results. The studies were highly heterogeneous, therefore meta-analysis was inappropriate. The following type of SDIs showed promising results: extended scope practice; quality management methodologies including Six Sigma, Lean methodology, and continuous quality improvement; productivity-enhancing technologies including speech recognition reporting, teleradiology and computerised physician order entry systems. We have suggested improved study design and the mapping of the definitions of patient waiting times in radiology to generic timelines as a starting point for moving towards a situation where it becomes less restrictive to compare and/or pool the results of future studies in a meta-analysis.

  2. If you 'watch and wait,' prostate cancer may progress dramatically

    International Nuclear Information System (INIS)

    Allison, Ron R.; Schulsinger, Alan; Vongtama, Vitune; Grant, Pat; Shin, Kyu H.; Huben, Robert

    1997-01-01

    Purpose: Observation has been proposed as an option for localized prostate cancer. However, most series reporting on 'watch and wait' include patients treated by TUR or hormones that may affect results. We retrospectively reviewed the natural history of truly untreated prostate cancer and report the outcome for these patients. Methods and Materials: From 1976 to 1992, 34 patients of median age 70 years (range 56-88) with biopsy proven localized adenocarcinoma of the prostate refused therapy. All had negative bone scan and none underwent TUR or hormone treatment. No patient was lost to follow-up (median 76 months). Failure patterns and survival were analyzed. Results: At diagnosis 27 patients had palpable nodules (T2), of which 13 were well differentiated and 14 moderately differentiated. Seven had moderately differentiated T3 lesions. Mild prostatitis including nocturia, hesistancy, and urgency were reported in 16 T2 and 6 T3 patients. Within 36 months, local progression requiring therapy occurred in all T3, all T2 moderate and 5 of 13 T2 well-differentiated patients. Systemic progression occurred in 6 of 7 T3, 9 of 14 T2 (mod), and 2 of 13 T2 (well) patients. Overall 59% are alive, 26% succumbed to prostate carcinoma and 15% to other causes. Conclusion: Observation results in a high rate of local progression requiring intervention (77%) and excessive systemic disease development (50%) for patients with clinically palpable disease. Perhaps this strategy is viable for earlier stage lesions detected by PSA but it must be tested in a rigorous fashion before accepted

  3. Spatial structure increases the waiting time for cancer

    Science.gov (United States)

    Martens, Erik A.; Kostadinov, Rumen; Maley, Carlo C.; Hallatschek, Oskar

    2011-11-01

    Cancer results from a sequence of genetic and epigenetic changes that lead to a variety of abnormal phenotypes including increased proliferation and survival of somatic cells and thus to a selective advantage of pre-cancerous cells. The notion of cancer progression as an evolutionary process has been attracting increasing interest in recent years. A great deal of effort has been made to better understand and predict the progression to cancer using mathematical models; these mostly consider the evolution of a well-mixed cell population, even though pre-cancerous cells often evolve in highly structured epithelial tissues. In this study, we propose a novel model of cancer progression that considers a spatially structured cell population where clones expand via adaptive waves. This model is used to assess two different paradigms of asexual evolution that have been suggested to delineate the process of cancer progression. The standard scenario of periodic selection assumes that driver mutations are accumulated strictly sequentially over time. However, when the mutation supply is sufficiently high, clones may arise simultaneously on distinct genetic backgrounds, and clonal adaptation waves interfere with each other. We find that in the presence of clonal interference, spatial structure increases the waiting time for cancer, leads to a patchwork structure of non-uniformly sized clones and decreases the survival probability of virtually neutral (passenger) mutations, and that genetic distance begins to increase over a characteristic length scale Lc. These characteristic features of clonal interference may help us to predict the onset of cancers with pronounced spatial structure and to interpret spatially sampled genetic data obtained from biopsies. Our estimates suggest that clonal interference likely occurs in the progression of colon cancer and possibly other cancers where spatial structure matters.

  4. Discovering the impact of preceding units' characteristics on the wait time of cardiac surgery unit from statistic data.

    Science.gov (United States)

    Liu, Jiming; Tao, Li; Xiao, Bo

    2011-01-01

    Prior research shows that clinical demand and supplier capacity significantly affect the throughput and the wait time within an isolated unit. However, it is doubtful whether characteristics (i.e., demand, capacity, throughput, and wait time) of one unit would affect the wait time of subsequent units on the patient flow process. Focusing on cardiac care, this paper aims to examine the impact of characteristics of the catheterization unit (CU) on the wait time of cardiac surgery unit (SU). This study integrates published data from several sources on characteristics of the CU and SU units in 11 hospitals in Ontario, Canada between 2005 and 2008. It proposes a two-layer wait time model (with each layer representing one unit) to examine the impact of CU's characteristics on the wait time of SU and test the hypotheses using the Partial Least Squares-based Structural Equation Modeling analysis tool. Results show that: (i) wait time of CU has a direct positive impact on wait time of SU (β = 0.330, p relationships among different characteristics (except for the effect of throughput on wait time in SU). Characteristics of CU have direct and indirect impacts on wait time of SU. Specifically, demand and wait time of preceding unit are good predictors for wait time of subsequent units. This suggests that considering such cross-unit effects is necessary when alleviating wait time in a health care system. Further, different patient risk profiles may affect wait time in different ways (e.g., positive or negative effects) within SU. This implies that the wait time management should carefully consider the relationship between priority triage and risk stratification, especially for cardiac surgery.

  5. Discovering the impact of preceding units' characteristics on the wait time of cardiac surgery unit from statistic data.

    Directory of Open Access Journals (Sweden)

    Jiming Liu

    Full Text Available INTRODUCTION: Prior research shows that clinical demand and supplier capacity significantly affect the throughput and the wait time within an isolated unit. However, it is doubtful whether characteristics (i.e., demand, capacity, throughput, and wait time of one unit would affect the wait time of subsequent units on the patient flow process. Focusing on cardiac care, this paper aims to examine the impact of characteristics of the catheterization unit (CU on the wait time of cardiac surgery unit (SU. METHODS: This study integrates published data from several sources on characteristics of the CU and SU units in 11 hospitals in Ontario, Canada between 2005 and 2008. It proposes a two-layer wait time model (with each layer representing one unit to examine the impact of CU's characteristics on the wait time of SU and test the hypotheses using the Partial Least Squares-based Structural Equation Modeling analysis tool. RESULTS: Results show that: (i wait time of CU has a direct positive impact on wait time of SU (β = 0.330, p < 0.01; (ii capacity of CU has a direct positive impact on demand of SU (β = 0.644, p < 0.01; (iii within each unit, there exist significant relationships among different characteristics (except for the effect of throughput on wait time in SU. CONCLUSION: Characteristics of CU have direct and indirect impacts on wait time of SU. Specifically, demand and wait time of preceding unit are good predictors for wait time of subsequent units. This suggests that considering such cross-unit effects is necessary when alleviating wait time in a health care system. Further, different patient risk profiles may affect wait time in different ways (e.g., positive or negative effects within SU. This implies that the wait time management should carefully consider the relationship between priority triage and risk stratification, especially for cardiac surgery.

  6. DNW--"did not wait" or "demographic needing work": a study of the profile of patients who did not wait to be seen in an Irish emergency department.

    LENUS (Irish Health Repository)

    Gilligan, P

    2009-11-01

    Patients who fail to wait for medical assessment in the emergency department (ED) have been referred to in the international literature as "did not wait" (DNW) or "left without being seen" (LWBS) patients or, indeed, simply as "walkouts". This is taken as a performance indicator internationally. In common with many countries, Ireland has very considerable problems in the delivery of ED care due largely to inadequate resources and the inappropriate use of EDs as holding bays for admitted patients. This is the first study of this size to profile the DNW phenomenon in Ireland.

  7. Conservative Wait-and-See Therapy Versus Antibiotic Treatment for Nontuberculous Mycobacterial Cervicofacial Lymphadenitis in Children

    NARCIS (Netherlands)

    Lindeboom, Jerome A.

    2011-01-01

    Background. In this explorative study, 50 children with microbiologically confirmed nontuberculous mycobacterial cervicofacial lymphadenitis were randomized to either receive antibiotic therapy or follow a conservative wait-and-see approach. Our primary objective was to assess the time for all

  8. Asymptotic inference for waiting times and patiences in queues with abandonment

    DEFF Research Database (Denmark)

    Gorst-Rasmussen, Anders; Hansen, Martin Bøgsted

    Motivated by applications in call center management, we propose a framework based on empirical process techniques for inference about the waiting time and patience distribution in multiserver queues with abandonment. The framework rigorises heuristics based on survival analysis of independent...

  9. Asymptotic inference for waiting times and patiences in queues with abandonment

    DEFF Research Database (Denmark)

    Gorst-Rasmussen, Anders; Hansen, Martin Bøgsted

    2009-01-01

    Motivated by applications in call center management, we propose a framework based on empirical process techniques for inference about waiting time and patience distributions in multiserver queues with abandonment. The framework rigorises heuristics based on survival analysis of independent...

  10. Waiting for transplant: physical, psychosocial, and nutritional status considerations for pediatric candidates and implications for care.

    Science.gov (United States)

    Anthony, Samantha J; Annunziato, Rachel A; Fairey, Elise; Kelly, Vicky L; So, Stephanie; Wray, Jo

    2014-08-01

    The waiting period for an organ transplant has been described as a time of tremendous uncertainty and vulnerability, posing unique challenges and stressors for pediatric transplant candidates and their families. It has been identified as the most stressful stage of the transplant journey, yet little attention has been given to the physical, psychological, or social impact of the waiting period in the literature. In this review, we discuss the physical, nutritional, and psychosocial implications of the waiting period for child and adolescent transplant candidates and the impact on their parents and siblings. We identify areas for future research and provide recommendations for clinical practice to support children, adolescents, and families during the waiting period. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. The ecology of the patient visit: physical attractiveness, waiting times, and perceived quality of care.

    Science.gov (United States)

    Becker, Franklin; Douglass, Stephanie

    2008-01-01

    This study examined the relationship between the attractiveness of the physical environment of healthcare facilities and patient perceptions of quality, service, and waiting time through systematic observations and patient satisfaction surveys at 7 outpatient practices at Weill Cornell Medical Center. Findings indicate positive correlations between more attractive environments and higher levels of perceived quality, satisfaction, staff interaction, and reduction of patient anxiety. The comparison of actual observed time and patients' perception of time showed that patients tend to overestimate shorter waiting times and underestimate longer waiting times in both the waiting area and the examination room. Further examinations of the way outpatient-practice environments impact patient and staff perceptions and how those perceptions impact behavior and medical outcomes are suggested.

  12. Psychosocial and Patient Education Needs of Prostate Cancers Selecting Watchful Waiting

    National Research Council Canada - National Science Library

    Knight, Sara J; Latini, David M

    2006-01-01

    ... of this approach to disease management. We propose to gather data from prostate cancer patients selecting watchful waiting in lieu of an active treatment for their cancer in order to understand the psychosocial and symptom management...

  13. Waiting time and the psychosocial consequences of false-positive mammography

    DEFF Research Database (Denmark)

    Heleno, Bruno M.; Siersma, Volkert; Brodersen, John

    2015-01-01

    Background: There is wide variation in the psychosocial response to false-positive mammography. We aimed to assess whether women having to wait longer to exclude cancer had increased psychosocial consequences that persisted after cancer was ruled out. Findings: We selected women with false......-positive mammography (n = 272), screened for breast cancer in Copenhagen and Funen (Denmark) over a 1-year period. We measured psychosocial consequences immediately before women attended their recall visit and 1, 6, 18 and 36 months after women received their final diagnosis. After women were told that cancer had been...... ruled out, adverse psychosocial consequences decreased with time. We found no statistically significant differences between women who had cancer ruled out immediately at the recall visit (waiting time of 0) and women who had to wait longer before cancer was ruled out (waiting times 1-30, 30...

  14. Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial.

    NARCIS (Netherlands)

    B. Kuijper (Barbara); J.T. Tans; A. Beelen (Anita); F. Nollet (Frans); M. de Visser (Marianne)

    2009-01-01

    textabstractOBJECTIVE: To evaluate the effectiveness of treatment with collar or physiotherapy compared with a wait and see policy in recent onset cervical radiculopathy. DESIGN: Randomised controlled trial. SETTING: Neurology outpatient clinics in three Dutch hospitals. PARTICIPANTS: 205 patients

  15. Public reporting on quality, waiting times and patient experience in 11 high-income countries

    OpenAIRE

    Rechel, Bernd; McKee, Martin; Haas, Marion; Marchildon, Gregory P; Bousquet, Frederic; Blümel, Miriam; Geissler, Alexander; van Ginneken, Ewout; Ashton, Toni; Saunes, Ingrid Sperre; Anell, Anders; Quentin, Wilm; Saltman, Richard; Culler, Steven; Barnes, Andrew

    2016-01-01

    : This article maps current approaches to public reporting on waiting times, patient experience and aggregate measures of quality and safety in 11 high-income countries (Australia, Canada, England, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and the United States). Using a questionnaire-based survey of key national informants, we found that the data most commonly made available to the public are on waiting times for hospital treatment, being reported for major hospi...

  16. Intake of wine, beer and spirits and waiting time to pregnancy

    DEFF Research Database (Denmark)

    Juhl, Mette; Olsen, Jørn; Andersen, Anne-Marie Nybo

    2003-01-01

    A high intake of alcohol may prolong waiting time to pregnancy, whereas a moderate intake may have no or perhaps even a positive effect on fecundity. In previous studies on fecundity, different types of beverages have not been taken into consideration, although moderate wine drinkers appear to have...... fewer strokes, lung and digestive tract cancers, and overall mortality than both abstainers and moderate drinkers of beer or spirits. We examined the association between different types of alcoholic beverages and waiting time to pregnancy....

  17. Discrimination in waiting times by insurance type and financial soundness of German acute care hospitals.

    Science.gov (United States)

    Schwierz, Christoph; Wübker, Achim; Wübker, Ansgar; Kuchinke, Björn A

    2011-10-01

    This paper shows that patients with private health insurance (PHI) are being offered significantly shorter waiting times than patients with statutory health insurance (SHI) in German acute hospital care. This behavior may be driven by the higher expected profitability of PHI relative to SHI holders. Further, we find that hospitals offering private insurees shorter waiting times when compared with SHI holders have a significantly better financial performance than those abstaining from or with less discrimination.

  18. Using Queuing Theory and Simulation Modelling to Reduce Waiting Times in An Iranian Emergency Department.

    Science.gov (United States)

    Haghighinejad, Hourvash Akbari; Kharazmi, Erfan; Hatam, Nahid; Yousefi, Sedigheh; Hesami, Seyed Ali; Danaei, Mina; Askarian, Mehrdad

    2016-01-01

    Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department (ED) is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emergency department services in an Iranian hospital ED and to propose scenarios to reduce its queue and waiting time. This is a cross-sectional study in which simulation software (Arena, version 14) was used. The input information was extracted from the hospital database as well as through sampling. The objective was to evaluate the response variables of waiting time, number waiting and utilization of each server and test the three scenarios to improve them. Running the models for 30 days revealed that a total of 4088 patients left the ED after being served and 1238 patients waited in the queue for admission in the ED bed area at end of the run (actually these patients received services out of their defined capacity). The first scenario result in the number of beds had to be increased from 81 to179 in order that the number waiting of the "bed area" server become almost zero. The second scenario which attempted to limit hospitalization time in the ED bed area to the third quartile of the serving time distribution could decrease the number waiting to 586 patients. Doubling the bed capacity in the emergency department and consequently other resources and capacity appropriately can solve the problem. This includes bed capacity requirement for both critically ill and less critically ill patients. Classification of ED internal sections based on severity of illness instead of medical specialty is another solution.

  19. Using Queuing Theory and Simulation Modelling to Reduce Waiting Times in An Iranian Emergency Department

    OpenAIRE

    Haghighinejad, Hourvash Akbari; Kharazmi, Erfan; Hatam, Nahid; Yousefi, Sedigheh; Hesami, Seyed Ali; Danaei, Mina; Askarian, Mehrdad

    2016-01-01

    Background: Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department (ED) is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emerg...

  20. Waiting times for diagnosis and treatment of head and neck cancer in Denmark in 2010 compared to 1992 and 2002

    DEFF Research Database (Denmark)

    Lyhne, N M; Christensen, A; Alanin, M C

    2013-01-01

    BACKGROUND AND AIM: Significant tumour progression was observed during waiting time for treatment of head and neck cancer. To reduce waiting times, a Danish national policy of fast track accelerated clinical pathways was introduced in 2007. This study describes changes in waiting time and the pot......BACKGROUND AND AIM: Significant tumour progression was observed during waiting time for treatment of head and neck cancer. To reduce waiting times, a Danish national policy of fast track accelerated clinical pathways was introduced in 2007. This study describes changes in waiting time...... and the potential influence of fast track by comparing waiting times in 2010 to 2002 and 1992. METHODS: Charts of all new patients diagnosed with squamous cell carcinoma of the oral cavity, pharynx and larynx at the five Danish head and neck oncology centres from January to April 2010 (n=253) were reviewed...

  1. The design and testing of interactive hospital spaces to meet the needs of waiting children.

    Science.gov (United States)

    Biddiss, Elaine; McPherson, Amy; Shea, Geoffrey; McKeever, Patricia

    2013-01-01

    To design an innovative interactive media display in a pediatric hospital clinic waiting space that addresses the growing demand for accessible, contact-surface-free options for play. In healthcare settings, waiting can be anxiety provoking for children and their accompanying family members. Opportunities for positive distraction have been shown to reduce waiting anxiety, leading to positive health outcomes. An interactive media display, ScreenPlay, was created and evaluated using a participatory design approach and a combination of techniques including quality function deployment and mixed data elicitation methods (questionnaires, focus groups, and observations). The user and organizational design requirements were established and used to review contemporary strategies for positive distraction in healthcare waiting spaces and to conceptualize and test ScreenPlay. Ten staff members, 11 children/youths, and 6 parents participated in the design and evaluation of ScreenPlay. ScreenPlay provided a positive, engaging experience without the use of contact surfaces through which infections can be spread. It was accessible to children, youth, and adults of all motor abilities. All participants strongly agreed that the interactive media display would improve the healthcare waiting experience. ScreenPlay is an interactive display that is the result of a successful model for the design of healthcare waiting spaces that is collaborative, interdisciplinary, and responsive to the needs of its community. Design process, healing environments, hospital, interdisciplinary, pediatric.

  2. Waiting time distribution revealing the internal spin dynamics in a double quantum dot

    Science.gov (United States)

    Ptaszyński, Krzysztof

    2017-07-01

    Waiting time distribution and the zero-frequency full counting statistics of unidirectional electron transport through a double quantum dot molecule attached to spin-polarized leads are analyzed using the quantum master equation. The waiting time distribution exhibits a nontrivial dependence on the value of the exchange coupling between the dots and the gradient of the applied magnetic field, which reveals the oscillations between the spin states of the molecule. The zero-frequency full counting statistics, on the other hand, is independent of the aforementioned quantities, thus giving no insight into the internal dynamics. The fact that the waiting time distribution and the zero-frequency full counting statistics give a nonequivalent information is associated with two factors. Firstly, it can be explained by the sensitivity to different timescales of the dynamics of the system. Secondly, it is associated with the presence of the correlation between subsequent waiting times, which makes the renewal theory, relating the full counting statistics and the waiting time distribution, no longer applicable. The study highlights the particular usefulness of the waiting time distribution for the analysis of the internal dynamics of mesoscopic systems.

  3. The impact of different prioritisation policies on waiting times: case studies of Norway and Scotland.

    Science.gov (United States)

    Januleviciute, Jurgita; Askildsen, Jan Erik; Kaarboe, Oddvar; Holmås, Tor Helge; Sutton, Matt

    2013-11-01

    We investigate the distributional consequences of two different waiting times initiatives, one in Norway, and one in Scotland. The primary focus of Scotland's recent waiting time reforms, introduced in 2003, and modified in 2005 and 2007, has been on reducing maximum waiting times through the imposition of high profile national targets accompanied by increases in resources. In Norway, the focus of the reform introduced in September 2004, has been on assigning patients referred to hospital a maximum waiting time based on disease severity, the expected benefit and the cost-effectiveness of the treatment. We use large, national administrative datasets from before and after each of these reforms and assign priority groups based on the maximum waiting times stipulated in medical guidelines. The analysis shows that the lowest priority patients benefited most from both reforms. This was at the cost of longer waiting times for patients that should have been given higher priority in Norway, while Scotland's high priority patients remained unaffected. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. [Reducing patient waiting time for the outpatient phlebotomy service using six sigma].

    Science.gov (United States)

    Kim, Yu Kyung; Song, Kyung Eun; Lee, Won Kil

    2009-04-01

    One of the challenging issues of the outpatient phlebotomy services at most hospitals is that patients have a long wait. The outpatient phlebotomy team of Kyungpook National University Hospital applied six sigma breakthrough methodologies to reduce the patient waiting time. The DMAIC (Define, Measure, Analyze, Improve, and Control) model was employed to approach the project. Two hundred patients visiting the outpatient phlebotomy section were asked to answer the questionnaires at inception of the study to ascertain root causes. After correction, we surveyed 285 patients for same questionnaires again to follow-up the effects. A defect was defined as extending patient waiting time so long and at the beginning of the project, the performance level was 2.61 sigma. Using fishbone diagram, all the possible reasons for extending patient waiting time were captured, and among them, 16 causes were proven to be statistically significant. Improvement plans including a new receptionist, automatic specimen transport system, and adding one phlebotomist were put into practice. As a result, the number of patients waited more than 5 min significantly decreased, and the performance level reached 3.0 sigma in December 2007 and finally 3.35 sigma in July 2008. Applying the six sigma, the performance level of waiting times for blood drawing exceeding five minutes were improved from 2.61 sigma to 3.35 sigma.

  5. The support needs of patients waiting for publicly funded bariatric surgery - implications for health service planners.

    Science.gov (United States)

    Sharman, M J; Venn, A J; Jose, K A; Williams, D; Hensher, M; Palmer, A J; Wilkinson, S; Ezzy, D

    2017-02-01

    The objective of this study was to investigate the experience of waiting for publicly funded bariatric surgery in an Australian tertiary healthcare setting. Focus groups and individual interviews involving people waiting for or who had undergone publicly funded bariatric surgery were audio-recorded, transcribed and analysed thematically. A total of 11 women and 6 men engaged in one of six focus groups in 2014, and an additional 10 women and 9 men were interviewed in 2015. Mean age was 53 years (range 23-66); mean waiting time was 6 years (range 0-12), and mean time since surgery was 4 years (range 0-11). Waiting was commonly reported as emotionally challenging (e.g. frustrating, depressing, stressful) and often associated with weight gain (despite weight-loss attempts) and deteriorating physical health (e.g. development of new or worsening obesity-related comorbidity or decline in mobility) or psychological health (e.g. development of or worsening depression). Peer support, health and mental health counselling, integrated care and better communication about waitlist position and management (e.g. patient prioritization) were identified support needs. Even if wait times cannot be reduced, better peer and health professional supports, together with better communication from health departments, may improve the experience or outcomes of waiting and confer quality-of-life gains irrespective of weight loss. © 2016 World Obesity Federation.

  6. Access to Grafts in a Liver Transplant Center: Does It Rely on the Severity of the Waiting List Population?

    Science.gov (United States)

    Daciuk, N I; Quiñonez, E G; Poupard, M; Vergara Sandoval, R M; Mattera, F J

    2018-03-01

    The number of transplants performed relies, partially, on recipients' variables on the waiting list. The goal of this study was to compare recipients from a high-volume liver center in Argentina with the rest of the country. This study was a retrospective analysis of liver transplant recipients nationally between January 2013 and April 2017. It involved extracting data from the open database CRESI-SINTRA (the Argentinian database of the National Procurement Organization, an equivalent to the United Network for Organ Sharing); expressing results by percentages, medians, and interquartile ranges (IQRs); and comparing the national population with the population transplanted at Hospital El Cruce (HEC). The Mann-Whitney U test was used for analysis. Nationally, 1434 liver transplants were performed. A total of 177 (12.34%) were emergency status; 811 (56.6%) were by the Model for End-Stage Liver Disease (MELD) (n = 759)/PELD (Pediatric End-Stage Liver Disease) (n = 52), with a median graft assignment position of 5 (IQR, 3-10) in 57.2 days (IQR, 11-217). Median MELD access was 29 points (IQR, 24-33). A total of 446 (31.1%) had MELD exceptions; 249 (55.8%) of these were due to Milan hepatocellular carcinoma. At the HEC, 167 liver transplantations were performed; 26 (15.6%) were emergency status and 97 (58.1%) by MELD (none PELD). Their median graft assignment position was 4 (IQR, 4-16) in 19.1 days (IQR, 4-90); median MELD access was 28 points (IQR, 24-31). Forty-five patients (26.9%) had MELD exceptions; 31 (68.9%) were due to hepatocellular carcinoma. Our center has a larger proportion of recipients transplanted by emergency status and MELD, similar MELD access, and less waiting list time, reflecting our wide policy of liver graft acceptance. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Effectiveness and acceptance of a web-based depression intervention during waiting time for outpatient psychotherapy: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Grünzig, Sasha-Denise; Baumeister, Harald; Bengel, Jürgen; Ebert, David; Krämer, Lena

    2018-05-22

    Due to limited resources, waiting periods for psychotherapy are often long and burdening for those in need of treatment and the health care system. In order to bridge the gap between initial contact and the beginning of psychotherapy, web-based interventions can be applied. The implementation of a web-based depression intervention during waiting periods has the potential to reduce depressive symptoms and enhance well-being in depressive individuals waiting for psychotherapy. In a two-arm randomized controlled trial, effectiveness and acceptance of a guided web-based intervention for depressive individuals on a waitlist for psychotherapy are evaluated. Participants are recruited in several German outpatient clinics. All those contacting the outpatient clinics with the wish to enter psychotherapy receive study information and a depression screening. Those adults (age ≥ 18) with depressive symptoms above cut-off (CES-D scale > 22) and internet access are randomized to either intervention condition (treatment as usual and immediate access to the web-based intervention) or waiting control condition (treatment as usual and delayed access to the web-based intervention). At three points of assessment (baseline, post-treatment, 3-months-follow-up) depressive symptoms and secondary outcomes, such as quality of life, attitudes towards psychotherapy and web-based interventions and adverse events are assessed. Additionally, participants' acceptance of the web-based intervention is evaluated, using measures of intervention adherence and satisfaction. This study investigates a relevant setting for the implementation of web-based interventions, potentially improving the provision of psychological health care. The results of this study contribute to the evaluation of innovative and resource-preserving health care models for outpatient psychological treatment. This trial has been registered on 13 February 2017 in the German clinical trials register (DRKS); registration

  8. Socioeconomic differences in waiting times for elective surgery: a population-based retrospective study

    Directory of Open Access Journals (Sweden)

    Petrelli Alessio

    2012-08-01

    Full Text Available Abstract Background Widespread literature on inequity in healthcare access and utilization has been published, but research on socioeconomic differences in waiting times is sparse and the evidence is fragmentary and controversial. The objective of the present study is the analysis of the relationship between individual socioeconomic level and waiting times for in-hospital elective surgery. Methods We retrospectively studied the waiting times experienced by patients registered on hospital waiting lists for 6 important surgical procedures by using the Hospital Discharge Database (HDD of the Piedmont Region (4,000,000 inhabitants in the North West of Italy from 2006 to 2008. The surgical procedures analyzed were: coronary artery by-pass (CABG, angioplasty, coronarography, endarterectomy, hip replacement and cholecystectomy. Cox regression models were estimated to study the relationship between waiting times and educational level taking into account the confounding effect of the following factors: sex, age, comorbidity, registration period, and Local Health Authorities (LHA as a proxy of supply. Results Median waiting times for low educational level were higher than for high educational level for all the selected procedures. Differences were particularly high for endarterectomy and hip replacement. For all considered procedures, except CABG, an inverse gradient between waiting times and educational level was observed: the conditional probabilities of undergoing surgery were lower among individuals with a low to middle level education than for individuals with a higher level of education after adjustment for sex, age, comorbidities, registration period, and LHAs. For most procedures the effect decreases over the follow up period. Conclusions The results of the study show evidence of inequalities in access to elective surgery in Italy. Implementation of policies aimed to promote national information initiatives that guarantee wider access to those

  9. Using Queuing Theory and Simulation Modelling to Reduce Waiting Times in An Iranian Emergency Department

    Directory of Open Access Journals (Sweden)

    Hourvash Akbari Haghighinejad

    2016-01-01

    Full Text Available Background: Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department (ED is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emergency department services in an Iranian hospital ED and to propose scenarios to reduce its queue and waiting time. Methods: This is a cross-sectional study in which simulation software (Arena, version 14 was used. The input information was extracted from the hospital database as well as through sampling. The objective was to evaluate the response variables of waiting time, number waiting and utilization of each server and test the three scenarios to improve them. Results: Running the models for 30 days revealed that a total of 4088 patients left the ED after being served and 1238 patients waited in the queue for admission in the ED bed area at end of the run (actually these patients received services out of their defined capacity. The first scenario result in the number of beds had to be increased from 81 to179 in order that the number waiting of the “bed area” server become almost zero. The second scenario which attempted to limit hospitalization time in the ED bed area to the third quartile of the serving time distribution could decrease the numberwaiting to 586 patients. Conclusion: Doubling the bed capacity in the emergency department and consequently other resources and capacity appropriately can solve the problem. This includes bed capacity requirement for both critically ill and less critically ill patients. Classification of ED internal sections based on severity of illness instead of medical specialty is another solution.

  10. Effect of socioeconomic deprivation on waiting time for cardiac surgery: retrospective cohort study

    Science.gov (United States)

    Pell, Jill P; Pell, Alastair C H; Norrie, John; Ford, Ian; Cobbe, Stuart M

    2000-01-01

    Objective To determine whether the priority given to patients referred for cardiac surgery is associated with socioeconomic status. Design Retrospective study with multivariate logistic regression analysis of the association between deprivation and classification of urgency with allowance for age, sex, and type of operation. Multivariate linear regression analysis was used to determine association between deprivation and waiting time within each category of urgency, with allowance for age, sex, and type of operation. Setting NHS waiting lists in Scotland. Participants 26 642 patients waiting for cardiac surgery, 1 January 1986 to 31 December 1997. Main outcome measures Deprivation as measured by Carstairs deprivation category. Time spent on NHS waiting list. Results Patients who were most deprived tended to be younger and were more likely to be female. Patients in deprivation categories 6 and 7 (most deprived) waited about three weeks longer for surgery than those in category 1 (mean difference 24 days, 95% confidence interval 15 to 32). Deprived patients had an odds ratio of 0.5 (0.46 to 0.61) for having their operations classified as urgent compared with the least deprived, after allowance for age, sex, and type of operation. When urgent and routine cases were considered separately, there was no significant difference in waiting times between the most and least deprived categories. Conclusions Socioeconomically deprived patients are thought to be more likely to develop coronary heart disease but are less likely to be investigated and offered surgery once it has developed. Such patients may be further disadvantaged by having to wait longer for surgery because of being given lower priority. PMID:10617517

  11. Freeze, Wait, Reanimate: Cryonic Suspension and Science Fiction

    Science.gov (United States)

    Shoffstall, Grant

    2010-01-01

    This essay takes as its chief point of departure Jacques Ellul's contention that imaginative treatments of malevolent technology in antitechnological science fiction, by way of inviting rejection, refusal, dismissal, or condemnation, conspire in facilitating human acceptance of and adjustment to technology as it otherwise presently is. The author…

  12. Can the waiting-point nucleus 78Ni be studied at an on-line mass-separator?

    Science.gov (United States)

    Wöhr, A.; Andreyev, A.; Bijnens, N.; Breitenbach, J.; Franchoo, S.; Huyse, M.; Kudryavtsev, Y. A.; Piechaczek, A.; Raabe, R. R.; Reusen, I.; Vermeeren, L.; Van Duppen, P.

    1997-02-01

    Short-lived nickel isotopes have been studied using a chemically selective Ion Guide Laser Ion Source (IGLIS) based on resonance ionisation of atoms at the Leuven Isotope Separator On-Line (LISOL) separator. The decay properties of different Ni isotopes have been studied using β-γ-coincidences. Experimental production rates of proton induced fission of 238U are obtained for 69,71Ni. These numbers are in a strong disagreement with Silberg-Tsao calculations.

  13. Chances of late surgery in relation to length of wait lists

    Directory of Open Access Journals (Sweden)

    Levy Adrian R

    2005-09-01

    Full Text Available Abstract Background The proportion of patients who undergo surgery within a clinically safe time is an important performance indicator in health systems that use wait lists to manage access to care. However, little is known about chances of on-time surgery according to variations in existing demand. We sought to determine what proportion of patients have had late coronary bypass surgery after registration on wait lists of different size in a network of hospitals with uniform standards for timing of surgery. Methods Using records from a population-based registry, we studied wait-list times prospectively collected in a cohort of patients registered on wait lists for coronary artery bypass grafting procedures. We compared the number of weeks from registration to surgery against target access times established for three urgency groups. The chances of undergoing surgery within target time have been evaluated in relation to wait-list size at registration and the number of surgeries performed without registration on a wait list. Results In 1991–2001, two in three patients were at risk of late surgery when registered on wait lists for isolated coronary bypass procedures in British Columbia, Canada. Although urgent patients had never seen a wait list with clearance time exceeding one week, the odds of on-time surgery were reduced by 25%, odds ratio [OR] = 0.75 (95% confidence interval [CI] 0.65–0.87 for every additional operation performed without registration on a list. When the wait list at registration required a clearance time of over one month, semi-urgent patients had 51% lower odds of on-time surgery as compared to lists with clearance time less than one week, OR = 0.49 (95%CI 0.41–0.60, after adjustment for age, sex, comorbidity, calendar period, hospital and week on the list. In the non-urgent group, the odds were 69% lower, OR = 0.31 (95%CI 0.20–0.47. Every time an operation in the same hospital was performed without registration on a

  14. Impact of visual art on patient behavior in the emergency department waiting room.

    Science.gov (United States)

    Nanda, Upali; Chanaud, Cheryl; Nelson, Michael; Zhu, Xi; Bajema, Robyn; Jansen, Ben H

    2012-07-01

    Wait times have been reported to be one of the most important concerns for people visiting emergency departments (EDs). Affective states significantly impact perception of wait time. There is substantial evidence that art depicting nature reduces stress levels and anxiety, thus potentially impacting the waiting experience. To analyze the effect of visual art depicting nature (still and video) on patients' and visitors' behavior in the ED. A pre-post research design was implemented using systematic behavioral observation of patients and visitors in the ED waiting rooms of two hospitals over a period of 4 months. Thirty hours of data were collected before and after new still and video art was installed at each site. Significant reduction in restlessness, noise level, and people staring at other people in the room was found at both sites. A significant decrease in the number of queries made at the front desk and a significant increase in social interaction were found at one of the sites. Visual art has positive effects on the ED waiting experience. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. The 2012 SAGE wait times program: Survey of Access to GastroEnterology in Canada

    Science.gov (United States)

    Leddin, Desmond; Armstrong, David; Borgaonkar, Mark; Bridges, Ronald J; Fallone, Carlo A; Telford, Jennifer J; Chen, Ying; Colacino, Palma; Sinclair, Paul

    2013-01-01

    BACKGROUND: Periodically surveying wait times for specialist health services in Canada captures current data and enables comparisons with previous surveys to identify changes over time. METHODS: During one week in April 2012, Canadian gastroenterologists were asked to complete a questionnaire (online or by fax) recording demographics, reason for referral, and dates of referral and specialist visits for at least 10 consecutive new patients (five consultations and five procedures) who had not been seen previously for the same indication. Wait times were determined for 18 indications and compared with those from similar surveys conducted in 2008 and 2005. RESULTS: Data regarding adult patients were provided by 173 gastroenterologists for 1374 consultations, 540 procedures and 293 same-day consultations and procedures. Nationally, the median wait times were 92 days (95% CI 85 days to 100 days) from referral to consultation, 55 days (95% CI 50 days to 61 days) from consultation to procedure and 155 days (95% CI 142 days to 175 days) (total) from referral to procedure. Overall, wait times were longer in 2012 than in 2005 (Pgastroenterology services continue to exceed recommended targets, remain unchanged since 2008 and exceed wait times reported in 2005. PMID:23472243

  16. Determinants of variability in waiting times for radiotherapy in the treatment of breast cancer

    International Nuclear Information System (INIS)

    Bouche, Gauthier; Ingrand, Isabelle; Mathoulin-Pelissier, Simone; Ingrand, Pierre; Breton-Callu, Christel; Migeot, Virginie

    2010-01-01

    Purpose: To examine psycho-social and geographic determinants of delay in starting radiotherapy in early invasive breast cancer patients. Material and methods: Waiting time was defined as the time elapsed until the beginning of radiotherapy, starting from the date of surgery (in absence of chemotherapy) or from the end of chemotherapy. Results: Eight hundred and ninety six women aged 24-89 took part in the study. Mean waiting times were 52 days (sd = 19) between surgery and radiotherapy and 31 days (sd = 14) between chemotherapy and radiotherapy. Differences between radiotherapy centres (p < 0.0001) accounted for 30% and 12%, respectively, of total variance in waiting times. Using a multivariate mixed analysis that took into account intra-centre correlation, the time between surgery and radiotherapy was shorter for young patients (p = 0.020), those who had sought information about their illness (p = 0.024) and those who had undergone surgery and radiotherapy in the same centre (p = 0.021). On the other hand, no patient characteristic was associated with the time between chemotherapy and radiotherapy. Conclusion: Centre is the major factor that explained longer waiting times in radiotherapy, emphasising the structural hypothesis. It is important to pursue initiatives to improve the organization within radiotherapy centres and then to verify that these initiatives have succeeded in shortening waiting times.

  17. A state of limbo: the politics of waiting in neo-liberal Latvia.

    Science.gov (United States)

    Ozoliņa-Fitzgerald, Liene

    2016-09-01

    This article presents an ethnographic study of politics of waiting in a post-Soviet context. While activation has been explored in sociological and anthropological literature as a neo-liberal governmental technology and its application in post-socialist context has also been compellingly documented, waiting as a political artefact has only recently been receiving increased scholarly attention. Drawing on ethnographic fieldwork at a state-run unemployment office in Riga, this article shows how, alongside activation, state welfare policies also produce passivity and waiting. Engaging with the small but developing field of sociological literature on the politics of waiting, I argue that, rather than interpreting it as a clash between 'neo-liberal' and 'Soviet' regimes, we should understand the double-move of activation and imposition of waiting as a key mechanism of neo-liberal biopolitics. This article thus extends the existing theorizations of the temporal politics of neo-liberalism. © London School of Economics and Political Science 2016.

  18. Waiting for Shadows from the Distant Solar System

    Science.gov (United States)

    Kohler, Susanna

    2016-03-01

    How can we hope to measure the hundreds of thousands of objects in our distant solar system? A team of astronomers is harnessing citizen science to begin to tackle this problem!A light curve from an occultation collected by a RECON site in Quincy, California. As the objects shadow passes, the background stars light dims. [RECON/Charley Arrowsmith (Feather River College)]Occultation InformationEstimates currently place the number of Kuiper belt objects larger than 100 km across at over 100,000. Knowing the sizes and characteristics of these objects is important for understanding the composition of the outer solar system and constraining models of the solar systems formation and evolution.Unfortunately, measuring small, dim bodies at large distances is incredibly difficult! One of the best ways to obtain the sizes of these objects is to watch as they occult a distant star. Timing the object as it passes across the face of the star can give us a good measure of its size and shape, when observed from multiple stations in the path of the shadow.An Extended NetworkOccultations by nearby objects (like main-belt asteroids) can be predicted fairly accurately, but those by trans-Neptunian objects are much more poorly constrained. Only ~900 trans-Neptunian objects have approximately known paths, and occultation-shadow predictions for these objects are often only accurate to ~1000km on the Earths surface. So how can we ensure that theres a telescope in the right location, ready to observe when an occultation occurs?Map of the 56 RECON sites distributed over 2000 km in the western United States. [Buie et al. 2016]The simplest answer is to set up a huge network of observing stations, and wait for the shadows to come to the network. With this approach, even if the predicted path isnt precisely known, some of the stations will still observe the occultation.Due to the number of stations needed, this project lends itself perfectly to citizen science. In a recently published paper by

  19. Prospective evaluation through questionnaires of the emotional status of cancer patients in the waiting rooms of a department of oncology

    OpenAIRE

    Roberta Resega; Sheila Piva; Annalisa Bramati; Christian Lurati; Nicla La Verde; Marco Riva; Marina Chiara Garassino; Anna Moretti; Claudio Mencacci; Valter Torri; Gabriella Farina; Maria Chiara Dazzani

    2016-01-01

    Objective: The aim of this study is to better identify the prevailing emotions and feelings of cancer patients during their stay in waiting rooms in a department of oncology. Methods: In July 2014, patients in the waiting rooms of our Department of Oncology were asked to fill out dedicated questionnaires. Patients had to choose sentences that best described their feelings, thoughts and experiences; this part was differentiated according to the waiting rooms (Consultation Rooms versus Day H...

  20. Posted wait times an added advantage to multi-facility systems?

    Science.gov (United States)

    2011-04-01

    Methodist Le Bonheur Healthcare in Memphis, TN, is investigating whether posting ED wait times via the internet can positively impact patient flow in the six EDs the health system operates in the Memphis region. The health system began posting wait times in August 2010, resulting in increases in ED volume ranging from 6% to 10%. The health system is monitoring ED arrivals by zip code to assess any impact on load balancing between its busy EDs. One marketing challenge is that a competitor is posting ED wait times as well, but it is posting the time it takes for a patient to be placed in a bed as opposed to the door-to-provider time that Methodist Le Bonheur is posting. The approach has the most impact on lower-acuity patients, but experts worry that in the future, payers may not be reimbursed for ED care for these patients.

  1. Change in hearing during 'wait and scan' management of patients with vestibular schwannoma

    DEFF Research Database (Denmark)

    Stangerup, Sven-Eric; Caye-Thomasen, P.; Tos, M.

    2008-01-01

    : At the time of diagnosis, 334 patients (53 per cent) had good hearing and speech discrimination of better than 70 per cent; at the end of the 10-year observation period, this latter percentage was 31 per cent. In 17 per cent of the patients, speech discrimination at diagnosis was 100 per cent; of these, 88......Aim: To evaluate hearing changes during 'wait and scan' management of patients with vestibular schwannoma. Subjects: Over a 10-year period, 636 patients have prospectively been allocated to 'wait and scan' management, with annual magnetic resonance scanning and audiological examination. Results...... surgery and of radiation therapy with those of 'wait and scan' management, it appears that, in vestibular schwannoma patients with a small tumour and normal speech discrimination, the main indication for active treatment should be established tumour growth Udgivelsesdato: 2008/7...

  2. Estimating the waiting time of multi-priority emergency patients with downstream blocking.

    Science.gov (United States)

    Lin, Di; Patrick, Jonathan; Labeau, Fabrice

    2014-03-01

    To characterize the coupling effect between patient flow to access the emergency department (ED) and that to access the inpatient unit (IU), we develop a model with two connected queues: one upstream queue for the patient flow to access the ED and one downstream queue for the patient flow to access the IU. Building on this patient flow model, we employ queueing theory to estimate the average waiting time across patients. Using priority specific wait time targets, we further estimate the necessary number of ED and IU resources. Finally, we investigate how an alternative way of accessing ED (Fast Track) impacts the average waiting time of patients as well as the necessary number of ED/IU resources. This model as well as the analysis on patient flow can help the designer or manager of a hospital make decisions on the allocation of ED/IU resources in a hospital.

  3. Intake of wine, beer and spirits and waiting time to pregnancy

    DEFF Research Database (Denmark)

    Juhl, Mette; Olsen, Jørn; Andersen, Anne-Marie Nybo

    2003-01-01

    BACKGROUND: A high intake of alcohol may prolong waiting time to pregnancy, whereas a moderate intake may have no or perhaps even a positive effect on fecundity. In previous studies on fecundity, different types of beverages have not been taken into consideration, although moderate wine drinkers...... appear to have fewer strokes, lung and digestive tract cancers, and overall mortality than both abstainers and moderate drinkers of beer or spirits. We examined the association between different types of alcoholic beverages and waiting time to pregnancy. METHODS: Self-reported data were used for 29......,844 pregnant women, recruited to the Danish National Birth Cohort in 1997-2000. Main outcome measures were odds ratios for a prolonged waiting time to pregnancy according to consumption of wine, beer and spirits. RESULTS: All levels of wine intake compared with non-wine drinking or with consumption of beer...

  4. Processing communications events in parallel active messaging interface by awakening thread from wait state

    Science.gov (United States)

    Archer, Charles J; Blocksome, Michael A; Ratterman, Joseph D; Smith, Brian E

    2013-10-22

    Processing data communications events in a parallel active messaging interface (`PAMI`) of a parallel computer that includes compute nodes that execute a parallel application, with the PAMI including data communications endpoints, and the endpoints are coupled for data communications through the PAMI and through other data communications resources, including determining by an advance function that there are no actionable data communications events pending for its context, placing by the advance function its thread of execution into a wait state, waiting for a subsequent data communications event for the context; responsive to occurrence of a subsequent data communications event for the context, awakening by the thread from the wait state; and processing by the advance function the subsequent data communications event now pending for the context.

  5. Three-Dimensional General-Relativistic Magnetohydrodynamic Simulations of Remnant Accretion Disks from Neutron Star Mergers: Outflows and r-Process Nucleosynthesis.

    Science.gov (United States)

    Siegel, Daniel M; Metzger, Brian D

    2017-12-08

    The merger of binary neutron stars, or of a neutron star and a stellar-mass black hole, can result in the formation of a massive rotating torus around a spinning black hole. In addition to providing collimating media for γ-ray burst jets, unbound outflows from these disks are an important source of mass ejection and rapid neutron capture (r-process) nucleosynthesis. We present the first three-dimensional general-relativistic magnetohydrodynamic (GRMHD) simulations of neutrino-cooled accretion disks in neutron star mergers, including a realistic equation of state valid at low densities and temperatures, self-consistent evolution of the electron fraction, and neutrino cooling through an approximate leakage scheme. After initial magnetic field amplification by magnetic winding, we witness the vigorous onset of turbulence driven by the magnetorotational instability (MRI). The disk quickly reaches a balance between heating from MRI-driven turbulence and neutrino cooling, which regulates the midplane electron fraction to a low equilibrium value Y_{e}≈0.1. Over the 380-ms duration of the simulation, we find that a fraction ≈20% of the initial torus mass is unbound in powerful outflows with asymptotic velocities v≈0.1c and electron fractions Y_{e}≈0.1-0.25. Postprocessing the outflows through a nuclear reaction network shows the production of a robust second- and third-peak r process. Though broadly consistent with the results of previous axisymmetric hydrodynamical simulations, extrapolation of our results to late times suggests that the total ejecta mass from GRMHD disks is significantly higher. Our results provide strong evidence that postmerger disk outflows are an important site for the r process.

  6. The astrophysical r-process and its dependence on properties of nuclei far from stability: Beta strength functions and neutron capture rates

    International Nuclear Information System (INIS)

    Klapdor, H.V.; Metzinger, J.; Oda, T.; Thielemann, F.K.; Hillebrandt, W.

    1981-01-01

    The question of the astrophysical site of the rapid neutron capture (r-) process which is believed to be responsible for the production of the heavy elements in the universe has been a problem in astrophysics for more than two decades. The solution of this problem is not only dependent on the development of realistic astrophysical supernova models, i.e. correct treatment of the hydrodynamics of gravitational collapse and supernova explosion and the equation of state of hot and dense matter, but is shown in this paper to be very sensitive also to 'standard' nuclear physics properties of nuclei far from stability such as beta decay properties and neutron capture rates. For both of the latter, strongly oversimplifying assumptions, not applying the development in nuclear physics during the last decade, have been made in almost all r-process calculations performed up to now. A critical discussion of the state of the art of such calculations seems therefore to be indicated. In this paper procedures are described which allow one to obtain: 1) β-decay properties (decay rates, β-delayed neutron emissions and fission rates); 2) neutron capture rates for neutron-rich nuclei considerably improved over what has been used up to now. The beta strength functions are calculated for approx. equal to6000 nuclei between beta stability line and neutron drip line. By hydrodynamical supernova explosion calculations using realistic stellar models it is shown that as a consequence of the improved β-rates explosive He burning is a convincing alternative site to the 'classical' r-process whose existence still is questionable. The new β-rates will be important also for the investigation of further astrophysical sites producing heavy elements such as the r(n)-processes in explosive C or Ne burning. (orig.)

  7. Waiting for total knee replacement surgery: factors associated with pain, stiffness, function and quality of life

    Directory of Open Access Journals (Sweden)

    Dionne Clermont E

    2009-05-01

    Full Text Available Abstract Background Recent evidences show that education and rehabilitation while waiting for knee replacement have positive effects on the patients' health status. Identification of factors associated with worse pain, function and health-related quality of life (HRQoL while waiting for surgery could help develop pre-surgery rehabilitation interventions that target specifically these factors and prioritize patients that may benefit the most from them. The objectives of this study were to measure pain, stiffness, function and HRQoL in patients at enrolment on waiting lists for knee replacement and to identify demographic, clinical, socioeconomic and psychosocial characteristics associated with these outcomes. Methods This study is part of a broader study measuring the effects of pre-surgery wait in patients scheduled for knee replacement. From 02/2006 to 09/2007, 197 patients newly scheduled for total knee replacement were recruited from the waiting lists of three university hospitals in Quebec City, Canada. Pain, stiffness and function were measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC and HRQoL was measured with the SF-36 Health Survey. Stepwise multiple regression analysis was used to assess the strength of the associations between the independent variables and the WOMAC and SF-36 scores. Results The scores of all eight HRQoL physical and mental domains of the SF-36 were significantly lower than aged matched Canadian normative data (p Conclusion Patients waiting for knee replacement have poor function and HRQoL. Characteristics that were found to be associated with these outcomes could help develop pre-surgery rehabilitation program and prioritize patients that may benefit the most from them. Such programs could include interventions to reduce psychological distress, therapeutic exercises targeting both knees and weight loss management.

  8. Wait times in the emergency department for patients with mental illness

    Science.gov (United States)

    Atzema, Clare L.; Schull, Michael J.; Kurdyak, Paul; Menezes, Natasja M.; Wilton, Andrew S.; Vermuelen, Marian J.; Austin, Peter C.

    2012-01-01

    Background: It has been suggested that patients with mental illness wait longer for care than other patients in the emergency department. We determined wait times for patients with and without mental health diagnoses during crowded and noncrowded periods in the emergency department. Methods: We conducted a population-based retrospective cohort analysis of adults seen in 155 emergency departments in Ontario between April 2007 and March 2009. We compared wait times and triage scores for patients with mental illness to those for all other patients who presented to the emergency department during the study period. Results: The patients with mental illness (n = 51 381) received higher priority triage scores than other patients, regardless of crowding. The time to assessment by a physician was longer overall for patients with mental illness than for other patients (median 82, interquartile range [IQR] 41–147 min v. median 75 [IQR 36–140] min; p < 0.001). The median time from the decision to admit the patient to hospital to ward transfer was markedly shorter for patients with mental illness than for other patients (median 74 [IQR 15–215] min v. median 152 [IQR 45–605] min; p < 0.001). After adjustment for other variables, patients with mental illness waited 10 minutes longer to see a physician compared with other patients during noncrowded periods (95% confidence interval [CI] 8 to 11), but they waited significantly less time than other patients as crowding increased (mild crowding: −14 [95% CI −12 to −15] min; moderate crowding: −38 [95% CI −35 to −42] min; severe crowding: −48 [95% CI −39 to −56] min; p < 0.001). Interpretation: Patients with mental illness were triaged appropriately in Ontario’s emergency departments. These patients waited less time than other patients to see a physician under crowded conditions and only slightly longer under noncrowded conditions. PMID:23148052

  9. The control of deliberate waiting strategies in a stop-signal task

    Directory of Open Access Journals (Sweden)

    R.P. Sylwan

    2004-06-01

    Full Text Available To inhibit an ongoing flow of thoughts or actions has been largely considered to be a crucial executive function, and the stop-signal paradigm makes inhibitory control measurable. Stop-signal tasks usually combine two concurrent tasks, i.e., manual responses to a primary task (go-task are occasionally countermanded by a stimulus which signals participants to inhibit their response in that trial (stop-task. Participants are always instructed not to wait for the stop-signal, since waiting strategies cause the response times to be unstable, invalidating the data. The aim of the present study was to experimentally control the strategies of waiting deliberately for the stop-signal in a stop-task by means of an algorithm that measured the variation in the reaction times to go-stimuli on-line, and displayed a warning legend urging participants to be faster when their reaction times were more than two standard deviations of the mean. Thirty-four university students performed a stop-task with go- and stop-stimuli, both of which were delivered in the visual modality and were lateralized within the visual field. The participants were divided into two groups (group A, without the algorithm, vs group B, with the algorithm. Group B exhibited lower variability of reaction times to go-stimuli, whereas no significant between-group differences were found in any of the measures of inhibitory control, showing that the algorithm succeeded in controlling the deliberate waiting strategies. Differences between deliberate and unintentional waiting strategies, and anxiety as a probable factor responsible for individual differences in deliberate waiting behavior, are discussed.

  10. Transformation of a Pediatric Primary Care Waiting Room: Creating a Bridge to Community Resources.

    Science.gov (United States)

    Henize, Adrienne W; Beck, Andrew F; Klein, Melissa D; Morehous, John; Kahn, Robert S

    2018-06-01

    Introduction Children and families living in poverty frequently encounter social risks that significantly affect their health and well-being. Physicians' near universal access to at-risk children and their parents presents opportunities to address social risks, but time constraints frequently interfere. We sought to redesign our waiting room to create a clinic-to-community bridge and evaluate the impact of that redesign on family-centered outcomes. Methods We conducted a pre-post study of a waiting room redesign at a large, academic pediatric primary care center. Design experts sought input about an optimal waiting room from families, community partners and medical providers. Family caregivers were surveyed before and after redesign regarding perceived availability of help with social needs and access to community resources, and hospitality and feelings of stress. Pre-post differences were assessed using the Chi square or Wilcoxon rank sum test. Results The key redesign concepts that emerged included linkages to community organizations, a welcoming environment, and positive distractions for children. A total of 313 caregiver surveys were completed (pre-160; post-153). Compared to pre-redesign, caregivers surveyed post-redesign were significantly more likely to perceive the waiting room as a place to obtain help connecting to community resources and find information about clinical and educational resources (both p < 0.05). Families were also significantly more likely to report the waiting room as more welcoming and relaxing, with sufficient privacy and space (all p < 0.05). Discussion Waiting rooms, typically a place of wasted time and space, can be redesigned to enhance families' engagement and connection to community resources.

  11. Patient satisfaction with wait times at an emergency ophthalmology on-call service.

    Science.gov (United States)

    Chan, Brian J; Barbosa, Joshua; Moinul, Prima; Sivachandran, Nirojini; Donaldson, Laura; Zhao, Lily; Mullen, Sarah J; McLaughlin, Christopher R; Chaudhary, Varun

    2018-04-01

    To assess patient satisfaction with emergency ophthalmology care and determine the effect provision of anticipated appointment wait time has on scores. Single-centre, randomized control trial. Fifty patients triaged at the Hamilton Regional Eye Institute (HREI) from November 2015 to July 2016. Fifty patients triaged for next-day appointments at the HREI were randomly assigned to receive standard-of-care preappointment information or standard-of-care information in addition to an estimated appointment wait time. Patient satisfaction with care was assessed postvisit using the modified Judgements of Hospital Quality Questionnaire (JHQQ). In determining how informing patients of typical wait times influenced satisfaction, the Mann-Whitney U test was performed. As secondary study outcomes, we sought to determine patient satisfaction with the intervention material using the Fisher exact test and the effect that wait time, age, sex, education, mobility, and number of health care providers seen had on satisfaction scores using logistic regression analysis. The median JHQQ response was "very good" (4/5) and between "very good" and "excellent" (4.5/5) in the intervention and control arms, respectively. There was no difference in patient satisfaction between the cohorts (Mann-Whitney U = 297.00, p = 0.964). Logistic regression analysis demonstrated that wait times influenced patient satisfaction (OR = 0.919, 95% CI 0.864-0.978, p = 0.008). Of the intervention arm patients, 92.0% (N = 23) found the preappointment information useful, whereas only 12.5% (N = 3) of the control cohort patients noted the same (p < 0.001). Provision of anticipated wait time information to patients in an emergency on-call ophthalmology clinic did not influence satisfaction with care as captured by the JHQQ. Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  12. No-waiting dentine self-etch concept-Merit or hype.

    Science.gov (United States)

    Huang, Xue-Qing; Pucci, César R; Luo, Tao; Breschi, Lorenzo; Pashley, David H; Niu, Li-Na; Tay, Franklin R

    2017-07-01

    A recently-launched universal adhesive, G-Premio Bond, provides clinicians with the alternative to use the self-etch technique for bonding to dentine without waiting for the adhesive to interact with the bonding substrate (no-waiting self-etch; Japanese brochure), or after leaving the adhesive undisturbed for 10s (10-s self-etch; international brochure). The present study was performed to examine in vitro performance of this new universal adhesive bonded to human coronal dentine using the two alternative self-etch modes. One hundred and ten specimens were bonded using two self-etch application modes and examined with or without thermomechanical cycling (10,000 thermal cycles and 240,000 mechanical cycles) to simulate one year of intraoral functioning. The bonded specimens were sectioned for microtensile bond testing, ultrastructural and nanoleakage examination using transmission electron microscopy. Changes in the composition of mineralised dentine after adhesive application were examined using Fourier transform infrared spectroscopy. Both reduced application time and thermomechanical cycling resulted in significantly lower bond strengths, thinner hybrid layers, and significantly more extensive nanoleakage after thermomechanical cycling. Using the conventional 10-s application time improved bonding performance when compared with the no-waiting self-etch technique. Nevertheless, nanoleakage was generally extensive under all testing parameters employed for examining the adhesive. Although sufficient bond strength to dentine may be achieved using the present universal adhesive in the no-waiting self-etch mode that does not require clinicians to wait prior to polymerisation of the adhesive, this self-etch concept requires further technological refinement before it can be recommended as a clinical technique. Although the surge for cutting application time to increase user friendliness remains the most frequently sought conduit for advancement of dentine bonding

  13. Waiting for the right time: how and why young Thai women manage to avoid heterosexual intercourse.

    Science.gov (United States)

    Supametaporn, Pinhatai; Stern, Phyllis Noerager; Rodcumdee, Branom; Chaiyawat, Waraporn

    2010-08-01

    Nineteen young Thai women were purposively selected from networks of nongovernmental organizations involving children and youths in Bangkok. Our grounded theory findings indicated that these young women used the basic social process they called "waiting for the right time" in order to maintain heterosexual abstinence. Waiting for the right time involved one overarching condition, honoring parental love, and included three overlapping properties: learning rules, planning life path, and ways of preserving virginity. The findings provide information that may lead to the development of culturally competent interventions for middle-class Thai youths to remain healthy and avoid pregnancy.

  14. Study on the interaction between the food and beverage servicescape and customer waiting experience

    Directory of Open Access Journals (Sweden)

    Yang, Chih-Yun

    2014-11-01

    Full Text Available Past research on the customer waiting experience tended to focus on two primary areas, namely managing the wait and managing the perception of the wait. Very few studies conducted in-depth analysis and discus¬sion of how external environmental factors affect the experience of customer waiting, which it was also viewed as a negative factor that decreases customer satisfaction toward service. However, in reality, the waiting experience can be positive as a result of certain environmental factors, and subsequently increases customer satisfaction toward the service. This study aimed to further examine the potential influencing factors arising from the servicescape during the customer waiting process, and the interaction between the servicescape and customers during their wait time. This paper is based on the causal feedback loop. A system dynamics perspective was applied to construct a conceptual systems model showing the interaction between the servi¬cescape and the customer waiting experience.Estudios previos sobre la experiencia de espera de los clients suelen centrarse sobre todo en dos áreas: la gestión de la espera y la gestión de la experiencia de espera. Existen muy pocos estudios que hayan realizado análisis y discusiones en profundidad sobre cómo los factores ambientales externos afectan a la experiencia de espera de los clientes, que se ha considerado siempre como un factor negativo que reduce la satisfacción del cliente hacia el servicio. Sin embargo, la experiencia de espera puede incrementar en reali¬dad la satisfacción del cliente hacia el servicio. Este estudio pretende profundizar en la influencia potencial de los factores que surgen del “servicescape” durante el proceso de espera del cliente, así como la interacción entre el “servicescape” y los clientes durante el tiempo de espera. Ese artículo se basa en el bucle de retroa¬limentación causal. Desde la perspectiva de la dinámica de sistemas se construye un

  15. Evaluation of wet-cupping therapy for persistent non-specific low back pain: a randomised, waiting-list controlled, open-label, parallel-group pilot trial.

    Science.gov (United States)

    Kim, Jong-In; Kim, Tae-Hun; Lee, Myeong Soo; Kang, Jung Won; Kim, Kun Hyung; Choi, Jun-Yong; Kang, Kyung-Won; Kim, Ae-Ran; Shin, Mi-Suk; Jung, So-Young; Choi, Sun-mi

    2011-06-10

    Persistent non-specific low back pain (PNSLBP) is one of the most frequently experienced types of back pain around the world. Wet-cupping is a common intervention for various pain conditions, especially in Korea. In this context, we conducted a pilot study to determine the effectiveness and safety of wet-cupping treatment for PNSLBP. We recruited 32 participants (21 in the wet-cupping group and 11 in the waiting-list group) who had been having PNSLBP for at least 3 months. The participants were recruited at the clinical research centre of the Korea Institute of Oriental Medicine, Korea. Eligible participants were randomly allocated to wet-cupping and waiting-list groups. Following the practice of traditional Korean medicine, the treatment group was provided with wet-cupping treatment at two acupuncture points among the BL23, BL24 and BL25 6 times within 2 weeks. Usual care, including providing brochures for exercise, general advice for PNSLBP and acetaminophen, was allowed in both groups. Separate assessors participated in the outcome assessment. We used the 0 to 100 numerical rating scale (NRS) for pain, the McGill Pain Questionnaire for pain intensity (PPI) and the Oswestry Disability Questionnaire (ODQ), and we assessed acetaminophen use and safety issues. The results showed that the NRS score for pain decreased (-16.0 [95% CI: -24.4 to -7.7] in the wet-cupping group and -9.1 [-18.1 to -0.1] in the waiting-list group), but there was no statistical difference between the groups (p = 0.52). However, the PPI scores showed significant differences between the two groups (-1.2 [-1.6 to -0.8] for the wet-cupping group and -0.2 [-0.8 to 0.4] for the waiting-list group, p cupping group during 4 weeks (p = 0.09). The ODQ score did not show significant differences between the two groups (-5.60 [-8.90 to -2.30] in the wet-cupping group and -1.8 [-5.8 to 2.2] in the waiting-list group, p = 0.14). There was no report of adverse events due to wet-cupping. This pilot study may

  16. The astrophysical r-process and its dependence on properties of nuclei far from stability beta strength functions and neutron capture rates

    CERN Document Server

    Klapdor-Kleingrothaus, H V; Metzinger, J; Oda, T; Thielemann, F K

    1981-01-01

    It is shown that the astrophysical r-process and the question of its site are very sensitive to 'standard' nuclear physics parameters like the beta decay properties and neutron capture rates. Since for these quantities in almost all r-process calculations up to now, and also in all estimates of the production rates of chronometric pairs, only very rough assumptions have been made, it is attempted to present procedures which put the calculation of these quantities for nuclei far from stability on a reliable physical basis. This is done by a microscopic description of the beta strength function and by using a statistical model based on a 'next to first principles' optical potential including effects of deformation for the neutron capture rates. The beta -decay rates for approximately 6000 nuclei between the beta -stability line and the neutron drip line are calculated. The heavy element synthesis by explosive He burning then is calculated using these beta -rates and using realistic star models treating the supe...

  17. Public involvement in the priority setting activities of a wait time management initiative: a qualitative case study.

    Science.gov (United States)

    Bruni, Rebecca A; Laupacis, Andreas; Levinson, Wendy; Martin, Douglas K

    2007-11-16

    As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement. This study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1) over 25 documents (e.g. strategic planning reports, public updates), and (2) 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates). Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. The Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system) and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality) for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system) resulting from the Ontario Wait Times Strategy. We described and evaluated a wait time management initiative (the Ontario Wait Time Strategy) with special attention to public

  18. Public involvement in the priority setting activities of a wait time management initiative: a qualitative case study

    Directory of Open Access Journals (Sweden)

    Laupacis Andreas

    2007-11-01

    Full Text Available Abstract Background As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement. Methods This study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1 over 25 documents (e.g. strategic planning reports, public updates, and (2 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates. Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. Results The Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system resulting from the Ontario Wait Times Strategy. Conclusion We described and evaluated a wait time management initiative (the Ontario

  19. China: the long wait. [Developments in the nuclear power programme

    Energy Technology Data Exchange (ETDEWEB)

    1990-03-01

    The repercussions of Tiananmen Square coupled with worse than expected balance of payments problems have been made it even more difficult than usual to discern the likely future direction of China's nuclear power programme. Currently there are three power reactors under construction, an indigenously designed 300MWe PWR at Qinsham and the two 900MWe Framatome units at Daya Bay, Guang-dong. Prior to the events of June the most likely way forward, beyond these units under construction, appeared to be development of 600MWe units for Chinese conditions in a joint venture with Western companies. There are strong pressures to ''go indigenous'', and attempt to develop a home grown 600MWe design or, perhaps more likely, go for repeats of the 300 MWe plant - assuming it can be operated successfully, a point on which some factions of the Chinese nuclear industry have their doubts. Nuclear district heating still has strong advocates, as an environmentally sound way of meeting the country's huge projected increases in primary energy consumption over the coming years. Construction of a 5MWt district heating reactor at Tsinghua University, Beijing, started in 1986, entered operation at the end of 1989 following a test phase and is now supplying 3MWt to heating of university buildings. (author).

  20. Epigenetics and obesity: a relationship waiting to be explained.

    Science.gov (United States)

    Symonds, Michael E; Budge, Helen; Frazier-Wood, Alexis C

    2013-01-01

    Obesity can have multifactorial causes that may change with development and are not simply attributable to one's genetic constitution. To date, expensive and laborious genome-wide association studies have only ascribed a small contribution of genetic variants to obesity. The emergence of the field of epigenetics now offers a new paradigm with which to study excess fat mass. Currently, however, there are no compelling epigenetic studies to explain the role of epigenetics in obesity, especially from a developmental perspective. It is clear that until there are advances in the understanding of the main mechanisms by which different fat types, i.e. brown, beige, and white, are established and how these differ between depots and species, population-based studies designed to determine specific aspects of epigenetics will be potentially limited. Obesity is a slowly evolving condition that is not simply explained by changes in the intake of one macronutrient. The latest advances in epigenetics, coupled with the establishment of relevant longitudinal models of obesity, which incorporate functionally relevant end points, may now permit the precise contribution of epigenetic modifications to excess fat mass to be effectively studied. © 2013 S. Karger AG, Basel.

  1. Trading with the waiting-list: the justice of Living Donor List Exchange

    NARCIS (Netherlands)

    den Hartogh, G.

    2010-01-01

    In a Living Donor List Exchange program, the donor makes his kidney available for allocation to patients on the postmortal waiting-list and receives in exchange a postmortal kidney, usually an O-kidney, to be given to the recipient he favours. The program can be a solution for a candidate donor who

  2. Decreasing Psychiatric Admission Wait Time in the Emergency Department by Facilitating Psychiatric Discharges.

    Science.gov (United States)

    Stover, Pamela R; Harpin, Scott

    2015-12-01

    Limited capacity in a psychiatric unit contributes to long emergency department (ED) admission wait times. Regulatory and accrediting agencies urge hospitals nationally to improve patient flow for better access to care for all types of patients. The purpose of the current study was to decrease psychiatric admission wait time from 10.5 to 8 hours and increase the proportion of patients discharged by 11 a.m. from 20% to 50%. The current study compared pre- and post-intervention data. Plan-Do-Study-Act cycles aimed to improve discharge processes and timeliness through initiation of new practices. Admission wait time improved to an average of 5.1 hours (t = 3.87, p = 0.006). The proportion of discharges occurring by 11 a.m. increased to 46% (odds ratio = 3.42, p planning processes and timeliness in a psychiatric unit significantly decreased admission wait time from the ED, improving access to psychiatric care. Copyright 2015, SLACK Incorporated.

  3. A study on the impact of prioritising emergency department arrivals on the patient waiting time.

    Science.gov (United States)

    Van Bockstal, Ellen; Maenhout, Broos

    2018-05-03

    In the past decade, the crowding of the emergency department has gained considerable attention of researchers as the number of medical service providers is typically insufficient to fulfil the demand for emergency care. In this paper, we solve the stochastic emergency department workforce planning problem and consider the planning of nurses and physicians simultaneously for a real-life case study in Belgium. We study the patient arrival pattern of the emergency department in depth and consider different patient acuity classes by disaggregating the arrival pattern. We determine the personnel staffing requirements and the design of the shifts based on the patient arrival rates per acuity class such that the resource staffing cost and the weighted patient waiting time are minimised. In order to solve this multi-objective optimisation problem, we construct a Pareto set of optimal solutions via the -constraints method. For a particular staffing composition, the proposed model minimises the patient waiting time subject to upper bounds on the staffing size using the Sample Average Approximation Method. In our computational experiments, we discern the impact of prioritising the emergency department arrivals. Triaging results in lower patient waiting times for higher priority acuity classes and to a higher waiting time for the lowest priority class, which does not require immediate care. Moreover, we perform a sensitivity analysis to verify the impact of the arrival and service pattern characteristics, the prioritisation weights between different acuity classes and the incorporated shift flexibility in the model.

  4. Pregnancy chances on an IVF/ICSI waiting list: a national prospective cohort study.

    NARCIS (Netherlands)

    Eijkemans, M.J.; Lintsen, A.M.E.; Hunault, C.C.; Bouwmans, C.A.; Hakkaart, L.; Braat, D.D.M.; Habbema, J.D.F.

    2008-01-01

    BACKGROUND: The effectiveness of IVF over expectant management has been proven only for bilateral tubal occlusion. We aimed to estimate the chance of pregnancy without treatment for IVF patients, using data on the waiting period before the start of IVF. METHODS: A prospective cohort study included

  5. Minimizing patient waiting time in emergency department of public hospital using simulation optimization approach

    Science.gov (United States)

    Ibrahim, Ireen Munira; Liong, Choong-Yeun; Bakar, Sakhinah Abu; Ahmad, Norazura; Najmuddin, Ahmad Farid

    2017-04-01

    Emergency department (ED) is the main unit of a hospital that provides emergency treatment. Operating 24 hours a day with limited number of resources invites more problems to the current chaotic situation in some hospitals in Malaysia. Delays in getting treatments that caused patients to wait for a long period of time are among the frequent complaints against government hospitals. Therefore, the ED management needs a model that can be used to examine and understand resource capacity which can assist the hospital managers to reduce patients waiting time. Simulation model was developed based on 24 hours data collection. The model developed using Arena simulation replicates the actual ED's operations of a public hospital in Selangor, Malaysia. The OptQuest optimization in Arena is used to find the possible combinations of a number of resources that can minimize patients waiting time while increasing the number of patients served. The simulation model was modified for improvement based on results from OptQuest. The improvement model significantly improves ED's efficiency with an average of 32% reduction in average patients waiting times and 25% increase in the total number of patients served.

  6. Dynamic call center routing policies using call waiting and agent idle times

    NARCIS (Netherlands)

    Chan, W.; Koole, G.M.; L'Ecuyer, P.

    2014-01-01

    We study call routing policies for call centers with multiple call types and multiple agent groups. We introduce new weight-based routing policies where each pair (call type, agent group) is given a matching priority defined as an affine combination of the longest waiting time for that call type and

  7. To Construction and Standardization of the Waiting Anxiety Questionnaire (WAQ in Iran.

    Directory of Open Access Journals (Sweden)

    Sodeh Tavakkoli

    2014-09-01

    Full Text Available This study aimed to develop and validate a questionnaire to measure waiting anxiety.This was a cross-sectional study. Extensive review of literature and expert opinions were used to develop and validate the waiting anxiety questionnaire. A sample of 321 participants was recruited through random cluster sampling (n= 190 Iranian men and n= 131 women. The participants filled out WAQ, the Speilberger's State-Trait Anxiety Inventory (STAI, Burtner Rating scale (BRS and Eysenk Personality questionnaire (EPQ for adults.Internal consistency of WAQ was revealed, meaning that all the 20 items were highly correlated with the total score. The Cronbach alpha equaled 0.83 for the Waiting Anxiety Questionnaire. The Pearson correlation coefficient of the questionnaire with the STAI, BRS and extraversion and neuroticism subscales of EPQ was 0.65, 0.78, - 0.47 and 0.43, respectively, which confirmed its convergent and divergent validity. Factors analysis extracting four cognitive, behavioral, sentimental and physiological factors could explain 67% of the total variance with an Eigen value of greater than 1.Our findings suggest that WAQ possesses appropriate validity and reliability to measure the individuals' anxiety during the waiting time.

  8. Relative entropy and waiting time for continuous-time Markov processes

    NARCIS (Netherlands)

    Chazottes, J.R.; Giardinà, C.; Redig, F.H.J.

    2006-01-01

    For discrete-time stochastic processes, there is a close connection between return (resp. waiting) times and entropy (resp. relative entropy). Such a connection cannot be straightforwardly extended to the continuous-time setting. Contrarily to the discrete-time case one needs a reference measure on

  9. Factors Associated with Waiting Time for Breast Cancer Treatment in a Teaching Hospital in Ghana

    Science.gov (United States)

    Dedey, Florence; Wu, Lily; Ayettey, Hannah; Sanuade, Olutobi A.; Akingbola, Titilola S.; Hewlett, Sandra A.; Tayo, Bamidele O.; Cole, Helen V.; de-Graft Aikins, Ama; Ogedegbe, Gbenga; Adanu, Richard

    2016-01-01

    Background: Breast cancer is the leading cause of cancer-related mortality among women in Ghana. Data are limited on the predictors of poor outcomes in breast cancer patients in low-income countries; however, prolonged waiting time has been implicated. Among breast cancer patients who received treatment at Korle Bu Teaching Hospital, this study…

  10. The unethical focus on access: a study of medical ethics and the waiting-time guarantee.

    Science.gov (United States)

    Karlberg, H I; Brinkmo, B-M

    2009-03-01

    All civilized societies favour ethical principles of equity. In healthcare, these principles generally focus on needs for medical care. Methods for establishing priorities among such needs are instrumental in this process. In this study, we analysed whether rules on access to healthcare, waiting-time guarantees, conflict with ethical principles of distributive justice. We interviewed directors, managers and other decision-makers of various healthcare providers of hospitals, primary care organizations and purchasing offices. We also conducted focus group interviews with professionals from a number of distinct medical areas. Our informants and their co-workers were reasonably familiar with the ethical platforms for priority-setting established by the Swedish parliament, giving the sickest patients complete priority. However, to satisfy the waiting-time guarantees, the informants often had to make priority decisions contrary to the ethical principles by favouring access before needs to keep waiting times within certain limits. The common opinion was that the waiting-time guarantee leads to crowding-out effects, overruling the ethical principles based on needs. For more than a decade, the interpretation in Sweden of the equitable principle based on medical needs has been distorted through political decisions, leading to healthcare providers giving priority to access rather than needs for care.

  11. Reviewing Policy: Starting the Wrong Conversations--The Public School Crisis and "Waiting for Superman"

    Science.gov (United States)

    Swalwell, Katy; Apple, Michael W.

    2011-01-01

    The documentary "Waiting for Superman" has become one of those rare things, a (supposed) documentary that generates a wider audience. It also is one of the more recent embodiments of what Nancy Fraser (1989) labels as the "politics of needs and needs discourses." Dominant groups listen carefully to the language and issues that…

  12. Intake of wine, beer and spirits and waiting time to pregnancy.

    Science.gov (United States)

    Juhl, Mette; Olsen, Jørn; Andersen, Anne-Marie Nybo; Grønbaek, Morten

    2003-09-01

    A high intake of alcohol may prolong waiting time to pregnancy, whereas a moderate intake may have no or perhaps even a positive effect on fecundity. In previous studies on fecundity, different types of beverages have not been taken into consideration, although moderate wine drinkers appear to have fewer strokes, lung and digestive tract cancers, and overall mortality than both abstainers and moderate drinkers of beer or spirits. We examined the association between different types of alcoholic beverages and waiting time to pregnancy. Self-reported data were used for 29,844 pregnant women, recruited to the Danish National Birth Cohort in 1997-2000. Main outcome measures were odds ratios for a prolonged waiting time to pregnancy according to consumption of wine, beer and spirits. All levels of wine intake compared with non-wine drinking or with consumption of beer or spirits had subfecundity odds ratios between 0.7 and 0.9. No association was seen regarding beer drinking, while the association with spirits was J-shaped. Our findings suggest that wine drinkers have slightly shorter waiting times to pregnancy than both non-wine drinkers and consumers of other alcoholic beverages. Whether this is an effect of wine itself or the characteristics of the wine drinker is not known.

  13. WAITING TIME DISTRIBUTION OF SOLAR ENERGETIC PARTICLE EVENTS MODELED WITH A NON-STATIONARY POISSON PROCESS

    International Nuclear Information System (INIS)

    Li, C.; Su, W.; Fang, C.; Zhong, S. J.; Wang, L.

    2014-01-01

    We present a study of the waiting time distributions (WTDs) of solar energetic particle (SEP) events observed with the spacecraft WIND and GOES. The WTDs of both solar electron events (SEEs) and solar proton events (SPEs) display a power-law tail of ∼Δt –γ . The SEEs display a broken power-law WTD. The power-law index is γ 1 = 0.99 for the short waiting times (<70 hr) and γ 2 = 1.92 for large waiting times (>100 hr). The break of the WTD of SEEs is probably due to the modulation of the corotating interaction regions. The power-law index, γ ∼ 1.82, is derived for the WTD of the SPEs which is consistent with the WTD of type II radio bursts, indicating a close relationship between the shock wave and the production of energetic protons. The WTDs of SEP events can be modeled with a non-stationary Poisson process, which was proposed to understand the waiting time statistics of solar flares. We generalize the method and find that, if the SEP event rate λ = 1/Δt varies as the time distribution of event rate f(λ) = Aλ –α exp (– βλ), the time-dependent Poisson distribution can produce a power-law tail WTD of ∼Δt α –3 , where 0 ≤ α < 2

  14. Continuity of care for patients on a waiting list for institutional long-term care.

    NARCIS (Netherlands)

    Caris-Verhallen, W.M.C.M.; Kerkstra, A.

    2001-01-01

    The aim of this study was to examine patients' satisfaction with continuity of care while on a waiting list for residential care or nursing home care. Two hundred and seventy-eight patients participated in the study, all living in the community setting of two cities in the Netherlands. These

  15. Willingness to Pay for a Maternity Waiting Home Stay in Zambia

    Science.gov (United States)

    White, Emily E.; Biemba, Godfrey; Mataka, Kaluba; Scott, Nancy

    2016-01-01

    Introduction Complications of pregnancy and childbirth can pose serious risks to the health of women, especially in resource‐poor settings. Zambia has been implementing a program to improve access to emergency obstetric and neonatal care, including expansion of maternity waiting homes‐residential facilities located near a qualified medical facility where a pregnant woman can wait to give birth. Yet it is unclear how much support communities and women would be willing to provide to help fund the homes and increase sustainability. Methods We conducted a mixed‐methods study to estimate willingness to pay for maternity waiting home services based on a survey of 167 women, men, and community elders. We also collected qualitative data from 16 focus group discussions to help interpret our findings in context. Results The maximum willingness to pay was 5.0 Zambian kwacha or $0.92 US dollars per night of stay. Focus group discussions showed that willingness to pay is dependent on higher quality of services such as food service and suggested that the pricing policy (by stay or by night) could influence affordability and use. Discussion While Zambians seem to value and be willing to contribute a modest amount for maternity waiting home services, planners must still address potential barriers that may prevent women from staying at the shelters. These include cash availability and affordability for the poorest households. PMID:28419708

  16. Stroke Education in an Emergency Department Waiting Room: a Comparison of Methods

    Directory of Open Access Journals (Sweden)

    Yu-Feng Yvonne Chan1

    2015-03-01

    Full Text Available Background: Since the emergency department (ED waiting room hosts a large, captive audience of patients and visitors, it may be an ideal location for conduct-ing focused stroke education. The aim of this study was to assess the effective-ness of various stroke education methods.Methods: Patients and visitors of an urban ED waiting room were randomized into one of the following groups: video, brochure, one-to-one teaching, combi-nation of these three methods, or control group. We administered a 13-question multiple-choice test to assess stroke knowledge prior to, immediately after, and at 1 month post-education to patients and visitors in the ED waiting room.Results: Of 4 groups receiving education, all significantly improved their test scores immediately post intervention (test scores 9.4±2.5-10.3±2.0, P<0.01. At 1 month, the combination group retained the most knowledge (9.4±2.4 exceed-ing pre-intervention and control scores (both 6.7±2.6, P<0.01.Conclusion: Among the various stroke education methods delivered in the ED waiting room, the combination method resulted in the highest knowledge reten-tion at 1-month post intervention.

  17. Patients’ Attitude towards Travelling For Breast Services versus Waiting Longer For Local Services

    LENUS (Irish Health Repository)

    Abd Elwahab, S

    2018-05-01

    Geographical access is a cornerstone of health care provision. However, prolonged waiting for breast clinic appointments in local services results in delayed diagnosis and excessive anxiety for patients. In this study, we present a patient satisfaction survey results of an initiative to offer out-patient clinic appointments for non-urgent patients referred to the breast unit in Letterkenny General Hospital (LGH), Ireland, and exceeded the recommended waiting period of 12 weeks. These patients were offered appointment in University Hospital Galway (UCHG), which is an average travel time of about 3.5-4.5 hours away from LGH. 163 patients out of 336 (48.5%) patients actively waiting more than 12 weeks for appointments in LGH accepted alternative appointments in UCHG. Despite the long travel distance for these patients, 100% of them reported high satisfaction and 97.3% said they would accept further UCHG appointments if a similar situation of prolonged waiting in LGH arises. None of these patients were diagnosed with cancer, and only one had a benign lumpectomy. This study showed that if offered alternative appointments, just under half of the patients would accept. The initiative provides a feasible solution for long waiters, and the survey shows that patients’ satisfaction remains high despite long travel.

  18. School, Activism and Politics at the Movies: Educator Reactions to the Film "Waiting for 'Superman'"

    Science.gov (United States)

    Wessel Powell, Christy

    2014-01-01

    Context: The documentary film about U.S. education reform, "Waiting for 'Superman'," was met with acclaim and controversy when released to theaters in 2010, and again when launching its grassroots "host a screening" campaign in 2011. The campaign ran concurrent with 2011 state legislative sessions, during which several states…

  19. Watchful waiting as a treatment strategy for patients with a ventral hernia appears to be safe

    DEFF Research Database (Denmark)

    Kokotovic, D; Sjølander, H; Gögenur, I

    2016-01-01

    PURPOSE: Due to risks of postoperative morbidity and recurrence some patients with a ventral hernia are not offered surgical repair. There is limited data on the rate and consequences of a watchful waiting (WW) strategy for these patients. The objective of this cohort study was to analyse outcome...

  20. A prospective study on the impact of waiting times for radiotherapy ...

    African Journals Online (AJOL)

    Background: Radiotherapy plays a vital role in the management of cervical cancer. However, because of high patient load and limited resources, waiting lists are unacceptably long. This is a highly curable malignancy that often occurs in economically active, relatively young women. The impact of treatment delays on society ...

  1. Experience of being a low priority patient during waiting time at an emergency department.

    Science.gov (United States)

    Dahlen, Ingrid; Westin, Lars; Adolfsson, Annsofie

    2012-01-01

    Work in the emergency department is characterized by fast and efficient medical efforts to save lives, but can also involve a long waiting time for patients. Patients are given a priority rating upon their arrival in the clinic based on the seriousness of their problem, and nursing care for lower priority patients is given a lower prioritization. Regardless of their medical prioritization, all patients have a right to expect good nursing care while they are waiting. The purpose of this study was to illustrate the experience of the low prioritized patient during their waiting time in the emergency department. A phenomenological hermeneutic research method was used to analyze an interview transcript. Data collection consisted of narrative interviews. The interviewees were 14 patients who had waited more than three hours for surgical, orthopedic, or other medical care. The findings resulted in four different themes, ie, being dependent on care, being exposed, being vulnerable, and being secure. Lower priority patients are not paid as much attention by nursing staff. Patients reported feeling powerless, insulted, and humiliated when their care was delayed without their understanding what was happening to them. Not understanding results in exposure that violates self-esteem. The goal of the health care provider must be to minimize and prevent suffering, prevent feelings of vulnerability, and to create conditions for optimal patient well being.

  2. High-dose chemoradiotherapy and watchful waiting for distal rectal cancer

    DEFF Research Database (Denmark)

    Appelt, Ane L; Pløen, John; Harling, Henrik

    2015-01-01

    -dose radiotherapy with concomitant chemotherapy followed by observation (watchful waiting) was successful for non-surgical management of low rectal cancer. METHODS: Patients with primary, resectable, T2 or T3, N0-N1 adenocarcinoma in the lower 6 cm of the rectum were given chemoradiotherapy (60 Gy in 30 fractions...

  3. Two facets of patience in young children: Waiting with and without an explicit reward.

    Science.gov (United States)

    Barragan-Jason, Gladys; Atance, Cristina; Kopp, Leia; Hopfensitz, Astrid

    2018-07-01

    Patience, or the ability to tolerate delay, is typically studied using delay of gratification (DoG) tasks. However, among other factors (e.g., type of reward), the use of a reward to test patience is affected by an individual's motivation to obtain the reward (e.g., degree of preference for the small vs. large reward). In addition, DoG tasks do not assess the extent to which an individual can wait in the absence of an explicit reward-or what we term "patience as a virtue." Accordingly, the current study used a new measure of patience-the "pure waiting paradigm"-in which 3- to 5-year-old children waited 3 min with nothing to do and with no explicit reward. We then examined the relation between performance on this task (as assessed by children's spontaneous patient behaviors) and performance on two DoG tasks (candy and video rewards). Significant correlations were found between DoG performance and patient behaviors in the pure waiting paradigm, especially when controlling for motivation. These results and methodology show for the first time a direct link between patience as a virtue and DoG performance and also provide new insights about the study of patience in children. Copyright © 2018 Elsevier Inc. All rights reserved.

  4. Waiting-time approximations in multi-queue systems with cyclic service

    NARCIS (Netherlands)

    Boxma, O.J.; Meister, B.W.

    1987-01-01

    This study is devoted to mean waiting-time approximations in a single-server multi-queue model with cyclic service and zero switching times of the server between consecutive queues. Two different service disciplines are considered: exhaustive service and (ordinary cyclic) nonexhaustive service. For

  5. Effectiveness of Multimedia for Transplant Preparation for Kidney Transplant Waiting List Patients.

    Science.gov (United States)

    Charoenthanakit, C; Junchotikul, P; Sittiudomsuk, R; Saiyud, A; Pratumphai, P

    2016-04-01

    A multimedia program could effectively advise patients about preparing for transplantation while on the waiting list for a kidney transplant. This study aimed to compare knowledge about transplant preparation for patients on a kidney transplant waiting list before and after participating in a multimedia program, and to evaluate patient satisfaction with the multimedia program. Research design was quasiexperimental with the use of 1 group. Subjects were 186 patients on the kidney transplant waiting list after HLA matching in Ramathibodi Hospital. The questionnaires were developed by the researchers. The statistical tools used were basic statistics, percentage, average, standard deviation, and the difference of score between before and after participation in the multimedia program (t test). The evaluation knowledge for transplant preparation for kidney transplant waiting list patients after participating in the multimedia program averaged 85.40%, and there was an increased improvement of score by an average 3.27 out of a possible full score of 20 (P multimedia program had good average, 4.58. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Practical Solutions for Reducing Container Ships’ Waiting Times at Ports Using Simulation Model

    Institute of Scientific and Technical Information of China (English)

    Abdorreza Sheikholeslami; Gholamreza Ilati; Yones Eftekhari Yeganeh

    2013-01-01

    The main challenge for container ports is the planning required for berthing container ships while docked in port. Growth of containerization is creating problems for ports and container terminals as they reach their capacity limits of various resources which increasingly leads to traffic and port congestion. Good planning and management of container terminal operations reduces waiting time for liner ships. Reducing the waiting time improves the terminal’s productivity and decreases the port difficulties. Two important keys to reducing waiting time with berth allocation are determining suitable access channel depths and increasing the number of berths which in this paper are studied and analyzed as practical solutions. Simulation based analysis is the only way to understand how various resources interact with each other and how they are affected in the berthing time of ships. We used the Enterprise Dynamics software to produce simulation models due to the complexity and nature of the problems. We further present case study for berth allocation simulation of the biggest container terminal in Iran and the optimum access channel depth and the number of berths are obtained from simulation results. The results show a significant reduction in the waiting time for container ships and can be useful for major functions in operations and development of container ship terminals.

  7. Maternity waiting facilities for improving maternal and neonatal outcome in low-resource countries

    NARCIS (Netherlands)

    van Lonkhuijzen, L.; Stekelenburg, J.; van Roosmalen, J.

    2009-01-01

    Background A Maternity Waiting Home (MWH) is a facility, within easy reach of a hospital or health centre which provides Emergency Obstetric Care (EmOC). Women may stay in the MWH at the end of their pregnancy and await labour. Once labour starts, women move to the health facility so that labour and

  8. Assessing and controlling the impact of hospital capacity planning on the waiting time

    NARCIS (Netherlands)

    Dellaert, N.; Çayiroglu, E.; Jeunet, J.

    2015-01-01

    In the literature, tactical plans of elective patients aim at increasing hospital efficiency through a better resource utilisation, although hospitals claim that patient satisfaction, usually measured by the waiting time, is also important. In this regard, the purpose of this paper is to show how

  9. Financial cost to institutions on patients waiting for gall bladder disease surgery.

    Science.gov (United States)

    Waqas, Ahmed; Qasmi, Shahzad Ahmed; Kiani, Faran; Raza, Ahmed; Khan, Khizar Ishtiaque; Manzoor, Shazia

    2014-01-01

    The aim of this study was to determine the financial costs to institution on patients waiting for gall bladder disease surgery and suggest measures to reduce them. This multi-centre prospective descriptive survey was performed on all patients who underwent an elective cholecystectomy by three consultants at secondary care hospitals in Pakistan between Jan 2010 to Jan 2012. Data was collected on demographics, the duration of mean waiting time, specific indications and nature of disease for including the patients in the waiting list, details of emergency re-admissions while awaiting surgery, investigations done, treatment given and expenditures incurred on them during these episodes. A total of 185 patients underwent elective open cholecystectomy. The indications for listing the patients for surgery were biliary colic in 128 patients (69%), acute cholecystitis in 43 patients (23%), obstructive jaundice in 8 patients (4.5%) and acute pancreatitis in 6 patients (3.2%). 146 (78.9%) and 39 (21.1%) of patients were listed as outdoor electives and indoor emergencies respectively. Of the 185 patients, 54 patients (29.2%) were re-admitted. Financial costs in Pakistani rupees per episode of readmission were 23050 per episode in total and total money spent on all readmissions was Rs. 17,05,700/-. Financial costs on health care institutions due to readmissions in patients waiting for gall bladder disease surgery are high. Identifying patients at risk for these readmissions and offering them early laparoscopic cholecystectomy is very important.

  10. Teaching in Cyberspace: Online versus Traditional Instruction Using a Waiting-List Experimental Design

    Science.gov (United States)

    Poirier, Christopher R.; Feldman, Robert S.

    2004-01-01

    To test the effectiveness of an online introductory psychology course, we randomly assigned students to a large, traditional course or to an online course from a population of students who indicated that either course type was acceptable using a "waiting list" experimental design. Students in the online course performed better on exams and equally…

  11. Hip and knee arthroplasty waiting list – how accurate and fair?

    African Journals Online (AJOL)

    access by hospital managers and provincial planners. ... interaction of administration and clinical staff. ... Resource-intensive procedures require the use of patient waiting lists in an attempt to increase fairness ... These deficiencies have prompted the introduction of a scoring-based prioritisation system incorporating clinical,.

  12. How to share concurrent asynchronous wait-free variables: Preliminary version

    NARCIS (Netherlands)

    M. Li (Ming); P.M.B. Vitányi (Paul)

    1989-01-01

    textabstractWe use a structured top-down approach to develop algorithms for atomic variables shared by concurrent asynchronous wait-free processes, starting from the problem specification. By this design we obtain a better understanding of what the algorithms do, why they do it, and that they

  13. Patients\\' response to waiting time in an out-patient pharmacy in ...

    African Journals Online (AJOL)

    Purpose: To identify the dispensing procedure at a pharmacy, investigate the possible operational problems that may lead to excessive patient waiting times as prescriptions are filled and to examine patient disposition to perceived delays at the pharmacy. Methods: The study was carried out in a 574-bed university teaching ...

  14. Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial

    NARCIS (Netherlands)

    Kuijper, Barbara; Tans, Jos Th J.; Beelen, Anita; Nollet, Frans; de Visser, Marianne

    2009-01-01

    Objective To evaluate the effectiveness of treatment with collar or physiotherapy compared with a wait and see policy in recent onset cervical radiculopathy. Design Randomised controlled trial. Setting Neurology outpatient clinics in three Dutch hospitals. Participants 205 patients with symptoms and

  15. Time on wait lists for coronary bypass surgery in British Columbia, Canada, 1991 – 2000

    Directory of Open Access Journals (Sweden)

    Hayden Robert

    2005-03-01

    Full Text Available Abstract Background In British Columbia, Canada, all necessary medical services are funded publicly. Concerned with growing wait lists in the mid-1990s, the provincial government started providing extra funding for coronary artery bypass grafting (CABG operations annually. Although aimed at improving access, it is not known whether supplementary funding changed the time that patients spent on wait lists for CABG. We sought to determine whether the period of registration on wait lists had an effect on time to isolated CABG and whether the period effect was similar across priority groups. Methods Using records from a population-based registry, we studied the wait-list time before and after supplementary funding became available. We compared the number of weeks from registration to surgery for equal proportions of patients in synthetic cohorts defined by five registration periods in the 1990s. Results Overall, 9,231 patients spent a total of 137,126 person-weeks on the wait lists. The time to surgery increased by the middle of the decade, and decreased toward the end of the decade. Relative to the 1991–92 registration period, the conditional weekly probabilities of undergoing surgery were 30% lower among patients registered on the wait lists in 1995–96, hazard ratio (HR = 0.70 (0.65–0.76, and 23% lower in 1997–98 patients, HR = 0.77 (0.71–0.83, while there were no differences with 1999–2000 patients, HR = 0.94 (0.88–1.02, after adjusting for priority group at registration, comorbidity, age and sex. We found that the effect of registration period was different across priority groups. Conclusion Our results provide evidence that time to CABG shortened after supplementary funding was provided on an annual basis to tertiary care hospitals within a single publicly funded health system. One plausible explanation is that these hospitals had capacity to increase the number of operations. At the same time, the effect was not uniform across

  16. Guided online or face-to-face cognitive behavioral treatment for insomnia: A randomized wait-list controlled trial

    NARCIS (Netherlands)

    Lancee, J.; van Straten, A.; Morina, N.; Kaldo, V.; Kamphuis, J.H.

    2016-01-01

    Study Objectives: To compare the efficacy of guided online and individual face-to-face cognitive behavioral treatment for insomnia (CBT-I) to a wait-list condition. Methods: A randomized controlled trial comparing three conditions: guided online; face-to-face; wait-list. Posttest measurements were

  17. Application of Queueing Theory to the Analysis of Changes in Outpatients' Waiting Times in Hospitals Introducing EMR.

    Science.gov (United States)

    Cho, Kyoung Won; Kim, Seong Min; Chae, Young Moon; Song, Yong Uk

    2017-01-01

    This research used queueing theory to analyze changes in outpatients' waiting times before and after the introduction of Electronic Medical Record (EMR) systems. We focused on the exact drawing of two fundamental parameters for queueing analysis, arrival rate (λ) and service rate (µ), from digital data to apply queueing theory to the analysis of outpatients' waiting times. We used outpatients' reception times and consultation finish times to calculate the arrival and service rates, respectively. Using queueing theory, we could calculate waiting time excluding distorted values from the digital data and distortion factors, such as arrival before the hospital open time, which occurs frequently in the initial stage of a queueing system. We analyzed changes in outpatients' waiting times before and after the introduction of EMR using the methodology proposed in this paper, and found that the outpatients' waiting time decreases after the introduction of EMR. More specifically, the outpatients' waiting times in the target public hospitals have decreased by rates in the range between 44% and 78%. It is possible to analyze waiting times while minimizing input errors and limitations influencing consultation procedures if we use digital data and apply the queueing theory. Our results verify that the introduction of EMR contributes to the improvement of patient services by decreasing outpatients' waiting time, or by increasing efficiency. It is also expected that our methodology or its expansion could contribute to the improvement of hospital service by assisting the identification and resolution of bottlenecks in the outpatient consultation process.

  18. Associations Between Waiting Times, Service Times, and Patient Satisfaction in an Endocrinology Outpatient Department: A Time Study and Questionnaire Survey.

    Science.gov (United States)

    Xie, Zhenzhen; Or, Calvin

    2017-01-01

    The issue of long patient waits has attracted increasing public attention due to the negative effects of waiting on patients' satisfaction with health care. The present study examined the associations between actual waiting time, perceived acceptability of waiting time, actual service time, perceived acceptability of service time, actual visit duration, and the level of patient satisfaction with care. We conducted a cross-sectional time study and questionnaire survey of endocrinology outpatients visiting a major teaching hospital in China. Our results show that actual waiting time was negatively associated with patient satisfaction regarding several aspects of the care they received. Also, patients who were less satisfied with the sociocultural atmosphere and the identity-oriented approach to their care tended to perceive the amounts of time they spent waiting and receiving care as less acceptable. It is not always possible to prevent dissatisfaction with waiting, or to actually reduce waiting times by increasing resources such as increased staffing. However, several improvements in care services can be considered. Our suggestions include providing clearer, more transparent information to keep patients informed about the health care services that they may receive, and the health care professionals who are responsible for those services. We also suggest that care providers are encouraged to continue to show empathy and respect for patients, that patients are provided with private areas where they can talk with health professionals and no one can overhear, and that hospital staff treat the family members or friends who accompany patients in a courteous and friendly way.

  19. Stress, psychological distress, and coping in patients on the waiting list for lung transplantation : an exploratory study

    NARCIS (Netherlands)

    Vermeulen, KM; Bosma, OH; van der Bij, W; Koeter, GH; TenVergert, EM

    Little information is available in literature on quality of life, stress and coping during the period patients are waiting for lung transplantation. This study explored potential stressful events that patients experience during the waiting period assessed the level of anxiety and depression and

  20. The British Columbia Nephrologists’ Access Study (BCNAS) – a prospective, health services interventional study to develop waiting time benchmarks and reduce wait times for out-patient nephrology consultations

    Science.gov (United States)

    2013-01-01

    Background Early referral and management of high-risk chronic kidney disease may prevent or delay the need for dialysis. Automatic eGFR reporting has increased demand for out-patient nephrology consultations and in some cases, prolonged queues. In Canada, a national task force suggested the development of waiting time targets, which has not been done for nephrology. Methods We sought to describe waiting time for outpatient nephrology consultations in British Columbia (BC). Data collection occurred in 2 phases: 1) Baseline Description (Jan 18-28, 2010) and 2) Post Waiting Time Benchmark-Introduction (Jan 16-27, 2012). Waiting time was defined as the interval from receipt of referral letters to assessment. Using a modified Delphi process, Nephrologists and Family Physicians (FP) developed waiting time targets for commonly referred conditions through meetings and surveys. Rules were developed to weigh-in nephrologists’, FPs’, and patients’ perspectives in order to generate waiting time benchmarks. Targets consider comorbidities, eGFR, BP and albuminuria. Referred conditions were assigned a priority score between 1-4. BC nephrologists were encouraged to centrally triage referrals to see the first available nephrologist. Waiting time benchmarks were simultaneously introduced to guide patient scheduling. A post-intervention waiting time evaluation was then repeated. Results In 2010 and 2012, 43/52 (83%) and 46/57 (81%) of BC nephrologists participated. Waiting time decreased from 98(IQR44,157) to 64(IQR21,120) days from 2010 to 2012 (p = management associated with improved access to nephrologists in BC. Improvements in waiting time was most marked for the highest priority patients, which suggests that benchmarks had an influence on triaging behavior. Further research is needed to determine whether this effect is sustainable. PMID:23988113

  1. Wait time management strategies for total joint replacement surgery: sustainability and unintended consequences.

    Science.gov (United States)

    Pomey, Marie-Pascale; Clavel, Nathalie; Amar, Claudia; Sabogale-Olarte, Juan Carlos; Sanmartin, Claudia; De Coster, Carolyn; Noseworthy, Tom

    2017-09-07

    In Canada, long waiting times for core specialized services have consistently been identified as a key barrier to access. Governments and organizations have responded with strategies for better access management, notably for total joint replacement (TJR) of the hip and knee. While wait time management strategies (WTMS) are promising, the factors which influence their sustainable implementation at the organizational level are understudied. Consequently, this study examined organizational and systemic factors that made it possible to sustain waiting times for TJR within federally established limits and for at least 18 months or more. The research design is a multiple case study of WTMS implementation. Five cases were selected across five Canadian provinces. Three success levels were pre-defined: 1) the WTMS maintained compliance with requirements for more than 18 months; 2) the WTMS met requirements for 18 months but could not sustain the level thereafter; 3) the WTMS never met requirements. For each case, we collected documents and interviewed key informants. We analyzed systemic and organizational factors, with particular attention to governance and leadership, culture, resources, methods, and tools. We found that successful organizations had specific characteristics: 1) management of the whole care continuum, 2) strong clinical leadership; 3) dedicated committees to coordinate and sustain strategy; 4) a culture based on trust and innovation. All strategies led to relatively similar unintended consequences. The main negative consequence was an initial increase in waiting times for TJR and the main positive consequence was operational enhancement of other areas of specialization based on the TJR model. This study highlights important differences in factors which help to achieve and sustain waiting times. To be sustainable, a WTMS needs to generate greater synergies between contextual-level strategy (provincial or regional) and organizational objectives and

  2. Experience of being a low priority patient during waiting time at an emergency department

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    Adolfsson A

    2012-01-01

    Full Text Available Ingrid Dahlen1,2, Lars Westin1, Annsofie Adolfsson11School of Life Sciences, University of Skövde, Skövde, Sweden; 2Emergency Department, Skaraborg Hospital, Skövde, SwedenBackground: Work in the emergency department is characterized by fast and efficient medical efforts to save lives, but can also involve a long waiting time for patients. Patients are given a priority rating upon their arrival in the clinic based on the seriousness of their problem, and nursing care for lower priority patients is given a lower prioritization. Regardless of their medical prioritization, all patients have a right to expect good nursing care while they are waiting. The purpose of this study was to illustrate the experience of the low prioritized patient during their waiting time in the emergency department.Methods: A phenomenological hermeneutic research method was used to analyze an interview transcript. Data collection consisted of narrative interviews. The interviewees were 14 patients who had waited more than three hours for surgical, orthopedic, or other medical care.Results: The findings resulted in four different themes, ie, being dependent on care, being exposed, being vulnerable, and being secure. Lower priority patients are not paid as much attention by nursing staff. Patients reported feeling powerless, insulted, and humiliated when their care was delayed without their understanding what was happening to them. Not understanding results in exposure that violates self-esteem.Conclusion: The goal of the health care provider must be to minimize and prevent suffering, prevent feelings of vulnerability, and to create conditions for optimal patient well being.Keywords: emergency department, patients, waiting times, nursing staff

  3. Randomized controlled trial on promoting influenza vaccination in general practice waiting rooms.

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    Christophe Berkhout

    Full Text Available Most of general practitioners (GPs use advertising in their waiting rooms for patient's education purposes. Patients vaccinated against seasonal influenza have been gradually lessening. The objective of this trial was to assess the effect of an advertising campaign for influenza vaccination using posters and pamphlets in GPs' waiting rooms.Registry based 2/1 cluster randomized controlled trial, a cluster gathering the enlisted patients of 75 GPs aged over 16 years. The trial, run during the 2014-2015 influenza vaccination campaign, compared patient's awareness from being in 50 GPs' standard waiting rooms (control group versus that of waiting in 25 rooms from GPs who had received and exposed pamphlets and one poster on influenza vaccine (intervention group, in addition to standard mandatory information. The main outcome was the number of vaccination units delivered in pharmacies. Data were extracted from the SIAM-ERASME claim database of the Health Insurance Fund of Lille-Douai (France. The association between the intervention (yes/no and the main outcome was assessed through a generalized estimating equation. Seventy-five GPs enrolled 10,597 patients over 65 years or suffering from long lasting diseases (intervention/control as of 3781/6816 patients from October 15, 2014 to February 28, 2015. No difference was found regarding the number of influenza vaccination units delivered (Relative Risk (RR = 1.01; 95% Confidence interval: 0.97 to 1.05; p = 0.561.Effects of the monothematic campaign promoting vaccination against influenza using a poster and pamphlets exposed in GPs' waiting rooms could not be demonstrated.

  4. It's worth the wait: optimizing questioning methods for effective intraoperative teaching.

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    Barrett, Meredith; Magas, Christopher P; Gruppen, Larry D; Dedhia, Priya H; Sandhu, Gurjit

    2017-07-01

    The use of questioning to engage learners is critical to furthering resident education intraoperatively. Previous studies have demonstrated that higher level questioning and optimal wait times (>3 s) result in learner responses reflective of higher cognition and retention. Given the importance of intraoperative learning, we investigated question delivery in the operating room. A total of 12 laparoscopic cholecystectomies were observed and recorded. All questions were transcribed and classified using Bloom's Taxonomy, a framework associated with hierarchical levels of learning outcomes. Wait time between question end and response was recorded. Six faculty attendings and seven house officers at our institution were observed. A total of 133 questions were recorded with an average number of questions per case of 11.2. The majority of questions 112 out of 133 (84%) were classified as Bloom's levels 1-3, with only 6% of questions of the highest level. The wait time before the resident answered the question averaged 1.75 s, with attendings interceding after 2.50 s. Question complexity and wait time did not vary based on resident postgraduate year level suggesting limited tailoring of question to learner. Intraoperative questioning is not aligned with higher level thinking. The majority of questions were Bloom's level 3 or below, limiting the complexity of answer formulation. Most responses were given within 2 s, hindering opportunity to pursue higher-order thinking. This suggests including higher level questions and tailoring questions to learner level may improve retention and maximize gains. In addition, with attendings answering 20% of their own questions, increasing their wait time offers another area for teaching development. © 2017 Royal Australasian College of Surgeons.

  5. Toward systematic reviews to understand the determinants of wait time management success to help decision-makers and managers better manage wait times.

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    Pomey, Marie-Pascale; Forest, Pierre-Gerlier; Sanmartin, Claudia; Decoster, Carolyn; Clavel, Nathalie; Warren, Elaine; Drew, Madeleine; Noseworthy, Tom

    2013-06-06

    Long waits for core specialized services have consistently been identified as a key barrier to access. Governments and organizations at all levels have responded with strategies for better wait list management. While these initiatives are promising, insufficient attention has been paid to factors influencing the implementation and sustainability of wait time management strategies (WTMS) implemented at the organizational level. A systematic review was conducted using the main electronic databases, such as CINAHL, MEDLINE, and Cochrane Database of Systematic Reviews, to identify articles published between 1990 and 2011 on WTMS for scheduled care implemented at the organizational level or higher and on frameworks for analyzing factors influencing their success. Data was extracted on governance, culture, resources, and tools. We organized a workshop with Canadian healthcare policy-makers and managers to compare our initial findings with their experience. Our systematic review included 47 articles: 36 related to implementation and 11 to sustainability. From these, we identified a variety of WTMS initiated at the organizational level or higher, and within these, certain factors that were specific to either implementation or sustainability and others common to both. The main common factors influencing success at the contextual level were stakeholder engagement and strong funding, and at the organizational level, physician involvement, human resources capacity, and information management systems. Specific factors for successful implementation at the contextual level were consultation with front-line actors and common standards and guidelines, and at the organizational level, financial incentives and dedicated staffing. For sustainability, we found no new factors. The workshop participants identified the same major factors as found in the articles and added others, such as information sharing between physicians and managers. Factors related to implementation were studied

  6. The importance of patient expectations as a determinant of satisfaction with waiting times for hip and knee replacement surgery.

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    Conner-Spady, Barbara L; Sanmartin, Claudia; Johnston, Geoffrey H; McGurran, John J; Kehler, Melissa; Noseworthy, Tom W

    2011-08-01

    The disconfirmation model hypothesizes that satisfaction is a function of a perceived discrepancy from an initial expectation. Our objectives were: (1) to test the disconfirmation model as it applies to patient satisfaction with waiting time (WT) and (2) to build an explanatory model of the determinants of satisfaction with WT for hip and knee replacement. We mailed 1000 questionnaires to 2 random samples: patients waiting or those who had received a joint replacement within the preceding 3-12 months. We used ordinal logistic regression analysis to build an explanatory model of the determinants of satisfaction. Of the 1330 returned surveys, 1240 contained patient satisfaction data. The sample was 57% female; mean age was 70 years (SD 11). Consistent with the disconfirmation model, when their WTs were longer than expected, both waiting (OR 5.77, 95% CI 3.57-9.32) and post-surgery patients (OR 6.57, 95% CI 4.21-10.26) had greater odds of dissatisfaction, adjusting for the other variables in the model. Compared to those who waited 3 months or less, post-surgery patients who waited 6 to 12 months (OR 2.59, 95% CI 1.27-5.27) and over 12 months (OR 3.30, 95% CI 1.65-6.58) had greater odds of being dissatisfied with their waiting time. Patients who felt they were treated unfairly had greater odds of being dissatisfied (OR 4.74, 95% CI 2.60-8.62). In patients on waiting lists and post-surgery for hip and knee replacement, satisfaction with waiting times is related to fulfillment of expectations about waiting, as well as a perception of fairness. Measures to modify expectations and increase perceived fairness, such as informing patients of a realistic WT and communication during the waiting period, may increase satisfaction with WTs. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  7. The comparison of 18C(n; γ)19C and 18C(α; n)21O reaction rates: consequences for the r-process

    International Nuclear Information System (INIS)

    Dan, M.; Singh, G.; Chatterjee, R.; Shubhchintak

    2017-01-01

    Neutron rich light and medium mass nuclei play a major role in determining the reaction flow towards the r-process seed nuclei production. In this text, we calculate the neutron capture rate of 18 C and compare it with that of α-capture by the same nucleus in the temperature range T 9 = 0:1 - 10. This temperature range roughly equals to an energy range of 1 keV to 1 MeV in centre of mass frame, where it is very difficult to perform direct reaction experiments. Further, the theoretical construction of 18 C-n continuum state for the 18 C(n; γ) 19 C direct reaction is a tedious job

  8. β-decay half-lives of neutron-rich isotopes of Fe, Co, Ni involved in the beginning of the r-process

    International Nuclear Information System (INIS)

    Czajkowski, S.; Bernas, M.; Brissot, R.

    1992-01-01

    The very neutron-rich Fe- to Ni-isotopes are of interest since they are located at the very beginning of the astrophysical r-process path. The β-decay half-lives of several isotopes, identified in thermal fission of 235 U or 239 Pu, have been measured at the ILL high-flux reactor using the Lohengrin spectrometer. Half-lives have been determined from time-correlations analysis between the fragment implantation and the detection of the subsequent β-particles in the same detector. With the fragment separator FRS , at GSI, the projectile fragments of 86 Kr have been separated. The β-decay half-life of 65 Fe has been measured. Received: (from VMMAIL[FRSAC11 for XIN[IAEA1 via NJE)

  9. A model to prioritize access to elective surgery on the basis of clinical urgency and waiting time

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    Santori Gregorio

    2009-01-01

    Full Text Available Abstract Background Prioritization of waiting lists for elective surgery represents a major issue in public systems in view of the fact that patients often suffer from consequences of long waiting times. In addition, administrative and standardized data on waiting lists are generally lacking in Italy, where no detailed national reports are available. This is true although since 2002 the National Government has defined implicit Urgency-Related Groups (URGs associated with Maximum Time Before Treatment (MTBT, similar to the Australian classification. The aim of this paper is to propose a model to manage waiting lists and prioritize admissions to elective surgery. Methods In 2001, the Italian Ministry of Health funded the Surgical Waiting List Info System (SWALIS project, with the aim of experimenting solutions for managing elective surgery waiting lists. The project was split into two phases. In the first project phase, ten surgical units in the largest hospital of the Liguria Region were involved in the design of a pre-admission process model. The model was embedded in a Web based software, adopting Italian URGs with minor modifications. The SWALIS pre-admission process was based on the following steps: 1 urgency assessment into URGs; 2 correspondent assignment of a pre-set MTBT; 3 real time prioritization of every referral on the list, according to urgency and waiting time. In the second project phase a prospective descriptive study was performed, when a single general surgery unit was selected as the deployment and test bed, managing all registrations from March 2004 to March 2007 (1809 ordinary and 597 day cases. From August 2005, once the SWALIS model had been modified, waiting lists were monitored and analyzed, measuring the impact of the model by a set of performance indexes (average waiting time, length of the waiting list and Appropriate Performance Index (API. Results The SWALIS pre-admission model was used for all registrations in the

  10. The Sit-and-Wait Hypothesis in Bacterial Pathogens: A Theoretical Study of Durability and Virulence

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    Liang Wang

    2017-11-01

    Full Text Available The intriguing sit-and-wait hypothesis predicts that bacterial durability in the external environment is positively correlated with their virulence. Since its first proposal in 1987, the hypothesis has been spurring debates in terms of its validity in the field of bacterial virulence. As a special case of the vector-borne transmission versus virulence tradeoff, where vector is now replaced by environmental longevity, there are only sporadic studies over the last three decades showing that environmental durability is possibly linked with virulence. However, no systematic study of these works is currently available and epidemiological analysis has not been updated for the sit-and-wait hypothesis since the publication of Walther and Ewald’s (2004 review. In this article, we put experimental evidence, epidemiological data and theoretical analysis together to support the sit-and-wait hypothesis. According to the epidemiological data in terms of gain and loss of virulence (+/- and durability (+/- phenotypes, we classify bacteria into four groups, which are: sit-and-wait pathogens (++, vector-borne pathogens (+-, obligate-intracellular bacteria (--, and free-living bacteria (-+. After that, we dive into the abundant bacterial proteomic data with the assistance of bioinformatics techniques in order to investigate the two factors at molecular level thanks to the fast development of high-throughput sequencing technology. Sequences of durability-related genes sourced from Gene Ontology and UniProt databases and virulence factors collected from Virulence Factor Database are used to search 20 corresponding bacterial proteomes in batch mode for homologous sequences via the HMMER software package. Statistical analysis only identified a modest, and not statistically significant correlation between mortality and survival time for eight non-vector-borne bacteria with sit-and-wait potentials. Meanwhile, through between-group comparisons, bacteria with higher

  11. Effect of self-triage on waiting times at a walk-in sexual health clinic.

    Science.gov (United States)

    Hitchings, Samantha; Barter, Janet

    2009-10-01

    Lengthy waiting times can be a major problem in walk-in sexual health clinics. They are stressful for both patients and staff and may lead to clients with significant health issues leaving the department before being seen by a clinician. A self-triage system may help reduce waiting times and duplication of work, improve patient pathways and decrease wasted visits. This paper describes implementation of a self-triage system in two busy sexual and reproductive health clinics. Patients were asked to complete a self-assessment form on registration to determine the reason for attendance. This then enabled patients to be directed to the most appropriate specialist or clinical service. The benefits of this approach were determined by measuring patient waiting times, reduction in unnecessary specialist review together with patient acceptability as tested by a patient satisfaction survey. The ease of comprehension of the triage form was also assessed by an independent readers' panel. A total of 193 patients were recruited over a 4-month period from November 2004 to February 2005. Patients from the November and December clinics were assigned to the 'traditional treatment' arm, with patients at subsequent clinics being assigned to the 'self-triage' system. Waiting times were collected by the receptionist and clinic staff. Ninety six patients followed the traditional route, 97 the new self-triage system. Sixty-nine (35.8%) patients completed the satisfaction survey. The self-triage system significantly reduced waiting time from 40 (22, 60) to 23 (10, 40) minutes [results expressed as median (interquartile range)]. There was a non-significant reduction in the proportion of patients seeing two clinicians from 21% to 13% (p = 0.17). Satisfaction levels were not significantly altered (95% compared to 97% satisfied, p = 0.64). The readers' panel found the triage form both easy to understand and to complete. Self-triage can effectively reduce clinic waiting times and allow better

  12. Assessing the impact of a waiting time survey on reducing waiting times in urban primary care clinics in Cape Town, South Africa

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    Johann Daniels

    2017-09-01

    Full Text Available A waiting time survey (WTS conducted in several clinics in Cape Town, South Africa provided recommendations on how to shorten waiting times (WT. A follow-up study was conducted to assess whether WT had reduced. Using a stratified sample of 22 clinics, a before and after study design assessed changes in WT. The WT was measured and perceptions of clinic managers were elicited, about the previous survey’s recommendations. The overall median WT decreased by 21 minutes (95%CI: 11.77- 30.23, a 28% decrease from the previous WTS. Although no specific factor was associated with decreases in WT, implementation of recommendations to reduce WT was 2.67 times (95%CI: 1.33-5.40 more likely amongst those who received written recommendations and 2.3 times (95%CI: 1.28- 4.19 more likely amongst managers with 5 or more years’ experience. The decrease in WT found demonstrates the utility of a WTS in busy urban clinics in developing country contexts. Experienced facility managers who timeously receive customised reports of their clinic’s performance are more likely to implement changes that positively impact on reducing WT.

  13. Transition in the waiting-time distribution of price-change events in a global socioeconomic system

    Science.gov (United States)

    Zhao, Guannan; McDonald, Mark; Fenn, Dan; Williams, Stacy; Johnson, Nicholas; Johnson, Neil F.

    2013-12-01

    The goal of developing a firmer theoretical understanding of inhomogeneous temporal processes-in particular, the waiting times in some collective dynamical system-is attracting significant interest among physicists. Quantifying the deviations between the waiting-time distribution and the distribution generated by a random process may help unravel the feedback mechanisms that drive the underlying dynamics. We analyze the waiting-time distributions of high-frequency foreign exchange data for the best executable bid-ask prices across all major currencies. We find that the lognormal distribution yields a good overall fit for the waiting-time distribution between currency rate changes if both short and long waiting times are included. If we restrict our study to long waiting times, each currency pair’s distribution is consistent with a power-law tail with exponent near to 3.5. However, for short waiting times, the overall distribution resembles one generated by an archetypal complex systems model in which boundedly rational agents compete for limited resources. Our findings suggest that a gradual transition arises in trading behavior between a fast regime in which traders act in a boundedly rational way and a slower one in which traders’ decisions are driven by generic feedback mechanisms across multiple timescales and hence produce similar power-law tails irrespective of currency type.

  14. A Cross-Sectional Survey of Population-Wide Wait Times for Patients Seeking Medical vs. Cosmetic Dermatologic Care.

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    Geeta Yadav

    Full Text Available Though previous work has examined some aspects of the dermatology workforce shortage and access to dermatologic care, little research has addressed the effect of rising interest in cosmetic procedures on access to medical dermatologic care. Our objective was to determine the wait times for Urgent and Non-Urgent medical dermatologic care and Cosmetic dermatology services at a population level and to examine whether wait times for medical care are affected by offering cosmetic services.A population-wide survey of dermatology practices using simulated calls asking for the earliest appointment for a Non-Urgent, Urgent and Cosmetic service.Response rates were greater than 89% for all types of care. Wait times across all types of care were significantly different from each other (all P < 0.05. Cosmetic care was associated with the shortest wait times (3.0 weeks; Interquartile Range (IQR = 0.4-3.4, followed by Urgent care (9.0 weeks; IQR = 2.1-12.9, then Non-Urgent Care (12.7 weeks; IQR = 4.4-16.4. Wait times for practices offering only Urgent care were not different from practices offering both Urgent and Cosmetic care (10.3 vs. 7.0 weeks.Longer wait times and greater variation for Urgent and Non-Urgent dermatologic care and shorter wait times and less variation for Cosmetic care. Wait times were significantly longer in regions with lower dermatologist density. Provision of Cosmetic services did not increase wait times for Urgent care. These findings suggest an overall dermatology workforce shortage and a need for a more streamlined referral system for dermatologic care.

  15. Impact of co-located general practitioner (GP) clinics and patient choice on duration of wait in the emergency department.

    Science.gov (United States)

    Sharma, Anurag; Inder, Brett

    2011-08-01

    To empirically model the determinants of duration of wait of emergency (triage category 2) patients in an emergency department (ED) focusing on two questions: (i) What is the effect of enhancing the degree of choice for non-urgent (triage category 5) patients on duration of wait for emergency (category 2) patients in EDs; and (ii) What is the effect of co-located GP clinics on duration of wait for emergency patients in EDs? The answers to these questions will help in understanding the effectiveness of demand management strategies, which are identified as one of the solutions to ED crowding. The duration of wait for each patient (difference between arrival time and time first seen by treating doctor) was modelled as a function of input factors (degree of choice, patient characteristics, weekend admission, metro/regional hospital, concentration of emergency (category 2) patients in hospital service area), throughput factors (availability of doctors and nurses) and output factor (hospital bed capacity). The unit of analysis was a patient episode and the model was estimated using a survival regression technique. The degree of choice for non-urgent (category 5) patients has a non-linear effect: more choice for non-urgent patients is associated with longer waits for emergency patients at lower values and shorter waits at higher values of degree of choice. Thus more choice of EDs for non-urgent patients is related to a longer wait for emergency (category 2) patients in EDs. The waiting time for emergency patients in hospital campuses with co-located GP clinics was 19% lower (1.5 min less) on average than for those waiting in campuses without co-located GP clinics. These findings suggest that diverting non-urgent (category 5) patients to an alternative model of care (co-located GP clinics) is a more effective demand management strategy and will reduce ED crowding.

  16. A Cross-Sectional Survey of Population-Wide Wait Times for Patients Seeking Medical vs. Cosmetic Dermatologic Care.

    Science.gov (United States)

    Yadav, Geeta; Goldberg, Hanna R; Barense, Morgan D; Bell, Chaim M

    2016-01-01

    Though previous work has examined some aspects of the dermatology workforce shortage and access to dermatologic care, little research has addressed the effect of rising interest in cosmetic procedures on access to medical dermatologic care. Our objective was to determine the wait times for Urgent and Non-Urgent medical dermatologic care and Cosmetic dermatology services at a population level and to examine whether wait times for medical care are affected by offering cosmetic services. A population-wide survey of dermatology practices using simulated calls asking for the earliest appointment for a Non-Urgent, Urgent and Cosmetic service. Response rates were greater than 89% for all types of care. Wait times across all types of care were significantly different from each other (all P Cosmetic care was associated with the shortest wait times (3.0 weeks; Interquartile Range (IQR) = 0.4-3.4), followed by Urgent care (9.0 weeks; IQR = 2.1-12.9), then Non-Urgent Care (12.7 weeks; IQR = 4.4-16.4). Wait times for practices offering only Urgent care were not different from practices offering both Urgent and Cosmetic care (10.3 vs. 7.0 weeks). Longer wait times and greater variation for Urgent and Non-Urgent dermatologic care and shorter wait times and less variation for Cosmetic care. Wait times were significantly longer in regions with lower dermatologist density. Provision of Cosmetic services did not increase wait times for Urgent care. These findings suggest an overall dermatology workforce shortage and a need for a more streamlined referral system for dermatologic care.

  17. Anomalous transport in fluid field with random waiting time depending on the preceding jump length

    International Nuclear Information System (INIS)

    Zhang Hong; Li Guo-Hua

    2016-01-01

    Anomalous (or non-Fickian) transport behaviors of particles have been widely observed in complex porous media. To capture the energy-dependent characteristics of non-Fickian transport of a particle in flow fields, in the present paper a generalized continuous time random walk model whose waiting time probability distribution depends on the preceding jump length is introduced, and the corresponding master equation in Fourier–Laplace space for the distribution of particles is derived. As examples, two generalized advection-dispersion equations for Gaussian distribution and lévy flight with the probability density function of waiting time being quadratic dependent on the preceding jump length are obtained by applying the derived master equation. (paper)

  18. Anomalous transport in fluid field with random waiting time depending on the preceding jump length

    Science.gov (United States)

    Zhang, Hong; Li, Guo-Hua

    2016-11-01

    Anomalous (or non-Fickian) transport behaviors of particles have been widely observed in complex porous media. To capture the energy-dependent characteristics of non-Fickian transport of a particle in flow fields, in the present paper a generalized continuous time random walk model whose waiting time probability distribution depends on the preceding jump length is introduced, and the corresponding master equation in Fourier-Laplace space for the distribution of particles is derived. As examples, two generalized advection-dispersion equations for Gaussian distribution and lévy flight with the probability density function of waiting time being quadratic dependent on the preceding jump length are obtained by applying the derived master equation. Project supported by the Foundation for Young Key Teachers of Chengdu University of Technology, China (Grant No. KYGG201414) and the Opening Foundation of Geomathematics Key Laboratory of Sichuan Province, China (Grant No. scsxdz2013009).

  19. A modelling framework for mitigating customers' waiting time at a vehicle inspection centre

    Science.gov (United States)

    Ahmad, Norazura; Abidin, Norhaslinda Zainal; Ilyas, Khibtiyah; Abduljabbar, Waleed Khalid

    2017-11-01

    In Malaysia, an agency that is entrusted by the Government to perform mandatory vehicle inspection for public, commercial and private vehicles, receive many customers daily. Often complaints of problems received from the customers are associated with waiting time that leads to lost of business and dissatisfied customers. To address this issue, we propose a framework for modelling a vehicle inspection system using an integration of simulation and optimization approaches. The strengths of simulation and optimization are reviewed briefly that is hoped to reveal the synergy between the established methods in determining an appropriate customer's waiting time for inspection at a vehicle inspection centre. Relevant concepts and preliminary results are also presented and discussed in this paper.

  20. Vibrant Energy Aware Spray and Wait Routing in Delay Tolerant Network

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    Viren G. Patel

    2013-01-01

    Full Text Available Delay tolerant networks (DTN are wireless networks where disconnections arise often due to the mobility of nodes, failures of energy, the low density of nodes, or when the network extends over long distances. In these situations, traditional routing protocols that have been developed for mobile ad hoc networks prove to be unsuccessful to the scope of transmitting messages between nodes. The Spray and Wait routing may achieve low routing and energy efficiency due to the blindness in the spray phase. To deal with this situation, we propose an opportunistic routing with enclosed message copies, called the Vibrant Energy aware Spray and Wait (VESW, which utilizes the information about vibrancy of node and remaining energy to allocate the number of copies between the corresponding pair nodes in the spray phase.

  1. Prescription duration and treatment episodes in oral glucocorticoid users: application of the parametric waiting time distribution

    DEFF Research Database (Denmark)

    Laugesen, Kristina; Støvring, Henrik; Hallas, Jesper

    2017-01-01

    for oral glucocorticoids and to describe continuous treatment episodes using the parametric waiting time distribution. Methods: We used Danish nationwide registries to identify all prescriptions for oral glucocorticoids during 1996-2014. We applied the parametric waiting time distribution to estimate...... duration of individual prescriptions each year by estimating the 80th, 90th, 95th and 99th percentiles for the interarrival distribution. These corresponded to the time since last prescription during which 80%, 90%, 95% and 99% of users presented a new prescription for redemption. We used the Kaplan...... of the interarrival distribution to apply as prescription duration has an impact on the level of misclassification. Use of the 80th percentile provides a measure of drug exposure that is specific, while the 99th percentile provides a sensitive measure....

  2. Analyzing patient's waiting time in emergency & trauma department in public hospital - A case study

    Science.gov (United States)

    Roslan, Shazwa; Tahir, Herniza Md; Nordin, Noraimi Azlin Mohd; Zaharudin, Zati Aqmar

    2014-09-01

    Emergency and Trauma Department (ETD) is an important element for a hospital. It provides medical service, which operates 24 hours a day in most hospitals. However overcrowding is not exclusion for ETD. Overflowing occurs due to affordable services provided by public hospitals, since it is funded by the government. It is reported that a patient attending ETD must be treated within 90 minutes, in accordance to achieve the Key Performance Indicator (KPI). However, due to overcrowd situations, most patients have to wait longer than the KPI standard. In this paper, patient's average waiting time is analyzed. Using Chi-Square Test of Goodness, patient's inter arrival per hour is also investigated. As conclusion, Monday until Wednesday was identified as the days that exceed the KPI standard while Chi-Square Test of Goodness showed that the patient's inter arrival is independent and random.

  3. Evaluation of wet-cupping therapy for persistent non-specific low back pain: a randomised, waiting-list controlled, open-label, parallel-group pilot trial

    Directory of Open Access Journals (Sweden)

    Kim Kun

    2011-06-01

    Full Text Available Abstract Background Persistent non-specific low back pain (PNSLBP is one of the most frequently experienced types of back pain around the world. Wet-cupping is a common intervention for various pain conditions, especially in Korea. In this context, we conducted a pilot study to determine the effectiveness and safety of wet-cupping treatment for PNSLBP. Methods We recruited 32 participants (21 in the wet-cupping group and 11 in the waiting-list group who had been having PNSLBP for at least 3 months. The participants were recruited at the clinical research centre of the Korea Institute of Oriental Medicine, Korea. Eligible participants were randomly allocated to wet-cupping and waiting-list groups. Following the practice of traditional Korean medicine, the treatment group was provided with wet-cupping treatment at two acupuncture points among the BL23, BL24 and BL25 6 times within 2 weeks. Usual care, including providing brochures for exercise, general advice for PNSLBP and acetaminophen, was allowed in both groups. Separate assessors participated in the outcome assessment. We used the 0 to100 numerical rating scale (NRS for pain, the McGill Pain Questionnaire for pain intensity (PPI and the Oswestry Disability Questionnaire (ODQ, and we assessed acetaminophen use and safety issues. Results The results showed that the NRS score for pain decreased (-16.0 [95% CI: -24.4 to -7.7] in the wet-cupping group and -9.1 [-18.1 to -0.1] in the waiting-list group, but there was no statistical difference between the groups (p = 0.52. However, the PPI scores showed significant differences between the two groups (-1.2 [-1.6 to -0.8] for the wet-cupping group and -0.2 [-0.8 to 0.4] for the waiting-list group, p Conclusion This pilot study may provide preliminary data on the effectiveness and safety of wet-cupping treatments for PNSLBP. Future full-scale randomised controlled trials will be needed to provide firm evidence of the effectiveness of this intervention

  4. Management of surgical waiting lists through a Possibilistic Linear Multiobjective Programming problem

    OpenAIRE

    Pérez Gladish, Blanca María; Arenas Parra, María del Mar; Bilbao Terol, Amelia María; Rodríguez Uria, María Victoria

    2005-01-01

    This study attempts to apply a management science technique to improve the efficiency of Hospital Administration. We aim to design the performance of the surgical services at a Public Hospital that allows the Decision-Maker to plan surgical scheduling over one year in order to reduce waiting lists. Real decision problems usually involve several objectives that have parameters which are often given by the decision maker in an imprecise way. It is possible to handle these kinds of problems ...

  5. The influence of parametric and external noise in act-and-wait control with delayed feedback.

    Science.gov (United States)

    Wang, Jiaxing; Kuske, Rachel

    2017-11-01

    We apply several novel semi-analytic approaches for characterizing and calculating the effects of noise in a system with act-and-wait control. For concrete illustration, we apply these to a canonical balance model for an inverted pendulum to study the combined effect of delay and noise within the act-and-wait setting. While the act-and-wait control facilitates strong stabilization through deadbeat control, a comparison of different models with continuous vs. discrete updating of the control strategy in the active period illustrates how delays combined with the imprecise application of the control can seriously degrade the performance. We give several novel analyses of a generalized act-and-wait control strategy, allowing flexibility in the updating of the control strategy, in order to understand the sensitivities to delays and random fluctuations. In both the deterministic and stochastic settings, we give analytical and semi-analytical results that characterize and quantify the dynamics of the system. These results include the size and shape of stability regions, densities for the critical eigenvalues that capture the rate of reaching the desired stable equilibrium, and amplification factors for sustained fluctuations in the context of external noise. They also provide the dependence of these quantities on the length of the delay and the active period. In particular, we see that the combined influence of delay, parametric error, or external noise and on-off control can qualitatively change the dynamics, thus reducing the robustness of the control strategy. We also capture the dependence on how frequently the control is updated, allowing an interpolation between continuous and frequent updating. In addition to providing insights for these specific models, the methods we propose are generalizable to other settings with noise, delay, and on-off control, where analytical techniques are otherwise severely scarce.

  6. Straight to flexible sigmoidoscopy: rationalization of 2-week wait referrals in suspected colorectal cancer.

    Science.gov (United States)

    Couch, D G; Murphy, J H; Boyle, K M; Hemingway, D M

    2015-11-01

    The 2-week wait pathway was designed to decrease the time from presentation to primary care of patients with 'red flag' symptoms of suspected cancer for review by a specialist for the diagnosis or exclusion of cancer. In our tertiary referral centre we have found that 968 colonoscopies per year are required to satisfy the demand for the 2-week wait, leading to limited colonoscopy availability for other services. We sought to determine the yield of colorectal cancer found at colonoscopy referred via the 2-week wait and referenced to the original red flag symptoms. This was in order to select the most efficacious alternative primary investigation based upon presenting symptoms. Electronic records were retrospectively analysed. All patients who went through the 2-week wait for suspicion of colorectal cancer in 2013 and were found to have colorectal cancer on colonoscopy were included. Patients not undergoing colonoscopy as the first investigation were excluded. The splenic flexure was deemed to be within the range of a flexible sigmoidoscope. In all, 2950 referrals were made. 968 colonoscopies were performed as the primary investigation of which 35 were found to have colorectal cancer. No patients referred with rectal bleeding and another symptom had a tumour more proximal to the range of flexible sigmoidoscopy. 80% of tumours proximal to the splenic flexure were suitable for CT diagnosis alone. Our data support the use of flexible sigmoidoscopy alone as an initial investigation for patients presenting with rectal bleeding with or without additional colorectal symptoms. Patients with anaemia (without bleeding) or change in bowel habit (without bleeding) may be investigated with CT colonography alone; colonoscopy may then be used selectively prior to surgery. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

  7. Waiting-time distributions of magnetic discontinuities: Clustering or Poisson process?

    International Nuclear Information System (INIS)

    Greco, A.; Matthaeus, W. H.; Servidio, S.; Dmitruk, P.

    2009-01-01

    Using solar wind data from the Advanced Composition Explorer spacecraft, with the support of Hall magnetohydrodynamic simulations, the waiting-time distributions of magnetic discontinuities have been analyzed. A possible phenomenon of clusterization of these discontinuities is studied in detail. We perform a local Poisson's analysis in order to establish if these intermittent events are randomly distributed or not. Possible implications about the nature of solar wind discontinuities are discussed.

  8. Fine-scale substrate use by a small sit-and-wait predator

    OpenAIRE

    Douglass H. Morse

    2006-01-01

    Substrate choice is one of the most important decisions that sit-and-wait predators must make. Not only may it dictate the prey available but also the cover for the predator which may conceal it from prey or its own predators. However, while on a particular substrate the behavior and use of that substrate may vary widely. When naïve, newly emerged crab spiderlings Misumena vatia (Thomisidae) occupied flowering goldenrod Solidago canadensis, their behavior differed markedly on inflorescences w...

  9. Passenger arrival and waiting time distributions dependent on train service frequency and station characteristics: A smart card data analysis

    DEFF Research Database (Denmark)

    Ingvardson, Jesper Bláfoss; Nielsen, Otto Anker; Raveau, Sebastián

    2018-01-01

    Waiting time at public transport stops is perceived by passengers to be more onerous than in-vehicle time, hence it strongly influences the attractiveness and use of public transport. Transport models traditionally assume that average waiting times are half the service headway by assuming random...... Copenhagen Area covering metro, suburban, and regional rail stations thereby giving a range of service headways from 2 to 60 min. It was shown that the proposed mixture distribution is superior to other distributions proposed in the literature. This can improve waiting time estimations in public transport...

  10. Waiting is the hardest part: anticipating medical test results affects processing and recall of important information.

    Science.gov (United States)

    Portnoy, David B

    2010-07-01

    Waiting for medical test results that signal physical harm can be a stressful and potentially psychologically harmful experience. Despite this, interventionists and physicians often use this wait time to deliver behavior change messages and other important information about the test, possible results and its implications. This study examined how "bracing" for a medical test result impacts cognitive processing, as well as recall of information delivered during this period. Healthy U.S. university students (N = 150) were tested for a deficiency of a fictitious saliva biomarker that was said to be predictive of long-term health problems using a 2 (Test Result) x 2 (Expected immediacy of result: 10 min, 1 month) factorial design. Participants expecting to get the test result shortly should have been bracing for the result. While waiting for the test results participants completed measures of cognitive processing. After participants received the test result, recall of information about the biomarker was tested in addition to cognitive measures. One week later, participants who were originally told they did not have the deficiency had their recall assessed again. Results showed that anticipating an imminent test result increased cognitive distraction in the processing of information and lowered recall of information about the test and the biomarker. These results suggest that delivering critical information to patients after administering a test and immediately before giving the results may not be optimal.

  11. The evaluation of a formalized queue management system for coronary angiography waiting lists.

    Science.gov (United States)

    Alter, D A; Newman, Alice M; Cohen, Eric A; Sykora, Kathy; Tu, Jack V

    2005-11-01

    Lengthy waiting lists for coronary angiography have been described in many health care systems worldwide. The extent to which formal queue management systems may improve the prioritization and survival of patients in the angiography queue is unknown. To prospectively evaluate the performance of a formal queue management system for patients awaiting coronary angiography in Ontario. The coronary angiography urgency scale, a formal queue management system developed in 1993 using a modified Delphi panel, allocates recommended maximum waiting times (RMWTs) in accordance with clinical necessity. By using a provincial clinical registry, 35,617 consecutive patients referred into the coronary angiography queue between April 1, 2001, and March 31, 2002, were prospectively tracked. Cox proportional hazards models were used to examined mortality risk across urgency after adjusting for additional clinical and comorbid factors. Good agreement was determined in urgency ratings between scores from the coronary angiography urgency scale and implicit physician judgement, which was obtained independently at the time of the index referral (weighted kappa = 0.49). The overall mortality in the queue was 0.3% (0.47%, 0.26% and 0.13% for urgent, semiurgent and elective patients, respectively). Urgency, as specified by the coronary angiography urgency scale, was the strongest predictor of death in the queue (Pqueue management system may decrease mortality in the coronary angiography queue. The authors recommend its implementation in health care systems where patients experience excessive waiting time delays for coronary angiography.

  12. Maternity waiting homes and institutional birth in Nicaragua: policy options and strategic implications.

    Science.gov (United States)

    García Prado, Ariadna; Cortez, Rafael

    2012-01-01

    With the aim of promoting institutional births and reducing the high maternal and child mortality rates in rural and poor zones, the government of Nicaragua is supporting the creation of maternity waiting homes. This study analyzes that strategy and examines the factors associated with the use of maternity waiting homes and institutional birth. To that end, we apply a quantitative approach, by means of an econometric analysis of the data extracted from surveys conducted in 2006 on a sample of women and parteras or traditional birth attendants, as well as a qualitative approach based on interviews with key informants. Results indicate that although the operation of the maternity waiting homes is usually satisfactory, there is still room for improvement along the following lines: (i) disseminating information about the homes to both women and men, as the latter frequently decide the course of women's healthcare, and to parteras, who can play an important role in referring women; (ii) strengthening the postpartum care; (iii) ensuring financial sustainability by obtaining regular financial support from the government to complement contributions from the community; and (iv) strengthening the local management and involvement of the regional government. These measures might be useful for health policy makers in Nicaragua and in other developing countries that are considering this strategy. Copyright © 2011 John Wiley & Sons, Ltd.

  13. [Patients' satisfaction and waiting time in oncology day care centers in Champagne-Ardenne].

    Science.gov (United States)

    Debreuve-Theresette, A; Jovenin, N; Stona, A C; Kraïem-Leleu, M; Burde, F; Parent, D; Hettler, D; Rey, J B

    2015-12-01

    Quality of life of patients suffering from cancer may be influenced by the way healthcare is organized and by patient experiences. Nowadays, chemotherapy is often provided in day care centers. This study aimed to assess patient waiting time and satisfaction in oncology day care centers in Champagne-Ardenne, France. This cross-sectional survey involved all patients receiving ambulatory chemotherapy during a one-week period in day care centers of Champagne-Ardenne public and private healthcare institutions participating in the study. Sociodemographic, medical and outpatient data were collected. Patient satisfaction was measured using the Out-Patsat35 questionnaire. Eleven (out of 16) oncology day care centers and 441 patients participated in the study. Most of the patients were women (n=252, 57.1%) and the mean age was 61±12 years. The mean satisfaction score was 82±14 (out of 100) and the mean waiting time between the assigned appointment time and administration of chemotherapy was 97±60 min. This study has shown that waiting times are important. However, patients are satisfied with the healthcare organization, especially regarding nursing support. Early preparation of chemotherapy could improve these parameters. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  14. Web-based stress management for newly diagnosed cancer patients (STREAM-1): a randomized, wait-list controlled intervention study.

    Science.gov (United States)

    Grossert, Astrid; Urech, Corinne; Alder, Judith; Gaab, Jens; Berger, Thomas; Hess, Viviane

    2016-11-03

    Being diagnosed with cancer causes major psychological distress, yet the majority of newly diagnosed cancer patients lack psychological support. Internet interventions overcome many barriers for seeking face-to-face support and allow for independence in time and place. We assess efficacy and feasibility of the first web-based stress management intervention (STREAM: STREss-Aktiv-Mindern) for newly diagnosed, German-speaking cancer patients. In a prospective, wait-list controlled trial 120 newly diagnosed cancer patients will be included within 12 weeks of starting anti-cancer treatment and randomized between an immediate (intervention group) or delayed (control group) 8-week, web-based intervention. The intervention consists of eight modules with weekly written feedback by a psychologist ("minimal-contact") based on well-established stress management manuals including downloadable audio-files and exercises. The aim of this study is to evaluate efficacy in terms of improvement in quality of life (FACT-F), as well as decrease in anxiety and depression (HADS), as compared to patients in the wait-list control group. A sample size of 120 patients allows demonstrating a clinically relevant difference of nine points in the FACT score after the intervention (T2) with a two-sided alpha of 0.05 and 80 % power. As this is the first online stress management intervention for German-speaking cancer patients, more descriptive outcomes are equally important to further refine the group of patients with the largest potential for benefit who then will be targeted more specifically in future trials. These descriptive endpoints include: patients' characteristics (type of cancer, type of treatment, socio-demographic factors), dropout rate and dropout reasons, adherence and satisfaction with the program. New technologies open new opportunities: minimal-contact psychological interventions are becoming standard of care in several psychological disorders, where their efficacy is often

  15. Evaluation of two dairy herd reproductive performance indicators that are adjusted for voluntary waiting period

    Directory of Open Access Journals (Sweden)

    Löf Emma

    2012-01-01

    Full Text Available Abstract Background Overall reproductive performance of dairy herds is monitored by various indicators. Most of them do not consider all eligible animals and do not consider different management strategies at farm level. This problem can be alleviated by measuring the proportion of pregnant cows by specific intervals after their calving date or after a fixed time period, such as the voluntary waiting period. The aim of this study was to evaluate two reproductive performance indicators that consider the voluntary waiting period at the herd. The two indicators were: percentage of pregnant cows in the herd after the voluntary waiting period plus 30 days (PV30 and percentage of inseminated cows in the herd after the voluntary waiting period plus 30 days (IV30. We wanted to assess how PV30 and IV30 perform in a simulation of herds with different reproductive management and physiology and to compare them to indicators of reproductive performance that do not consider the herd voluntary waiting period. Methods To evaluate the reproductive indicators we used the SimHerd-program, a stochastic simulation model, and 18 scenarios were simulated. The scenarios were designed by altering the reproductive management efficiency and the status of reproductive physiology of the herd. Logistic regression models, together with receiver operating characteristics (ROC, were used to examine how well the reproductive performance indicators could discriminate between herds of different levels of reproductive management efficiency or reproductive physiology. Results The logistic regression models with the ROC analysis showed that IV30 was the indicator that best discriminated between different levels of management efficiency followed by PV30, calving interval, 200-days not-in calf-rate (NotIC200, in calf rate at100-days (IC100 and a fertility index. For reproductive physiology the ROC analysis showed that the fertility index was the indicator that best discriminated

  16. Measurement of ground state properties of neutron-rich nuclei on the r-process path between the N=50 and N=82 shells

    CERN Multimedia

    2007-01-01

    The evolution of the unknown ground-state ${\\beta}$-decay properties of the neutron-rich $^{84-89}$Ge, $^{90-93}$Se and $^{102-104}$Sr isotopes near the r-process path is of high interest for the study of the abundance peaks around the N=50 and N=82 neutron shells. At ISOLDE, beams of certain elements with sufficient isotopic purity are produced as molecular sidebands rather than atomic beams. This applies e.g, to germanium, separated as GeS$^{+}$, selenium separated as SeCO$^{+}$ and strontium separated as SrF$^{+}$. However, in case of neutron-rich isotopes produced in actinide targets, new "isobaric" background of atomic ions appears on the mass of the molecular sideband. For this particular case, the ECR charge breeder, positioned in the experimental hall after ISOLDE first mass separation, can be advantageously used as a purification device, by breaking the molecules and removing the molecular contaminants. This proposal indicates our interest in the study of basic nuclear structure properties of neutron...

  17. s-process studies in the light of new experimental cross sections: Distribution of neutron fluences and r-process residuals

    International Nuclear Information System (INIS)

    Kaeppeler, F.; Beer, H.; Wisshak, K.; Clayton, D.D.; Macklin, R.L.; Ward, R.A.

    1981-08-01

    A best set of neutron-capture cross sections has been evaluated for the most important s-process isotopes. With this data base, s-process studies have been carried out using the traditional model which assumes a steady neutron flux and an exponential distribution of neutron irradiations. The calculated sigmaN-curve is in excellent agreement with the empirical sigmaN-values of pure s-process nuclei. Simultaneously, good agreement is found between the difference of solar and s-process abundances and the abundances of pure r-process nuclei. We also discuss the abundance pattern of the iron group elements where our s-process results complement the abundances obtained from explosive nuclear burning. The results obtained from the traditional s-process model such as seed abundances, mean neutron irradiations, or neutron densities are compared to recent stellar model calculations which assume the He-burning shells of red giant stars as the site for the s-process. (orig.) [de

  18. ADAPTATION OF JOHNSON SEQUENCING ALGORITHM FOR JOB SCHEDULING TO MINIMISE THE AVERAGE WAITING TIME IN CLOUD COMPUTING ENVIRONMENT

    Directory of Open Access Journals (Sweden)

    SOUVIK PAL

    2016-09-01

    Full Text Available Cloud computing is an emerging paradigm of Internet-centric business computing where Cloud Service Providers (CSPs are providing services to the customer according to their needs. The key perception behind cloud computing is on-demand sharing of resources available in the resource pool provided by CSP, which implies new emerging business model. The resources are provisioned when jobs arrive. The job scheduling and minimization of waiting time are the challenging issue in cloud computing. When a large number of jobs are requested, they have to wait for getting allocated to the servers which in turn may increase the queue length and also waiting time. This paper includes system design for implementation which is concerned with Johnson Scheduling Algorithm that provides the optimal sequence. With that sequence, service times can be obtained. The waiting time and queue length can be reduced using queuing model with multi-server and finite capacity which improves the job scheduling model.

  19. The association between waiting for psychological therapy and therapy outcomes as measured by the CORE-OM.

    Science.gov (United States)

    Beck, Alison; Burdett, Mark; Lewis, Helen

    2015-06-01

    To investigate the impact of waiting for psychological therapy on client well-being as measured by the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) global distress (GD) score. Global distress scores were retrieved for all clients referred for psychological therapy in a secondary care mental health service between November 2006 and May 2013 and who had completed a CORE-OM at assessment and first session. GD scores for a subgroup of 103 clients who had completed a CORE-OM during the last therapy session were also reviewed. The study sample experienced a median wait of 41.14 weeks between assessment and first session. The relationship between wait time from referral acceptance to assessment, and assessment GD score was not significant. During the period between assessment and first session no significant difference in GD score was observed. Nevertheless 29.1% of the sample experienced reliable change; 16.0% of clients reliably improved and 13.1% reliably deteriorated whilst waiting for therapy. Demographic factors were not found to have a significant effect on the change in GD score between assessment and first session. Waiting time was associated with post-therapy outcomes but not to a degree which was meaningful. The majority of individuals (54.4%), regardless of whether they improved or deteriorated whilst waiting for therapy, showed reliable improvement at end of therapy as measured by the CORE-OM. The majority of GD scores remained stable while waiting for therapy; however, 29.1% of secondary care clients experienced either reliable improvement or deterioration. Irrespective of whether they improved, deteriorated or remained unchanged whilst waiting for therapy, most individuals who had a complete end of therapy assessment showed reliable improvements following therapy. There was no significant difference in GD score between assessment and first session recordings. A proportion of clients (29.1%) showed reliable change, either improvement or

  20. Hospital Capacity, Waiting Times and Sick Leave Duration - an Empirical Analysis of a Norwegian Health Policy Reform

    OpenAIRE

    Aakvik, Arild; Holmås, Tor Helge; Kjerstad, Egil

    2012-01-01

    A health policy reform aiming to reduce hospital waiting times and sickness absences, the Faster Return to Work (FRW) scheme, is evaluated by creating treatment and control groups to facilitate causal interpretations of the empirical results. We use a unique dataset on individuals where we match hospital data with social security data and socio-economic characteristics. The main idea behind the reform is that long waiting times for hospital treatment lead to unnecessarily long periods of sick...

  1. IS WAITING THE HARDEST PART? A CRITICAL STUDY OF THE EXPERIENCE OF WOMEN AWAITING BREAST BIOPSY RESULTS.

    Science.gov (United States)

    Hodgkinson, T; Govender, C; Rayne, S

    2017-06-01

    Most previous research efforts have focused on the psychological effects of receiving a cancer diagnosis rather than the period of waiting for definitive Results. Early detection of cancer is directly linked to successful treatment regimes, yet these procedures evoke significant anxiety in patients. The long wait for medical test Results in state health institutions, with one of the possible outcomes being a cancer diagnosis, means that the days of waiting can induce emotional distress before the diagnosis has even been given. Eight research collaborators were invited to, in their own voice, shed light on their individual experiences while waiting for their biopsy Results to gain an understanding of the experiences of each collaborator by letting her tell her story and to explore the possibility of shared experience between collaborators. Research collaborators at a local, government hospital kept a journal for the two-week waiting period for their biopsy Results. Shortly before receiving their Results, they took part in a short semi-structured interview to inquire about their waiting. The theoretical framework used for data interpretation is critical theory focusing on the structures within society and healthcare systems that impact on the experience of waiting. The undercurrent of critical commentary about the roles of the gender, economic, political and cultural factors that contribute to the screening experience for women in South Africa helps to shed light on the complex forces at play within the procedures. The Results indicate that for some women waiting provokes significant psychological stress which manifests in multiple psychological processes including the psychological bracing phenomenon, denial, suppression and negation of their emotional experience all perpetuated by the structures of power within the health care system. More understanding of the psychological experience of awaiting a cancer diagnosis is required and there is an important place for

  2. A Study to Determine Patient Waiting Time at the Outpatient Pharmacy at Wilford Hall USAF Medical Center

    Science.gov (United States)

    1988-06-01

    at Wilford Hall USAF Medical Center significantly reduced the patient wait time at the main outpatient pharmacy. Satellite pharmacies have been ).’l...PRESENTING TO WINDOW 1, 19 MAR 88. 47 C:. A’.’E-:A: -ESCRIRTIONS PER PATIENT ...........48 H. WILFORD HALL MEDICAL CENTER OUTPATIENT QUESTIONNAIRE...that wait times at tne outpatient pharmacy were excessive. It was this concern that motivated the Medical Center Administrator to request that patient

  3. A Cross-Sectional Survey of Population-Wide Wait Times for Patients Seeking Medical vs. Cosmetic Dermatologic Care

    Science.gov (United States)

    Yadav, Geeta; Goldberg, Hanna R.; Barense, Morgan D.; Bell, Chaim M.

    2016-01-01

    Background Though previous work has examined some aspects of the dermatology workforce shortage and access to dermatologic care, little research has addressed the effect of rising interest in cosmetic procedures on access to medical dermatologic care. Our objective was to determine the wait times for Urgent and Non-Urgent medical dermatologic care and Cosmetic dermatology services at a population level and to examine whether wait times for medical care are affected by offering cosmetic services. Methods A population-wide survey of dermatology practices using simulated calls asking for the earliest appointment for a Non-Urgent, Urgent and Cosmetic service. Results Response rates were greater than 89% for all types of care. Wait times across all types of care were significantly different from each other (all P dermatologic care and shorter wait times and less variation for Cosmetic care. Wait times were significantly longer in regions with lower dermatologist density. Provision of Cosmetic services did not increase wait times for Urgent care. These findings suggest an overall dermatology workforce shortage and a need for a more streamlined referral system for dermatologic care. PMID:27632206

  4. Normas, justiça, atribuição e poder: uma revisão e agenda de pesquisa sobre filas de espera Norms, justice, attribution and power: a revision and research agenda about waiting lines

    Directory of Open Access Journals (Sweden)

    Fabio Iglesias

    2007-04-01

    Full Text Available Partindo do pressuposto de que a fila de espera é um sistema social, são analisados brevemente sua natureza e seus tipos de ocorrência. Quatro temáticas da psicologia social que podem ser usadas para abordar os fenômenos de comportamento envolvidos em filas são analisadas: (a normas sociais e influência social; (b justiça, em suas vertentes distributiva, processual e interacional; (c atribuição de causalidade; (d relações de poder e de status. Como agenda de pesquisa, são identificadas ainda as lacunas empíricas em cada uma dessas temáticas, considerando a relevância teórica e prática dos problemas relacionados a situações reais de atendimento por filas de espera.Considering waiting lines as social systems, a short analysis of the nature and types of queues is presented. Four themes of social psychology are used to analyze behavior in waiting lines: (a social norms and social influence, (b distributive, procedural and interactional justice, (c causal attribution, and (d relations of power and status. Possible topics of research are pointed out in each of these themes, considering the theoretical and applied relevance of problems involving real waiting line situations.

  5. Role of Erosion in Shaping Point Bars

    Science.gov (United States)

    Moody, J.; Meade, R.

    2012-04-01

    A powerful metaphor in fluvial geomorphology has been that depositional features such as point bars (and other floodplain features) constitute the river's historical memory in the form of uniformly thick sedimentary deposits waiting for the geomorphologist to dissect and interpret the past. For the past three decades, along the channel of Powder River (Montana USA) we have documented (with annual cross-sectional surveys and pit trenches) the evolution of the shape of three point bars that were created when an extreme flood in 1978 cut new channels across the necks of two former meander bends and radically shifted the location of a third bend. Subsequent erosion has substantially reshaped, at different time scales, the relic sediment deposits of varying age. At the weekly to monthly time scale (i.e., floods from snowmelt or floods from convective or cyclonic storms), the maximum scour depth was computed (by using a numerical model) at locations spaced 1 m apart across the entire point bar for a couple of the largest floods. The maximum predicted scour is about 0.22 m. At the annual time scale, repeated cross-section topographic surveys (25 during 32 years) indicate that net annual erosion at a single location can be as great as 0.5 m, and that the net erosion is greater than net deposition during 8, 16, and 32% of the years for the three point bars. On average, the median annual net erosion was 21, 36, and 51% of the net deposition. At the decadal time scale, an index of point bar preservation often referred to as completeness was defined for each cross section as the percentage of the initial deposit (older than 10 years) that was still remaining in 2011; computations indicate that 19, 41, and 36% of the initial deposits of sediment were eroded. Initial deposits were not uniform in thickness and often represented thicker pods of sediment connected by thin layers of sediment or even isolated pods at different elevations across the point bar in response to multiple

  6. A web-based appointment system to reduce waiting for outpatients: a retrospective study.

    Science.gov (United States)

    Cao, Wenjun; Wan, Yi; Tu, Haibo; Shang, Fujun; Liu, Danhong; Tan, Zhijun; Sun, Caihong; Ye, Qing; Xu, Yongyong

    2011-11-22

    Long waiting times for registration to see a doctor is problematic in China, especially in tertiary hospitals. To address this issue, a web-based appointment system was developed for the Xijing hospital. The aim of this study was to investigate the efficacy of the web-based appointment system in the registration service for outpatients. Data from the web-based appointment system in Xijing hospital from January to December 2010 were collected using a stratified random sampling method, from which participants were randomly selected for a telephone interview asking for detailed information on using the system. Patients who registered through registration windows were randomly selected as a comparison group, and completed a questionnaire on-site. A total of 5641 patients using the online booking service were available for data analysis. Of them, 500 were randomly selected, and 369 (73.8%) completed a telephone interview. Of the 500 patients using the usual queuing method who were randomly selected for inclusion in the study, responses were obtained from 463, a response rate of 92.6%. Between the two registration methods, there were significant differences in age, degree of satisfaction, and total waiting time (P0.05). Being ignorant of online registration, not trusting the internet, and a lack of ability to use a computer were three main reasons given for not using the web-based appointment system. The overall proportion of non-attendance was 14.4% for those using the web-based appointment system, and the non-attendance rate was significantly different among different hospital departments, day of the week, and time of the day (Pweb-based appointment system could significantly increase patient's satisfaction with registration and reduce total waiting time effectively. However, further improvements are needed for broad use of the system.

  7. The Effectiveness Analysis of Waiting Processes in the Different Branches of a Bank by Queue Model

    Directory of Open Access Journals (Sweden)

    Abdullah ÖZÇİL

    2015-06-01

    Full Text Available Despite the appreciable increase in the number of bank branches every year, nowadays queues for services don’t decrease and even become parts of our daily lives. By minimizing waiting processes the least, increasing customer satisfaction should be one of branch managers’ main goals. A quick and also customer oriented service with high quality is the most important factor for customer loyalty. In this study, Queueing theory, one of Operation Research techniques, is handled and in application, the data are obtained related to waiting in queue of customer in six different branches of two banks operating in Denizli and then they are analyzed by Queueing theory and also calculated the average effectiveness of the system. The study’s data are obtained by six branches of two banks called as A1, A2, A3, B1, B2 and B3. At the end of study it is presented to the company some advices that can bring benefits to the staff and customers. In this study, Queueing theory, one of Operation Research techniques, is handled and in application, the data are obtained related to waiting in queue of customer in three different branches of a bank operating in Denizli and then they are analyzed by Queueing theory and also calculated the average effectiveness of the system. The study’s data are obtained by three branches of the bank called A1, A2 and A3. At last it is presented to the company some advices that can bring more benefits to the staff and clients.

  8. Quality of life in patients with unilateral vestibular schwannoma on wait and see - strategy.

    Science.gov (United States)

    Klersy, P C; Arlt, F; Hofer, M; Meixensberger, J

    2018-01-01

    A 'wait and see' strategy is an option when managing patients with small vestibular schwannomas (VS). A risk of growth and worsening of hearing may influence a patient's daily quality of life (QOL). Therefore, the present study focused on QOL parameters in patients who are on a 'wait and see' strategy following magnetic resonance imaging (MRI)-based diagnosis of small unilateral VS. Sixty-five patients (mean age 64.4 years; male:female, 32:33) who suffered from a small unilateral VS (9.34 mm, range 1.5-23 mm) between 2013 and 2016 were included in a prospective single center study. During follow-up, in addition to clinical and neurological examinations and MRI imaging, all patients answered the Short Form 36 questionnaire once to characterize QOL. Additionally, the severity of tinnitus was determined by the Mini-TQ-12 from Hiller and Goebel. It was found during follow-up that there was no lowering of QOL in patients with small VS who were on 'wait and see' strategy compared with Germany's general population and no tumor growth was detected in 53 patients (81.5%). Patients with a tumor diameter larger than 10 mm did not suffer from stronger tinnitus, vertigo or unsteadiness than the group with an average tumor size, which is smaller than 10 mm. Sixty-two patients (95.4%) showed ipsilateral hearing loss and three of these reported deafness (4.6%). Severe vertigo or tinnitus is connected with lower levels of mental component scale and physical component scale. These findings reduced the QOL (p = 0.05). In our series, QOL is not influenced in patients with unilateral untreated small VS in comparison to Germany's general population. This is helpful information when advising patients during follow-up and finding out the optimal timing of individual treatment.

  9. Syria: a waited petroleum production of 600 000 barrels per day for the end of 1993

    International Nuclear Information System (INIS)

    Anon.

    1993-01-01

    This paper describes the reserves of petroleum deposits and gives statistical data on the production of the main oil fields in Syria. Petroleum production has grown from 160000 barrels per day in 1984 to 515000 barrels per day in 1992 and a production at a level of 600000 barrels per day is waited in 1993. Several petroleum companies, operating in Syria, have contributed to this rise, especially Al-Furat Petroleum Company (AFPC), joint venture between Syrian Petroleum Company (SPC) and Pecten/Shell/Deminex, followed by Deiz Ezzor Petroleum Company (DEZPC), association between the french company Elf Aquitaine and SPC. 2 tabs

  10. Mandatory waiting periods and biased abortion counseling in Central and Eastern Europe.

    Science.gov (United States)

    Hoctor, Leah; Lamačková, Adriana

    2017-11-01

    Several Central and Eastern European countries have recently enacted retrogressive laws and policies introducing new preconditions that women must fulfill before they can obtain legal abortion services. Mandatory waiting periods and biased counseling and information requirements are particularly common examples of these new prerequisites. The present article considers these requirements in light of international human rights standards and public health guidelines, and outlines the manner in which, by imposing regressive barriers on women's access to legal abortion services, these new laws and policies undermine women's health and well-being, fail to respect women's human rights, and reinforce harmful gender stereotypes and abortion stigma. © 2017 International Federation of Gynecology and Obstetrics.

  11. Plants are not sitting ducks waiting for herbivores to eat them.

    Science.gov (United States)

    Lev-Yadun, Simcha

    2016-05-03

    There is a common attitude toward plants, accordingly, plants are waiting around to be found and eaten by herbivores. This common approach toward plants is a great underestimation of the huge and variable arsenal of defensive plant strategies. Plants do everything evolution has allowed them to do in order not to be eaten. Therefore, plants are not sitting ducks and many plants outsmart and even exploit many invertebrate and vertebrate herbivores and carnivores for pollination and for seed dispersal, and even carnivores and parasitoids for defense.

  12. Reliable blood pressure self-measurement in the obstetric waiting room

    DEFF Research Database (Denmark)

    Wagner, Stefan; Kamper, C. H.; Rasmussen, Niels H

    2014-01-01

    Background: Patients often fail to adhere to clinical recommendations when using current blood pressure self-measurement (BPSM) methods and equipment. As existing BPSM equipment is not able to detect non-adherent behavior, this could result in misdiagnosis and treatment error. To overcome...... patients scheduled for self-measuring their blood pressure (BP) in the waiting room at an obstetrics department's outpatient clinic to perform an additional BPSM using ValidAid. We then compared the automatically measured and classified values from ValidAid with our manual observations. Results: We found...

  13. Waiting time distribution for the first conception leading to a live birth

    International Nuclear Information System (INIS)

    Shrestha, G.; Biswas, S.

    1985-01-01

    An attempt has been made in this paper to obtain probability model describing the distribution of the waiting time from marriage to first conception based on the data from marriage to first live birth. The speciality of this present approach lies in assuming the marital exposure to be finite which was assumed to be infinite by most of the earlier investigators for mathematical simplicity. Illustration of the applicability of the model on the data pertaining to first order of conception and monthly probability of conception for women married at different age groups have been illustrated in this paper. (author)

  14. Optimal Research and Numerical Simulation for Scheduling No-Wait Flow Shop in Steel Production

    Directory of Open Access Journals (Sweden)

    Huawei Yuan

    2013-01-01

    Full Text Available This paper considers the m-machine flow shop scheduling problem with the no-wait constraint to minimize total completion time which is the typical model in steel production. First, the asymptotic optimality of the Shortest Processing Time (SPT first rule is proven for this problem. To further evaluate the performance of the algorithm, a new lower bound with performance guarantee is designed. At the end of the paper, numerical simulations show the effectiveness of the proposed algorithm and lower bound.

  15. Vantage point - A private matter.

    Science.gov (United States)

    McCrae, Niall

    2015-12-01

    IMAGINE THAT you have been struggling with depression and your doctor has referred you for cognitive behaviour therapy (CBT). Such treatment is provided on the NHS through the Improving Access to Psychological Therapies (IAPT) programme. But there is a catch; you have been placed on a three-month waiting list.

  16. Gender and socioeconomic status as determinants of waiting time for inpatient surgery in a system with implicit queue management.

    Science.gov (United States)

    Arnesen, Kjell E; Erikssen, Jan; Stavem, Knut

    2002-12-01

    In a system with implicit queue management, to examine gender and socioeconomic status as determinants of waiting time for inpatient surgery, after adjusting for other potential predictors. A cohort of 452 subjects was examined in outpatient clinics of a general hospital and referred to inpatient surgery. They were followed until scheduled hospital admission (n=396) or until the requested procedure no longer was relevant (n=56). We compared waiting time between groups from referral date until hospital admission, using Kaplan-Meier estimates of waiting times and log rank test. A Cox proportional hazards model was used for assessing the risk ratio (RR) of hospital admission for scheduled surgery. Gender and socioeconomic status could not explain variations in waiting time. However, patients with suspected/verified neoplastic disease or a risk of serious deterioration without treatment had markedly shorter waiting times than the reference groups, with adjusted RR (95% confidence intervals (95%CI)) of time to receiving in-patient surgery of 2.3 (1.7-3.0) and 2.0 (1.3-3.0), respectively. Being on sick leave was associated with shorter waiting time, adjusted RR of 1.7 (1.2-2.5). Referrals from within the hospital or other hospitals had also shorter waiting times than referrals from primary health care physicians, adjusted RR=1.4 (1.1-1.8). There was no evidence of bias against women or people in lower socioeconomic classes in this implicit queue management system. However, patients' access to inpatient surgery was associated with malignancy, prognosis, sick leave status, physician experience, referral pattern and the major diagnosis category.

  17. The End of Points

    Science.gov (United States)

    Feldman, Jo

    2018-01-01

    Have teachers become too dependent on points? This article explores educators' dependency on their points systems, and the ways that points can distract teachers from really analyzing students' capabilities and achievements. Feldman argues that using a more subjective grading system can help illuminate crucial information about students and what…

  18. Demerit points systems.

    NARCIS (Netherlands)

    2006-01-01

    In 2012, 21 of the 27 EU Member States had some form of demerit points system. In theory, demerit points systems contribute to road safety through three mechanisms: 1) prevention of unsafe behaviour through the risk of receiving penalty points, 2) selection and suspension of the most frequent

  19. Emergency department waiting room stress: can music or aromatherapy improve anxiety scores?

    Science.gov (United States)

    Holm, Lydia; Fitzmaurice, Laura

    2008-12-01

    The aim of this study was to determine the effect of music alone, aromatherapy alone, and music in addition to aromatherapy on anxiety levels of adults accompanying children to a pediatricemergency department waiting area. The study was conducted over 28 consecutive days, assigned to 1 of 4 groups: no intervention, music, aromatherapy, and both music and aromatherapy. Adults accompanying children to the emergency department of an urban pediatric tertiary care referral center were given a survey including a Spielberger state anxiety inventory with additional questions about whether they noticed an aroma or music and if so their response to it. The music was classic ingenre with a tempo of 60 to 70 beats per minute. The aromatherapyused the essential oil Neroli dispersed using 2 aromatherapydiffusers placed in strategic airflow ends of the emergency department. The 1104 surveys were completed. There was a statistically significant decrease in anxietylevel on those days when music was playing (36.3 vs. 39.2; P = 0.017). There was no difference in anxiety levels on those days when aromatherapy was present compared with the nonaromatherapy days (37.3 vs. 38.0; P = 0.347). Music is an easy and useful way to decrease the anxiety of visitors in an emergency department waiting area. Although no difference was detected for the aromatherapy group, this could be because of environmental conditions or imprecise application of the aromatherapy; further study is needed to either prove or disprove its effectiveness in this setting.

  20. "Wait and see" vaccinating behaviour during a pandemic: a game theoretic analysis.

    Science.gov (United States)

    Bhattacharyya, Samit; Bauch, Chris T

    2011-07-26

    During the 2009 H1N1 pandemic, many individuals did not seek vaccination immediately but rather decided to "wait and see" until further information was available on vaccination costs. This behaviour implies two sources of strategic interaction: as more individuals become vaccinated, both the perceived vaccination cost and the probability that susceptible individuals become infected decline. Here we analyze the outcome of these two strategic interactions by combining game theory with a disease transmission model during an outbreak of a novel influenza strain. The model exhibits a "wait and see" Nash equilibrium strategy, with vaccine delayers relying on herd immunity and vaccine safety information generated by early vaccinators. This strategic behaviour causes the timing of the epidemic peak to be strongly conserved across a broad range of plausible transmission rates, in contrast to models without such adaptive behaviour. The model exhibits not only feedback mechanisms but also a feed-forward mechanism: a high initial perceived vaccination cost perpetuates high perceived vaccine costs (and lower vaccine coverage) throughout the remainder of the outbreak. This suggests that any effect of risk communication at the start of a pandemic outbreak will be amplified compared to the same amount of risk communication effort distributed throughout the outbreak. Copyright © 2011 Elsevier Ltd. All rights reserved.

  1. Public reporting on quality, waiting times and patient experience in 11 high-income countries.

    Science.gov (United States)

    Rechel, Bernd; McKee, Martin; Haas, Marion; Marchildon, Gregory P; Bousquet, Frederic; Blümel, Miriam; Geissler, Alexander; van Ginneken, Ewout; Ashton, Toni; Saunes, Ingrid Sperre; Anell, Anders; Quentin, Wilm; Saltman, Richard; Culler, Steven; Barnes, Andrew; Palm, Willy; Nolte, Ellen

    2016-04-01

    This article maps current approaches to public reporting on waiting times, patient experience and aggregate measures of quality and safety in 11 high-income countries (Australia, Canada, England, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and the United States). Using a questionnaire-based survey of key national informants, we found that the data most commonly made available to the public are on waiting times for hospital treatment, being reported for major hospitals in seven countries. Information on patient experience at hospital level is also made available in many countries, but it is not generally available in respect of primary care services. Only one of the 11 countries (England) publishes composite measures of overall quality and safety of care that allow the ranking of providers of hospital care. Similarly, the publication of information on outcomes of individual physicians remains rare. We conclude that public reporting of aggregate measures of quality and safety, as well as of outcomes of individual physicians, remain relatively uncommon. This is likely to be due to both unresolved methodological and ethical problems and concerns that public reporting may lead to unintended consequences. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  2. The effects of a long wait for children's dental general anaesthesia.

    Science.gov (United States)

    North, Sarah; Davidson, Lesley E; Blinkhorn, Anthony S; Mackie, Iain C

    2007-03-01

    The purpose of this study was to monitor the effect of an interruption in a service for children who were scheduled to have dental extractions under general anaesthesia (GA). The reasons for offering GA and the treatment given while the service was not available, together with the history of the pain, antibiotic usage and alterations to the number of teeth extracted were recorded. When the GA extraction service stopped, the children who were scheduled to have their teeth extracted were placed on a waiting list. When the service recommenced 6 months later, the children were invited to attend a reassessment. Relevant data were collected at this visit using a proforma. A total of 321 children had their extractions delayed. Only 249 of these attended for a reassessment. During the waiting period, 102 parents (41.0%) reported that their children required analgesics, 71 (28.5%) stated that their children's sleep was disturbed and 82 (32.9%) recorded problems with eating. One hundred and twenty-three children (49.4%) had received antibiotics, with 49 (19.6%) having been prescribed two or more courses. The majority of treatment plans (85.5%) remained unchanged. Many children who had had their extractions delayed suffered further pain and disruption to their life.

  3. The Lived Experiences of Patients Waiting for Coronary Artery Bypass Grafting: A Hermeneutic Phenomenological Study

    Directory of Open Access Journals (Sweden)

    Mohammad Abbasi

    2017-06-01

    Full Text Available Background and Objectives: Waiting for coronary artery bypass grafting is an unpleasant experience for patients and is associated with physical and psychological problems. The aim of this study was to recognize lived experiences of patients waiting for coronary artery bypass graft. Methods: This qualitative study was conducted using an interpretative phenomenological approach and proposed method of Van Manen. Twelve participants (9 men and 3 women were purposefully selected with maximum variation from Shahid Beheshti Hospital of Qom city, in 2016. The data of this study were collected through in-depth semi-structured interviews in the period of time between 40 to 70 minutes. The recorded interviews were transcribed verbatim to text, then, the transcribed texts were analyzed using the proposed van Manen’s six-step method. Results: From analysis of participants' statements, concepts, such as sense of panic, fear of death, understanding patients’ collaboration, understanding the importance of heart, decision for heart surgery, and trying to keep calm, were deduced. Conclusion: The participants of this study, from diagnosis of cardiovascular disease until the time of artery bypass grafting, thought that they were at risk for heart attack and death, and in spite of fear of death and sense of panic, they used peer-patients to control these negative experiences. Therefore, the members of health care team, particularly nurses, can provide necessary trainings to help patients from diagnosis time until surgery.

  4. "Wait a while, my love" -- an Indonesian popular song with a family planning message.

    Science.gov (United States)

    Pekerti, R; Musa, R

    1989-10-01

    "Wait a While, My Love," recorded by pop singer Irianti Emingpraja, was the first Indonesian rock sock to contain a family planning message. The album including the song has sold over 100,000 copies. The song has also been packaged as a 60-second video that can be used as an opening theme for radio and television programs. The song, aimed at encouraging Indonesian youth to postpone marriage, has the following lyrics: "Flying free like a seagull/I'll cover many places 'round the world/Give me time for study and reflection, to grow as a mature wise woman/Oh, wait a while, my love/Don't buy me a ring, reflection of your inner love/I'll climb my way up to the top of the world/And reaching our rainbow of hope." The song was produced with support from the United Nations Fund for Population Activities and the Indonesian National Family Planning Coordinating Board. Key factors to be examined in producing a popular song with a family planning message include the specific message desired, the target audience, type of music, the singer, the producer, marketing, a multimedia campaign strategy, and distribution outlets.

  5. Developing priority criteria for magnetic resonance imaging: results from the Western Canada Waiting List project

    International Nuclear Information System (INIS)

    Hadorn, D.C.

    2002-01-01

    The Western Canada Waiting List (WCWL) Project is a federally funded partnership of 19 organizations, including medical associations, health authorities, ministries of health and research organizations, that was created to develop tools to assist in assessing the relative urgency and priority of patients on waiting lists. The WCWL panel on magnetic resonance imaging (MRI) was 1 of 5 panels constituted under this project. The panel developed and tested a set of standardized clinical criteria for setting priorities among patients awaiting MRI. The criteria were applied to 407 patients in the 4 western provinces. Regression analysis was used to determine the set of criteria weights that collectively best predicted clinicians' overall ratings of patients' urgency for MRI. Reliability was assessed using clinicians' ratings of 6 hypothetical paper cases. The resulting weighted criteria accounted for about two-fifths of the observed variance in overall urgency ratings (R 2 = 39.9%). The panel then modified the criteria on the basis of regression results and clinical judgment. Most of the revised criteria items showed poor inter-rater reliability, but test-retest reliability (over a 2-month interval) was relatively good. Criteria items requiring probability judgments were a challenge for clinicians. Further development and testing of the tool appears warranted, although considerable question remains concerning the utility of priority criteria for MRI and other diagnostic services. (author)

  6. An evaluation on the impact of national cancer wait targets on a (UK) radiotherapy department

    International Nuclear Information System (INIS)

    Roberts, Neill

    2012-01-01

    The radiotherapy department in this evaluation has been working towards full compliance with national cancer wait targets (CWT) since their implementation. 31 and 62 day targets set a maximum time frame for cancer patients to commence treatment. This evaluation explored the impact of these targets on staff and patients within the radiotherapy department and their overall impact on the radiotherapy service. Methods: This evaluation followed a mixed method approach of sequential triangulation. Qualitative data collection and analysis dominate findings but existing quantitative data, available within the department, was used to support the overall findings. Staff and patient interviews were used to establish attitudes to and experiences of the CWT initiative in relation to radiotherapy treatment. Quantitative data was taken from the local Cancer Centre CWT database that tracks patients referred for radiotherapy. Findings and Conclusion: Qualitative data analysis identified four main themes: pressure, appropriateness of target lengths, quality of treatment provided and efficiency of working practices within the department. Responses within these themes were both positive and negative with patients mainly the former and staff the latter. Quantitative evaluation found an increased monitoring and management burden from the CWT initiative, primarily for administrative, clerical and managerial staff. The main impact of the CWT initiative was an increase in pressure on staff due to reduced time to prepare and deliver treatment. Patients felt the initiative had not impacted negatively on their care and experienced a reduction in anxiety due to a reduction in waiting time.

  7. Childlessness of men in Canada: Result of a waiting game in a changing family context

    Directory of Open Access Journals (Sweden)

    Zenaida R. Ravanera

    2014-03-01

    Full Text Available Childlessness was about 12–13 per cent for cohorts born in 1927 to 1941, but increased in younger cohorts, with the childlessness of men born in 1957–1961 reaching 20 per cent. Using data from the 2006 Canadian General Social Survey on families, we show that the intention to be childfree among young men has largely remained low, at 8 to 10 per cent. As men grow older, the intention to be childfree increases such that at age 45–49, 16 per cent intend not to become fathers. Rather than a deliberate choice, the increase in childlessness could be the result of a waiting game. Longer stays in school, later entry into the work force, and starting marital relations at older ages contribute to delays in becoming fathers. While for many men the delay does not necessarily end in childlessness, for others the period of waiting changes their intention to become fathers. The adjustment of intentions and the eventual childlessness are made easier because of the reduced normative pressure to have children.

  8. The Program Cost of a Brief Video Intervention Shown in Sexually Transmitted Disease Clinic Waiting Rooms.

    Science.gov (United States)

    Gift, Thomas L; OʼDonnell, Lydia N; Rietmeijer, Cornelis A; Malotte, Kevin C; Klausner, Jeffrey D; Margolis, Andrew D; Borkowf, Craig B; Kent, Charlotte K; Warner, Lee

    2016-01-01

    Patients in sexually transmitted disease (STD) clinic waiting rooms represent a potential audience for delivering health messages via video-based interventions. A controlled trial at 3 sites found that patients exposed to one intervention, Safe in the City, had a significantly lower incidence of STDs compared with patients in the control condition. An evaluation of the intervention's cost could help determine whether such interventions are programmatically viable. The cost of producing the Safe in the City intervention was estimated using study records, including logs, calendars, and contract invoices. Production costs were divided by the 1650 digital video kits initially fabricated to get an estimated cost per digital video. Clinic costs for showing the video in waiting rooms included staff time costs for equipment operation and hardware depreciation and were estimated for the 21-month study observation period retrospectively. The intervention cost an estimated $416,966 to develop, equaling $253 per digital video disk produced. Per-site costs to show the video intervention were estimated to be $2699 during the randomized trial. The cost of producing and implementing Safe in the City intervention suggests that similar interventions could potentially be produced and made available to end users at a price that would both cover production costs and be low enough that the end users could afford them.

  9. "I can't wait to find out what Nature has in store for us"

    CERN Multimedia

    Anaïs Schaeffer

    2012-01-01

    Professor Guido Altarelli, a physicist at CERN and the University of Rome, has received two prizes since the beginning of the year: the Julius Wess prize awarded by the Karlsruhe Institute of Technology (KIT) and the Sakurai prize awarded by the American Physical Society.   Guido Altarelli (left), receiving the Julius Wess prize in Karlsruhe on 16 January. It's been a good start to the year for Guido Altarelli. After receiving two prestigious prizes in the space of a few weeks for achievements during his long career, all he's waiting for is the Higgs boson! "I can't wait to find out what Nature has in store for us!", he smiles. Hardly surprising when you think that Altarelli has been looking for the answers since the very start of his career in particle physics. As a theorist at CERN for over twenty years, he has always worked closely with the experiments, first at the SPS, then at LEP and now at the LHC. Today, following the significant progress in...

  10. Reducing waiting time and raising outpatient satisfaction in a Chinese public tertiary general hospital-an interrupted time series study

    Directory of Open Access Journals (Sweden)

    Jing Sun

    2017-08-01

    Full Text Available Abstract Background It is globally agreed that a well-designed health system deliver timely and convenient access to health services for all patients. Many interventions aiming to reduce waiting times have been implemented in Chinese public tertiary hospitals to improve patients’ satisfaction. However, few were well-documented, and the effects were rarely measured with robust methods. Methods We conducted a longitudinal study of the length of waiting times in a public tertiary hospital in Southern China which developed comprehensive data collection systems. Around an average of 60,000 outpatients and 70,000 prescribed outpatients per month were targeted for the study during Oct 2014-February 2017. We analyzed longitudinal time series data using a segmented linear regression model to assess changes in levels and trends of waiting times before and after the introduction of waiting time reduction interventions. Pearson correlation analysis was conducted to indicate the strength of association between waiting times and patient satisfactions. The statistical significance level was set at 0.05. Results The monthly average length of waiting time decreased 3.49 min (P = 0.003 for consultations and 8.70 min (P = 0.02 for filling prescriptions in the corresponding month when respective interventions were introduced. The trend shifted from baseline slight increasing to afterwards significant decreasing for filling prescriptions (P =0.003. There was a significant negative correlation between waiting time of filling prescriptions and outpatient satisfaction towards pharmacy services (r = −0.71, P = 0.004. Conclusions The interventions aimed at reducing waiting time and raising patient satisfaction in Fujian Provincial Hospital are effective. A long-lasting reduction effect on waiting time for filling prescriptions was observed because of carefully designed continuous efforts, rather than a one-time campaign, and with appropriate incentives

  11. Reducing waiting time and raising outpatient satisfaction in a Chinese public tertiary general hospital-an interrupted time series study.

    Science.gov (United States)

    Sun, Jing; Lin, Qian; Zhao, Pengyu; Zhang, Qiongyao; Xu, Kai; Chen, Huiying; Hu, Cecile Jia; Stuntz, Mark; Li, Hong; Liu, Yuanli

    2017-08-22

    It is globally agreed that a well-designed health system deliver timely and convenient access to health services for all patients. Many interventions aiming to reduce waiting times have been implemented in Chinese public tertiary hospitals to improve patients' satisfaction. However, few were well-documented, and the effects were rarely measured with robust methods. We conducted a longitudinal study of the length of waiting times in a public tertiary hospital in Southern China which developed comprehensive data collection systems. Around an average of 60,000 outpatients and 70,000 prescribed outpatients per month were targeted for the study during Oct 2014-February 2017. We analyzed longitudinal time series data using a segmented linear regression model to assess changes in levels and trends of waiting times before and after the introduction of waiting time reduction interventions. Pearson correlation analysis was conducted to indicate the strength of association between waiting times and patient satisfactions. The statistical significance level was set at 0.05. The monthly average length of waiting time decreased 3.49 min (P = 0.003) for consultations and 8.70 min (P = 0.02) for filling prescriptions in the corresponding month when respective interventions were introduced. The trend shifted from baseline slight increasing to afterwards significant decreasing for filling prescriptions (P =0.003). There was a significant negative correlation between waiting time of filling prescriptions and outpatient satisfaction towards pharmacy services (r = -0.71, P = 0.004). The interventions aimed at reducing waiting time and raising patient satisfaction in Fujian Provincial Hospital are effective. A long-lasting reduction effect on waiting time for filling prescriptions was observed because of carefully designed continuous efforts, rather than a one-time campaign, and with appropriate incentives implemented by a taskforce authorized by the hospital managers. This

  12. Prospective evaluation through questionnaires of the emotional status of cancer patients in the waiting rooms of a department of oncology

    Directory of Open Access Journals (Sweden)

    Roberta Resega

    2016-07-01

    Full Text Available Objective: The aim of this study is to better identify the prevailing emotions and feelings of cancer patients during their stay in waiting rooms in a department of oncology. Methods: In July 2014, patients in the waiting rooms of our Department of Oncology were asked to fill out dedicated questionnaires. Patients had to choose sentences that best described their feelings, thoughts and experiences; this part was differentiated according to the waiting rooms (Consultation Rooms versus Day Hospital. In another section, patients were asked to choose their prevailing primary emotions: joy, fear, sadness, anger, disgust or surprise. Results: Two hundred eighty questionnaires were considered valid for statistical analysis. Regarding feelings, all patients in the Day Hospital and Consultation Rooms stated that they feel anxious (48% and 53%, respectively. By differentiating patients according to the setting, patients in the Day Hospital answered that they will face chemotherapy, thinking that it will be useful to defeat the disease (56%, and patients in Consultation Rooms answered that time in the waiting rooms goes more slowly (65%. Regarding the prevailing emotions experienced by patients, sadness was the most selected, followed by fear and surprise. Conclusions: A prevalent emotional and cognitive state while waiting is anxiety, followed by positive thoughts. Patients presented anxiety and fear independently from the setting of care. We believe that each oncologist should be aware of the degrees of fear and sadness that patients experience during an oncological examination because these emotions can have an impact on communication and understanding.

  13. Emergency Department Waiting Times (EDWaT): A Patient Flow Management and Quality of Care Rating mHealth Application.

    Science.gov (United States)

    Househ, Mowafa; Yunus, Faisel

    2014-01-01

    Saudi hospital emergency departments (ED) have suffered from long waiting times, which have led to a delay in emergency patient care. The increase in the population of Saudi Arabia is likely to further stretch the healthcare services due to overcrowding leading to decreased healthcare quality, long patient waits, patient dissatisfaction, ambulance diversions, decreased physician productivity, and increased frustration among medical staff. This will ultimately put patients at risk for poor health outcomes. Time is of the essence in emergencies and to get to an ED that has the shortest waiting time can mean life or death for a patient, especially in cases of stroke and myocardial infarction. In this paper, we present our work on the development of a mHealth Application - EDWaT - that will: provide patient flow information to the emergency medical services staff, help in quick routing of patients to the nearest hospital, and provide an opportunity for patients to review and rate the quality of care received at an ED, which will then be forwarded to ED services administrators. The quality ratings will help patients to choose between two EDs with the same waiting time and distance from their location. We anticipate that the use of EDWaT will help improve ED wait times and the quality of care provision in Saudi hospitals EDs.

  14. Waiting times before dental care under general anesthesia in children with special needs in the Children's Hospital of Casablanca.

    Science.gov (United States)

    Badre, Bouchra; Serhier, Zineb; El Arabi, Samira

    2014-01-01

    Oral diseases may have an impact on quality of children's life. The presence of severe disability requires the use of care under general anesthesia (GA). However, because of the limited number of qualified health personnel, waiting time before intervention can be long. To evaluate the waiting time before dental care under general anesthesia for children with special needs in Morocco. A retrospective cohort study was carried out in pediatric dentistry unit of the University Hospital of Casablanca. Data were collected from records of patients seen for the first time between 2006 and 2011. The waiting time was defined as the time between the date of the first consultation and intervention date. 127 children received dental care under general anesthesia, 57.5% were male and the average age was 9.2 (SD = 3.4). Decay was the most frequent reason for consultation (48%), followed by pain (32%). The average waiting time was 7.6 months (SD = 4.2 months). The average number of acts performed per patient was 13.5. Waiting times were long, it is necessary to take measures to reduce delays and improve access to oral health care for this special population.

  15. Point specificity in acupuncture

    Directory of Open Access Journals (Sweden)

    Choi Emma M

    2012-02-01

    Full Text Available Abstract The existence of point specificity in acupuncture is controversial, because many acupuncture studies using this principle to select control points have found that sham acupoints have similar effects to those of verum acupoints. Furthermore, the results of pain-related studies based on visual analogue scales have not supported the concept of point specificity. In contrast, hemodynamic, functional magnetic resonance imaging and neurophysiological studies evaluating the responses to stimulation of multiple points on the body surface have shown that point-specific actions are present. This review article focuses on clinical and laboratory studies supporting the existence of point specificity in acupuncture and also addresses studies that do not support this concept. Further research is needed to elucidate the point-specific actions of acupuncture.

  16. Interesting Interest Points

    DEFF Research Database (Denmark)

    Aanæs, Henrik; Dahl, Anders Lindbjerg; Pedersen, Kim Steenstrup

    2012-01-01

    on spatial invariance of interest points under changing acquisition parameters by measuring the spatial recall rate. The scope of this paper is to investigate the performance of a number of existing well-established interest point detection methods. Automatic performance evaluation of interest points is hard......Not all interest points are equally interesting. The most valuable interest points lead to optimal performance of the computer vision method in which they are employed. But a measure of this kind will be dependent on the chosen vision application. We propose a more general performance measure based...... position. The LED illumination provides the option for artificially relighting the scene from a range of light directions. This data set has given us the ability to systematically evaluate the performance of a number of interest point detectors. The highlights of the conclusions are that the fixed scale...

  17. Waiting for a kidney transplant: the experience of patients with end-stage renal disease in South Korea.

    Science.gov (United States)

    Chong, Hye Jin; Kim, Hyun Kyung; Kim, Sung Reul; Lee, Sik

    2016-04-01

    To explore the experiences of Korean patients with end-stage renal disease awaiting kidney transplantation. The need for kidney transplantation has increased worldwide, while the number of kidney donors has not increased commensurately. This mismatch is a serious issue in South Korea. Prolonged waits for transplantation may cause physical and psychosocial issues and lead to poor outcomes. Nevertheless, the experience of waiting for kidney transplantation in South Korea has never been explored in depth. A qualitative descriptive design was used. The participants were eight patients diagnosed with end-stage renal disease on the waiting list for kidney transplantation in South Korea. Data were collected through individual in-depth interviews. All conversations during interviews were recorded and transcribed verbatim. Transcribed data were analysed using conventional content analysis. The experience of waiting for kidney transplantation consisted of six categories: (1) the light at the end of the tunnel, (2) being on call without any promise, (3) a tough tug of war between excitement and frustration, (4) doubts in the complexity, (5) A companion on the hard journey and (6) getting ready for D-day. Kidney transplantation candidates experience psychosocial difficulties and concerns while waiting for long periods of time without any assurance of resolution. Systematic education and psychosocial support from health care professionals and family members help patients get through what they describe as a difficult journey. Comprehensive management programs for kidney transplantation candidates are needed. Health care professionals need to recognise the psychosocial concerns of patients awaiting kidney transplantation. Clinicians should provide patients with information and support throughout the waiting period. © 2016 John Wiley & Sons Ltd.

  18. Lung cancer care trajectory at a Canadian centre: an evaluation of how wait times affect clinical outcomes.

    Science.gov (United States)

    Kasymjanova, G; Small, D; Cohen, V; Jagoe, R T; Batist, G; Sateren, W; Ernst, P; Pepe, C; Sakr, L; Agulnik, J

    2017-10-01

    Lung cancer continues to be one of the most common cancers in Canada, with approximately 28,400 new cases diagnosed each year. Although timely care can contribute substantially to quality of life for patients, it remains unclear whether it also improves patient outcomes. In this work, we used a set of quality indicators that aim to describe the quality of care in lung cancer patients. We assessed adherence with existing guidelines for timeliness of lung cancer care and concordance with existing standards of treatment, and we examined the association between timeliness of care and lung cancer survival. Patients with lung cancer diagnosed between 2010 and 2015 were identified from the Pulmonary Division Lung Cancer Registry at our centre. We demonstrated that the interdisciplinary pulmonary oncology service successfully treated most of its patients within the recommended wait times. However, there is still work to be done to decrease variation in wait time. Our results demonstrate a significant association between wait time and survival, supporting the need for clinicians to optimize the patient care trajectory. It would be helpful for Canadian clinicians treating patients with lung cancer to have wait time guidelines for all treatment modalities, together with standard definitions for all time intervals. Any reductions in wait times should be balanced against the need for thorough investigation before initiating treatment. We believe that our unique model of care leads to an acceleration of diagnostic steps. Avoiding any delay associated with referral to a medical oncologist for treatment could be an acceptable strategy with respect to reducing wait time.

  19. Transient solution of an M/M/1 vacation queue with a waiting server and impatient customers

    Directory of Open Access Journals (Sweden)

    Sherif I. Ammar

    2017-07-01

    Full Text Available Recently, Ammar [1] has discussed the transient behavior of a multiple vacations queue with impatient customers. In this paper, a similar technique is used to derive a new elegant explicit solution for an M/M/1 vacation queue with impatient customers and a waiting server, where the server is allowed to take a vacation whenever the system is empty after waiting for a random period of time. If the server does not return from the vacation before the expiry of the customer impatience time, the customer abandons the system forever. Moreover, the formulas of mean and variance expressed in terms of the obtained possibilities for this model.

  20. Waiting time analysis for MX/G/1 priority queues with/without vacations under random order of service discipline

    Directory of Open Access Journals (Sweden)

    Norikazu Kawasaki

    2000-01-01

    Full Text Available We study MX/G/1 nonpreemptive and preemptive-resume priority queues with/without vacations under random order of service (ROS discipline within each class. By considering the conditional waiting times given the states of the system, which an arbitrary message observes upon arrival, we derive the Laplace-Stieltjes transforms of the waiting time distributions and explicitly obtain the first two moments. The relationship for the second moments under ROS and first-come first-served disciplines extends the one found previously by Takacs and Fuhrmann for non-priority single arrival queues.