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Sample records for waiting period prior

  1. 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.

  2. Relational development in children with cleft lip and palate: influence of the waiting period prior to the first surgical intervention and parental psychological perceptions of the abnormality.

    Science.gov (United States)

    Grollemund, Bruno; Guedeney, Antoine; Vazquez, Marie-Paule; Picard, Arnaud; Soupre, Véronique; Pellerin, Philippe; Simon, Etienne; Velten, Michel; Dissaux, Caroline; Kauffmann, Isabelle; Bruant-Rodier, Catherine; Danion-Grilliat, Anne

    2012-06-08

    the quality of information during the waiting period, and the quality of support provided for parents and children by the healthcare team before the first surgical intervention. ClinicalTrials.gov Identifier: NCT00993993.

  3. Relational development in children with cleft lip and palate: influence of the waiting period prior to the first surgical intervention and parental psychological perceptions of the abnormality

    Directory of Open Access Journals (Sweden)

    Grollemund Bruno

    2012-06-01

    effects will be analysed, so as to serve as a reference for improving the quality of information during the waiting period, and the quality of support provided for parents and children by the healthcare team before the first surgical intervention. Trial Registration ClinicalTrials.gov Identifier: NCT00993993.

  4. [The international adoption waiting period: waiting experience and coping strategies].

    Science.gov (United States)

    Pedro-Viejo, Ana Berástegui

    2008-11-01

    The adoption waiting period is a powerful stressor that can affect the well-being and configuration of future family life. Adoption research and practice have not paid enough attention to this phase. The principal aim of this study is to address prospective adoptive parents' experience of and coping with this period. For this purpose, 63 families answered a feelings scale, a coping resources scale and a needs questionnaire, all elaborated for the study. Results show that a shorter length of waiting time, using cognitive and learning coping strategies and associative participation were related to a better general experience of adoption whereas process-centred strategies were related to a worse experience of adoption. Families would like to see more speed in the process, more warmth and humanity in their relation with institutions and better information about their expedients. We conclude by proposing some activities and services during the waiting period that could be useful for post adoption.

  5. A novel intervention for medical waiting periods in IVF and early pregnancy

    NARCIS (Netherlands)

    Ockhuijsen, H.D.L.

    2014-01-01

    Patients who make use of healthcare services have to deal with all kind of waiting periods like waiting for the results of a biopsy or waiting for the results of a fertility treatment. Waiting periods can cause high levels of distress because the outcomes of these waiting periods are often

  6. Waiting for care: effects of Ontario's 3-month waiting period for OHIP on landed immigrants.

    Science.gov (United States)

    Goel, Ritika; Bloch, Gary; Caulford, Paul

    2013-06-01

    To describe the experiences of a group of new immigrants and caregivers of new immigrants who were subject to the 3-month waiting period for the Ontario Health Insurance Plan and needed to access health care services during that time. Qualitative study using a phenomenologic framework. Participants were recruited through the Scarborough Community Volunteer Clinic in Toronto, Ont. Interviews were conducted in person at the clinic or by telephone. Seven participants were interviewed who themselves needed to access health care during the 3-month waiting period for the Ontario Health Insurance Plan or who were caring for someone who did. Seven semistructured, in-depth interviews were conducted using an interview guide; these were recorded and transcribed verbatim. Data were analyzed for themes to arrive at the essence of the participants' experiences. Participants believed that there was a lack of clear information and a lack of help from officials. Other common themes included poor social situations, financial loss or threat of financial loss related to health care, a choice to delay seeking care owing to cost, difficulty accessing alternative care, and appreciation for those who advocated on their behalf. Other themes that arose included emotional hardship, poor health outcomes or threat of poor health outcomes resulting from not seeking care, the importance and unpredictability of health, as well as negative impressions of Canada as a country as a result of the negative experience of seeking care. New immigrants to Ontario who need to access health care services during the 3-month waiting period for provincial health insurance and the caregivers of such newcomers can have potentially very negative experiences. They might be unable to access care without financial barriers and might, therefore, choose to delay seeking health care until the end of the waiting period; this can lead to emotional hardship for themselves and their caregivers as well as to potentially poor

  7. 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…

  8. Bracing Later and Coping Better: Benefits of Mindfulness During a Stressful Waiting Period.

    Science.gov (United States)

    Sweeny, Kate; Howell, Jennifer L

    2017-10-01

    People frequently await uncertain news, yet research reveals that the strategies people naturally use to cope with uncertainty are largely ineffective. We tested the role of mindfulness for improving the experience of a stressful waiting period. Law graduates awaiting their bar exam results either reported their trait mindfulness (Study 1; N = 150) or were instructed to practice mindfulness meditation (Study 2; N = 90). As hypothesized, participants who were naturally more mindful or who practiced mindfulness managed their expectations more effectively by bracing for the worst later in the waiting period and perceived themselves as coping better. Additionally, participants who were low in dispositional optimism and high in intolerance of uncertainty benefited most from mindfulness (relative to control) meditation. These findings point to a simple and effective way to wait better, particularly for those most vulnerable to distress.

  9. Two definitions of waiting well.

    Science.gov (United States)

    Sweeny, Kate; Reynolds, Chandra A; Falkenstein, Angelica; Andrews, Sara E; Dooley, Michael D

    2016-02-01

    Waiting for uncertain news is often distressing, at times even more distressing than facing bad news. The goal of this article was to investigate strategies for "waiting well" during these periods of uncertainty. Specifically, we propose 2 definitions of waiting well. First, people can wait in such a way as to ease their distress during the waiting period. Second, people could wait in such a way as to ease the pain of bad news or enhance the thrill of good news. We conducted a longitudinal study of law graduates (N = 230) awaiting their result on the California bar exam. Participants completed questionnaires prior to the exam, every 2 weeks during the 4-month waiting period, and shortly after learning whether they passed or failed. Cross-lagged models revealed that participants were quite unsuccessful at waiting well by our first definition. That is, their coping strategies were ineffective for reducing distress associated with uncertainty, apparently even backfiring in some cases. However, multiple regression analyses examining relationships between waiting experiences and responses to good and bad news found that many participants were successful at waiting well according to our second definition: Participants who suffered through a waiting period marked by anxiety, rumination, and pessimism responded more productively to bad news and more joyfully to good news, as compared with participants who suffered little during the wait. These findings substantiate the difficulty of enduring a stressful waiting period but suggest that this difficulty may pay off once the news arrives. (c) 2016 APA, all rights reserved).

  10. Frequency and Outcomes of a Symptom-Free Waiting Period After Sport-Related Concussion.

    Science.gov (United States)

    Pfaller, Adam Y; Nelson, Lindsay D; Apps, Jennifer N; Walter, Kevin D; McCrea, Michael A

    2016-11-01

    Guidelines and practices for the management of sport-related concussion (SRC) have evolved swiftly over the past 2 decades. Despite common recommendations for a symptom-free waiting period (SFWP) before returning to sport, past reports have suggested poor utilization rates for this intervention. To obtain current estimates of the utilization and characterization of SFWPs with high school and collegiate athletes. Descriptive epidemiology study. Data were extracted from a larger prospective study that followed athletes with SRC across 13 institutions in southeastern Wisconsin from 2012 to 2014. Participants included 143 contact and collision sport athletes who were followed serially through their recoveries after SRCs. In the current study sample, 99.3% of athletes used an SFWP. The mean self-reported symptom duration was 6.35 days (median, 5 days), with 72.7% reporting symptom recovery within 1 week of injury, 93.7% within 2 weeks, and 99.3% within 30 days. Rate of same-season repeat concussion was low (3.8%) and was similar to or lower than the overall rate of concussion (4.3%). Five same-season repeat concussions occurred at a range of 8 to 42 days after initial injuries. In comparison with prior published data collected from 1999 to 2004, utilization and duration of SFWPs were higher in the current study samples (99.3% vs 60.3% of athletes reported an SFWP; mean duration, 6.1 vs 3.2 days), and athletes were withheld from sports for more days than previously reported (12.3 vs 7.4 days). Rate of same-season repeat concussion was equivalent to that of prior published data. The findings support improved adherence to clinical management guidelines through increased utilization of SFWPs after SRC. © 2016 The Author(s).

  11. A Study on Effects of Waiting Period in Software Operation on the Operator's Psychophysiological State

    Science.gov (United States)

    Hayasaka, Yoshiaki; Kimura, Tatsuhiro; Segawa, Norihisa; Miyazaki, Masatoshi; Yamazaki, Kiyoyuki; Murayama, Yuko

    The authors have been studying psychophysiological workload of human interface (HI) with physiological measurements and analysis. In this study, we investigated a kind of mental workload produced by user's unexpected waiting period from the request input to the termination of data processing during personal computer (PC) operation. As the experimental setting of HI, we used interactive software containing easy questions with unexpected time interval between each question. The effects of progress indicator (PI) indicating during waiting period on psychophysiological status of users were analyzed by using respiration, finger plethysmogram (PTG), heart rate (HR) and electroencephalogram (EEG) measurements. Results showed that the theta wave component of the EEG increased in the non-PI condition, even though autonomic nervous system parameters showed no significant change. Negative correlation between preference score for HI and integrated theta component percentage was observed only in non-PI condition. It is supposed that the PI was controlling theta activity coused by waiting stress in experimental condition. Utilizing physiological indices for HI assessment, this experimental method could be available to waiting stress estimation.

  12. 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

  13. The concept of a waiting period for preoperative patient consent: Prospective study of 51 shoulder arthroscopy cases.

    Science.gov (United States)

    Coudane, H; Mangin, M; Karam, Y; Seivert, V; Mainard, D; Danan, J L; Py, B; Lighezzolo-Alnot, J

    2017-09-01

    The French Code of Public Health (CSP) does not explicitly require that patients should be given a certain amount of time to think about a procedure, except for cosmetic surgery, where 15 days is required (Art. L 6322-2 CSP). We hypothesized that patients require a waiting period during their decision-making process for scheduled shoulder arthroscopy procedure. This prospective observational study of 51 patients analysed the concept of a waiting period based on a 10-item questionnaire. A comparative statistical approach was used and the P values were calculated using a paired Wilcoxon rank-sum test. Of the 51 patients, 42 (82%) rejected the concept of a waiting period before the procedure and 37 patients (73%) did not want a mandatory waiting period imposed by law. This study looked at the decision-making process during scheduled orthopaedic surgery and differentiated between the conscious and unconscious approach corresponding to an active and passive waiting period. A waiting period does not allow patients to make a conceptually deliberative decision that conforms to the criteria defined by the French Health Authority. This study rejects the need for a mandatory waiting period imposed on surgeons and patients as it does not integrate itself into the informative model of ethical decision-making for scheduled shoulder arthroscopy. Prospective, observational; level of evidence IV. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  14. Utah's 72-Hour Waiting Period for Abortion: Experiences Among a Clinic-Based Sample of Women.

    Science.gov (United States)

    Roberts, Sarah C M; Turok, David K; Belusa, Elise; Combellick, Sarah; Upadhyay, Ushma D

    2016-12-01

    In 2012, Utah became the first state to enact a 72-hour waiting period for abortion. Despite debate about the law's potential effects, research has not examined women's experiences with it. A cohort of 500 women recruited at four family planning facilities in Utah in 2013-2014 completed baseline surveys at the time of an abortion information visit and follow-up telephone interviews three weeks later. Logistic regression and coding of open-ended responses were used to examine which women had abortions and, for those who did not, their reasons. Among the 309 women completing follow-up, 86% had had an abortion, 8% were no longer seeking abortion, 3% had miscarried or discovered they had not been pregnant, and 2% were still seeking abortion; one woman was still deciding, and the waiting period had pushed one woman beyond her facility's gestational limit for abortion. At the information visit, women reported little conflict about the abortion decision (mean score on a scale of 0-100 was 13.9 for those who eventually had an abortion and 28.5 for others). Low decisional conflict, but not socioeconomic status, was associated with having an abortion (odds ratio, 1.1). On average, eight days elapsed between the information visit and the abortion. As most women in this cohort were not conflicted about their decision when they sought care, the 72-hour waiting requirement seems to have been unnecessary. Individualized patient counseling for the small minority who were conflicted when they presented for care may have been more appropriate. Copyright © 2016 by the Guttmacher Institute.

  15. Trajectories of anxiety and depression in liver transplant candidates during the waiting-list period.

    Science.gov (United States)

    Annema, Coby; Roodbol, Petrie F; Van den Heuvel, Edwin R; Metselaar, Herold J; Van Hoek, Bart; Porte, Robert J; Ranchor, Adelita V

    2017-09-01

    To explore whether distinct trajectories of anxiety and depression exist among liver transplant candidates, and to gain insight into demographic, clinical, and individual characteristics related with these trajectories. A multicentre, prospective cohort study among 216 liver transplant candidates. Respondents filled out a questionnaire at study entrance and subsequently every 6 months until transplantation or removal from the waiting list. Anxiety (STAI6), depression (CES-D), demographic, and individual variables were assessed by questionnaire. Clinical variables were retrieved by medical record review. The SAS PROC TRAJ procedure was used to identify distinct trajectories. Univariate and multiple ordinal logistic regression analyses were used to explore related variables. Regarding anxiety, three stable trajectories were identified as follows: below clinical level (51%), slightly above clinical level (34%), and high above clinical level (15%). Regarding depression, four stable trajectories were identified as follows: below clinical level (23%), slightly below clinical level (34%), slightly above clinical level (28%), and high above clinical level (6%). For anxiety as well as for depression, experiencing more liver disease symptoms, a lower level of personal control, making more use of emotional coping, and making less use of task-oriented coping increased the likelihood of membership in those trajectories with higher symptom levels. Distinct, but stable, trajectories of anxiety and depression were present in liver transplant candidates. The trajectories with symptom levels above clinical relevant levels for anxiety or depression comprised, respectively, 49% and 34% of the respondents. Therefore, psychological screening and subsequently providing appropriate interventions are warranted early in the transplant process. Statement of contribution What is already known on this subject For transplant candidates, the waiting-list period is a period of uncertainty and

  16. Does waiting pay off for couples?: Partnership duration prior to household formation and union stability

    Directory of Open Access Journals (Sweden)

    Christine Schnor

    2015-09-01

    Full Text Available Background: Most couples that live together began their relationship while having separate addresses. In contrast to the large body of literature on the role of pre-marital cohabitation in divorce, very little is known about how the partnership period before moving in together affects union stability. Objective: This article investigates: 1 the timing of household formation in a couple's history, 2 the impact of such timing on dissolution behavior, and 3 how household formation and dissolution differ for first and higher-order partnerships. Methods: Using data based on 15,081 partnerships (of which 45Š were coresidential unions from the German Family Panel, cumulative incidence curves reveal the dynamic of the non-coresidential partnership episode. For the sample of coresidential unions (N=6,741, piecewise constant survival models with a person-specific frailty term are estimated in order to assess the influence of household formation timing on union stability. Results: Partnership arrangements with partners living in separate households are transitory in nature and may result in either household formation or separation. First partnerships transform into coresidential unions less often and later than higher-order partnerships. Union stability is positively related to the duration of the preceding non-coresidential period. Especially among unions with a non-coresidential period of 7 to 24 months, first partnerships have lower dissolution risks than higher-order partnerships. Conclusions: The results suggest that the non-coresidential period is a significant phase in the partnership, as it enables couples to acquire information about the quality of their partnership.

  17. Experiences of counselling in the emergency department during the waiting period: importance of family participation.

    Science.gov (United States)

    Paavilainen, Eija; Salminen-Tuomaala, Mari; Kurikka, Sirpa; Paussu, Paula

    2009-08-01

    To describe patients' experiences of counselling, defined as information giving and advice by nursing staff, in the emergency department. A particular focus was on the waiting period and on the importance of family participation in counselling. Counselling is a widely studied topic in nursing. Too little is known about counselling in emergency departments and especially about participation of family members and suitability of counselling for the patient's life situation. Descriptive quantitative study. Data were collected by questionnaires from patients (n = 107) visiting a hospital emergency department. The data were subjected to statistical analysis. Forty-two per cent of patients arrived at the emergency department with a family member: spouse or cohabiting partner, mother, father or daughter. Patients were fairly satisfied with the counselling. The presence of a family member was important to the majority of patients (75%). About half of the patients wanted information concerning their illness, condition and treatment to be given to their family members. Those visiting the department with a family member were more satisfied with counselling and felt that it promoted their participation in care. It is to encourage patients' family members to participate in counselling situations in emergency departments. However, the type of information passed on to family members should be carefully discussed and prepared. Patients' family members seem to be important partners in counselling situations. The presence of family members supports patients in the emergency department during the waiting period and helps them orientate in their situation. When family members are present, issues which patients wish to discuss should be carefully planned. Family presence should be encouraged in emergency departments.

  18. 76 FR 77534 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2011-12-13

    ... the waiting period provided by law and the premerger notification rules. The listing for each...; Navistar International Corporation; Carl C. Icahn. 20120044 G AstraZeneca plc; Pfizer Inc.; AstraZeneca plc....P. 20120117 G Big River Resources, LLC; Western Wisconsin Renewable Energy Cooperative; Big River...

  19. 76 FR 27320 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2011-05-11

    .... 04/14/2011 20110666 G James River Coal Company; International Resource Partners LP; James River Coal... the waiting period provided by law and the premerger notification rules. The listing for each.... Rasmussen; Sidney B. DeBoer 20110689 G International Petroleum Investment Company; Compania Espanola de...

  20. 78 FR 41797 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2013-07-11

    ... the waiting period provided by law and the premerger notification rules. The listing for each... River Investments, LLC; Remington Hybrid Seed Company, Inc.; Teays River Investments, LLC. 20130919 G..., Inc.; Opko Health, Inc. 20130972 G International Business Machines Corporation; SoftLayer Holdings...

  1. Clinical significance of surgery for gastric submucosal tumours with size enlargement during watchful waiting period.

    Science.gov (United States)

    Miyazaki, Yasuhiro; Nakajima, Kiyokazu; Kurokawa, Yukinori; Takahashi, Tsuyoshi; Takiguchi, Shuji; Miyata, Hiroshi; Yamasaki, Makoto; Hirota, Seiichi; Nishida, Toshirou; Mori, Masaki; Doki, Yuichiro

    2013-08-01

    The true impact of surgery for small, asymptomatic and biopsy-negative gastric submucosal tumours (SMTs) with size enlargement during 'watchful waiting' period has not been fully understood. From 2005 to 2012, 100 patients with gastric SMTs underwent surgery. Twenty-three of them with size enlargement during observation period were enrolled in the retrospective analysis. Data included clinicopathologic findings, genetic findings, operative outcomes and prognoses. All patients (13 males, 10 females), with median age of 54 (41-71), had their lesions detected by routine health check-up (n=21) or incidentally (2). The tumours were 1.8 (0.5-4.0)cm in size at their initial detection, and enlarged up to 3.2 (2.0-7.0)cm at the operation during 63.0 (14.6-233.7) months. As surgical procedure, laparoscopic partial gastrectomy accounted for the majority (78.3%). Histologic examination revealed gastrointestinal stromal tumour (GIST) (21) and schwannoma (2). Although 16 out of 21 GISTs were categorised into 'Very low' (1), and 'Low' (13) risk according to Fletcher's classification, 'Intermediate' (5) and 'High' (2) risk were identified in the series. No recurrences/metastases were noted in 23.2 (0.9-87) months of postoperative follow-up. Our study revealed the existence of high mitotic GISTs in asymptomatic, small gastric SMTs with size enlargement, and laparoscopic surgery was safely applied to majority of those cases. Prompt surgical intervention should therefore be considered for those lesions. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Randomized control trial follow-up: Online program and waiting period for unmarried parents in Title IV-D Court.

    Science.gov (United States)

    Rudd, Brittany N; Poladian, Ani R; Holtzworth-Munroe, Amy; Applegate, Amy G; D'Onofrio, Brian M

    2017-04-01

    Despite a lack of research on parent programs for separating unmarried parents, many judicial officers mandate participation. Rudd, Holtzworth-Munroe, Reyome, Applegate, and D'Onofrio (2015) conducted the only randomized controlled trial of any online parent program for separating parents, ProudToParent.org (PTP), and related court processes (e.g., having a waiting period between the establishment of paternity and the court hearing regarding child related issues vs. having the hearing the same day). They recruited a unique sample of 182 cases in a Title IV-D Court (i.e., a court for primarily low income parents) (Authorization of Appropriations, 42 U.S.C. § 651, 2013), in which paternity was previously contested but subsequently established via court-ordered genetic testing. Unexpectedly, cases assigned to PTP and a waiting period were the least likely to reach agreement at their court hearing. In the current study, we extend these results to examine the impact of the study conditions on relitigation in the year following the court hearing; only 11.2% of cases filed a motion, and 7.8% had a hearing. The group that was least likely to reach full initial agreement (i.e., assigned to PTP and the waiting period) were the most likely to relitigate. Further, controlling for study conditions, reaching a full agreement in the Title IV-D court decreased the odds of having a court hearing in the following year. Reaching agreements on the specific issues involved in such cases (e.g., custody, child support) reduced the likelihood of both motions and hearings in the year after the Title IV-D hearings. The implications of these findings are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  3. Health care justice and its implications for current policy of a mandatory waiting period for elective tubal sterilization.

    Science.gov (United States)

    Moaddab, Amirhossein; McCullough, Laurence B; Chervenak, Frank A; Fox, Karin A; Aagaard, Kjersti Marie; Salmanian, Bahram; Raine, Susan P; Shamshirsaz, Alireza A

    2015-06-01

    Tubal sterilization during the immediate postpartum period is 1 of the most common forms of contraception in the United States. This time of the procedure has the advantage of 1-time hospitalization, which results in ease and convenience for the woman. The US Collaborative Review of Sterilization Study indicates the high efficacy and effectiveness of postpartum tubal sterilization. Oral and written informed consent is the ethical and legal standard for the performance of elective tubal sterilization for permanent contraception for all patients, regardless of source of payment. Current health care policy and practice regarding elective tubal sterilization for Medicaid beneficiaries places a unique requirement on these patients and their obstetricians: a mandatory waiting period. This requirement originates in decades-old legislation, which we briefly describe. We then introduce the concept of health care justice in professional obstetric ethics and explain how it originates in the ethical concepts of medicine as a profession and of being a patient and its deontologic and consequentialist dimensions. We next identify the implications of health care justice for the current policy of a mandatory 30-day waiting period. We conclude that Medicaid policy allocates access to elective tubal sterilization differently, based on source of payment and gender, which violates health care justice in both its deontologic and consequentialist dimensions. Obstetricians should invoke health care justice in women's health care as the basis for advocacy for needed change in law and health policy, to eliminate health care injustice in women's access to elective tubal sterilization. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Waiting for a pacemaker

    DEFF Research Database (Denmark)

    Risgaard, B.; Elming, H.; Jensen, G.V.

    2012-01-01

    to implantation. A lack of implantation capacity was responsible for 4.5 of the waiting days. Twenty-nine patients (11.2) developed infection while waiting, primarily urinary tract infections. Thirteen patients (5.0) suffered non-sustained ventricular tachycardia, and eight patients (3.1) suffered clinical...... 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. Published on behalf of the European Society of Cardiology. All...

  5. Estimation of Diafenthiuron Residues in Cardamom (Elettaria cardamomum (L. Maton Using Normal Phase HPLC: Dissipation Pattern and Safe Waiting Period in Green and Cured Cardamom Capsules

    Directory of Open Access Journals (Sweden)

    Johnson Stanley

    2014-01-01

    Full Text Available Diafenthiuron is an effective insecticide used for pest management in cardamom. Residues of diafenthiuron and its degradation/dissipation pattern in cardamom were determined to work out safe waiting period. Samples were collected after three sprays of diafenthiuron @ 400 and 800 g a.i ha−1 and the residues extracted in acetonitrile and quantified in normal phase HPLC in UV detector. Diafenthiuron was detected in 6.61±0.1 min. The limits of detection (LOD and limits of quantification (LOQ were determined to be 0.01 and 0.05 μgmL−1. The initial deposits were found to be 3.82 and 4.10 μg g−1 after sprays of diafenthiuron @ 400 g a.i ha−1 in the first and second experiments, respectively. Nearly cent percent of residues dissipated at 10 days after treatment in the recommended dose of diafenthiuron 400 g a.i ha−1 and the half life varied from 2.0 to 2.8 days with a waiting period of 5.5 to 6.7 days in green capsules of cardamom. The waiting period was 5.4 to 7.0 days in cured capsules of cardamom. With harvest being the focal point for enforcement of residue tolerances, the suggested waiting period of seven days is safe without the problem of pesticide residues in harvestable produce.

  6. Using Tic-Tac software to reduce anxiety-related behaviour in adults with autism and learning difficulties during waiting periods: a pilot study.

    Science.gov (United States)

    Campillo, Cristina; Herrera, Gerardo; Remírez de Ganuza, Conchi; Cuesta, José L; Abellán, Raquel; Campos, Arturo; Navarro, Ignacio; Sevilla, Javier; Pardo, Carlos; Amati, Fabián

    2014-04-01

    Deficits in the perception of time and processing of changes across time are commonly observed in individuals with autism. This pilot study evaluated the efficacy of the use of the software tool Tic-Tac, designed to make time visual, in three adults with autism and learning difficulties. This research focused on applying the tool in waiting situations where the participants exhibited anxiety-related behaviour. The intervention followed a baseline and intervention (AB) design, and a partial interval recording procedure was used to code the presence of stereotypes, nervous utterances, wandering or other examples of nervousness during the selected waiting situations. The results showed that the use of Tic-Tac resulted in lower levels of anxiety-related behaviour in all three participants, compared to the baseline, suggesting that this software may be an effective technology for helping people with autism with organisation and predictability during waiting periods. The results are discussed in terms of limitations and implications for further study.

  7. Evaluating the optimum rest period prior to blood collection for fractionated plasma free metanephrines analysis

    LENUS (Irish Health Repository)

    Griffin, T.P.

    2016-05-01

    The high diagnostic accuracy of plasma metanephrines (PMets) in the di-agnosis of Phaeochromocytoma\\/Paraganglioma (PPGL) is well established. Considerable controversy exists regarding optimum sampling conditions for PMets. The use of reference intervals that do not compromise diagnostic sensitivity is recommended. However, the optimum rest period prior to sampling has yet to be clearly established. The aim of this study was to evaluate PMets concentrations in paired blood samples collected following 30 and 40 min seated-rest prior to sampling, in patients in whom it was clinically rea-sonable to suspect that PPGL may be present.

  8. 11 CFR 9003.4 - Expenses incurred prior to the beginning of the expenditure report period or prior to receipt of...

    Science.gov (United States)

    2010-01-01

    ... 11 Federal Elections 1 2010-01-01 2010-01-01 false Expenses incurred prior to the beginning of the expenditure report period or prior to receipt of Federal funds. 9003.4 Section 9003.4 Federal Elections FEDERAL ELECTION COMMISSION PRESIDENTIAL ELECTION CAMPAIGN FUND: GENERAL ELECTION FINANCING ELIGIBILITY FOR PAYMENTS § 9003.4 Expenses incurred...

  9. Precise periodic components estimation for chronobiological signals through Bayesian Inference with sparsity enforcing prior.

    Science.gov (United States)

    Dumitru, Mircea; Mohammad-Djafari, Ali; Sain, Simona Baghai

    2016-12-01

    The toxicity and efficacy of more than 30 anticancer agents present very high variations, depending on the dosing time. Therefore, the biologists studying the circadian rhythm require a very precise method for estimating the periodic component (PC) vector of chronobiological signals. Moreover, in recent developments, not only the dominant period or the PC vector present a crucial interest but also their stability or variability. In cancer treatment experiments, the recorded signals corresponding to different phases of treatment are short, from 7 days for the synchronization segment to 2 or 3 days for the after-treatment segment. When studying the stability of the dominant period, we have to consider very short length signals relative to the prior knowledge of the dominant period, placed in the circadian domain. The classical approaches, based on Fourier transform (FT) methods are inefficient (i.e., lack of precision) considering the particularities of the data (i.e., the short length). Another particularity of the signals considered in such experiments is the level of noise: such signals are very noisy and establishing the periodic components that are associated with the biological phenomena and distinguishing them from the ones associated with the noise are difficult tasks. In this paper, we propose a new method for the estimation of the PC vector of biomedical signals, using the biological prior informations and considering a model that accounts for the noise. The experiments developed in cancer treatment context are recording signals expressing a limited number of periods. This is a prior information that can be translated as the sparsity of the PC vector. The proposed method considers the PC vector estimation as an Inverse Problem (IP) using the general Bayesian inference in order to infer the unknown of our model, i.e. the PC vector but also the hyperparameters (i.e the variances). The sparsity prior information is modeled using a sparsity enforcing prior law

  10. Endometrial gene expression in primiparous dairy cows at the end of the voluntary waiting period is affected by nutrition: Total mixed ration vs increasing levels of herbage allowance.

    Science.gov (United States)

    Astessiano, A L; Carriquiry, M; Mattiauda, D A; Adrien, M L; Chilibroste, P; Meikle, A

    2017-10-01

    The study postulated that differential nutritional management during the early lactation period would be reflected in endometrial expression of genes related to embryo growth at the end of the voluntary waiting period. Thus, the effect of the combined use of total mixed ration (TMR) and grazing under different herbage allowances during the first 75 days post-partum (DPP) on endometrial gene expression was evaluated in primiparous dairy cows. Cows were blocked by body weight, age and body condition score and randomly assigned to three grazing treatments: high (HA, 30 kg DM per cow per day), medium (MA, 15 kg DM per cow per day) and low (LA, 7.5 kg DM per cow per day) herbage allowance (mixed pasture, 2,600 kg DM per ha) plus 8 kg DM of supplement or TMR (55% forage, 45% concentrate) fed ad libitum (TMR) from calving to 75 DPP. At 57 DPP, cows were synchronized for oestrus (day 0, 68 DPP) and at day 7, endometrial biopsies were obtained. The nutritional treatment did not affect insulin, IGF-1 and leptin concentrations on days 0, 4 or 7. Expression of IGF1, IGFBP3, IGFBP4, ADIPOR1 and ADIPOR2 mRNA was significantly affected by the nutritional treatment. Endometrial IGF1 and IGFBP4 mRNA were twofold greater in TMR and HA than MA and LA cows. Expression of IGFBP3 and ADIPOR1 mRNAs was greater in TMR and HA than MA cows, but did not differ from LA cows. All groups had greater expression of ADIPOR2 mRNA than MA cows. This study provided solid evidence of the importance of nutritional management during early lactation on uterine environment at the end of the voluntary waiting period. The greater expression of genes related to embryo growth and uterine function (IGF system, progesterone and adiponectin receptors) in cows fed diets maximizing energy intake suggests a favourable environment for embryonic growth, which may explain the improved reproductive performance of cows in good energy balance. © 2017 Blackwell Verlag GmbH.

  11. Prolonged patients' In-Hospital Waiting Period after discharge eligibility is associated with increased risk of infection, morbidity and mortality: a retrospective cohort analysis.

    Science.gov (United States)

    Rosman, Maya; Rachminov, Orna; Segal, Omer; Segal, Gad

    2015-06-25

    Prolonged, inappropriate hospital stay after patients' eligibility for discharge from internal medicine departments is a world-wide health-care systems' problem. Nevertheless, the extent to which such surplus hospital stays are associated with infectious complications, their time frame of appearance and their long-term implications was not previously addressed. We conducted a retrospective cohort analysis of patients experiencing an In-hospital Waiting Period (IHWP) after discharge eligibility in a single, tertiary hospital. We screened the records of 245 patients out of which 104 patients fulfilled our inclusion criteria. The mean length of IHWP was 15.7 ± 4.79 day during which 9(8.7 %) patients died. The study primary composite end-point, in-hospital mortality or hospital acquired infection (pneumonia, UTI or sepsis) occurred in 32(31 %) patients. The most hazardous time was during the first 3 IHWP days: 63.7 % of patients experienced a complication and 44 % of the total complications occurred during this period. The occurrence of any complication during IHWP was associated, with statistical significance, with increased risk of mortality during the first year after IHWP initiation (HR = 6.02, p = 0.014). Prolongation of hospital stay after patients are deemed to be discharged from internal medicine departments is associated with increased morbidity and mortality, mainly during the first surplus days of in-hospital stay. Efforts should be made to shorten such hospital stays as much as possible.

  12. "Amnesia" for summer camps and high school graduation: memory work increases reports of prior periods of remembering less.

    Science.gov (United States)

    Read, J D; Lindsay, D S

    2000-01-01

    Claims regarding amnesia for childhood sexual abuse have often been based on studies of adults' responses to questions of the form, "Was there ever a period of time when you remembered less of the abuse than you do now?" In this experiment, 43 adult (mean age = 42) participants rated their current and prior memories of several nontraumatic childhood/adolescent events. Reports of prior periods of less memory were fairly common. Participants then engaged in "reminiscence" or "enhanced" retrieval activities directed toward remembering more about a selected target event. Following retrieval, 35% of the reminiscence condition participants reported prior poor memory for the target event, as did 70% of the enhanced condition. These results highlight the need for appropriate control conditions in retrospective studies of amnesia for childhood trauma.

  13. A Review of OIE Country Status Recovery Using Vaccinate-to-Live Versus Vaccinate-to-Die Foot-and-Mouth Disease Response Policies II: Waiting Periods After Emergency Vaccination in FMD Free Countries.

    Science.gov (United States)

    Geale, D W; Barnett, P V; Clarke, G W; Davis, J; Kasari, T R

    2015-08-01

    For countries with OIE status, FMD free country where vaccination is not practised, vaccinate-to-live policies have a significant economic disincentive as the trade restriction waiting period is double that of vaccinate-to-die policies. The disposal of healthy vaccinated animals strictly for the purpose of regaining markets with debatable scientific justification is a global concern. The feasibility of aligning the waiting periods to facilitate vaccinate-to-live is explored. The first article of this two-part review (Barnett et al., 2015) explored the qualities of higher potency Foot-and-Mouth Disease (FMD) vaccines, performance of differentiating infected from vaccinated animals (DIVA) diagnostic assays particularly in vaccinates and carriers, as well as aspects of current limitations of post-outbreak surveillance. Here, the history behind the OIE waiting periods for FMD free status is reviewed as well as whether the risk of vaccinated animals and their subsequent products differ appreciably at 3 versus 6 months. It is concluded that alignment is feasible for vaccinate-to-live using higher potency FMD vaccines within the current OIE waiting period framework of 3 and 6 months blocks of time. These waiting periods reflect precedence, historical practicalities and considered expert opinion rather than a specific scientific rationale. The future lies in updated epidemiological and diagnostic technology to establish an acceptable level of statistical certainty for surveillance or target probability of freedom of FMDV (infection or circulation) not time restricted waiting periods. The OIE Terrestrial Code limits trade from a FMD free country where vaccination is not practiced to animal products and live non-vaccinated animals. The risk of FMDV in products derived from higher potency vaccinated animals is appreciably less than for countries with infected FMD status or even from a FMD free country where vaccination is practised for which the Code has Articles with

  14. Physicians' attentional performance following a 24-hour observation period: do we need to regulate sleep prior to work?

    Science.gov (United States)

    Smyth, P; Maximova, K; Jirsch, J D

    2017-08-01

    The tradition of physicians working while sleep deprived is increasingly criticised. Medical regulatory bodies have restricted resident physician duty-hours, not addressing the greater population of physicians. We aimed to assess factors such as sleep duration prior to a 24-hour observation period on physicians' attention. We studied 70 physicians (mean age 38 years old (SD 10.8 years)): 36 residents and 34 faculty from call rosters at the University of Alberta. Among 70 physicians, 52 (74%) performed overnight call; 18 did not perform overnight call and were recruited to control for the learning effect of repetitive neuropsychological testing. Attentional Network Test (ANT) measured physicians' attention at the beginning and end of the 24-hour observation period. Participants self-reported ideal sleep needs, sleep duration in the 24 hours prior to (ie, baseline) and during the 24-hour observation period (ie, follow-up). Median regression models examined effects on ANT parameters. Sleep deprivation at follow-up was associated with reduced attentional accuracy following the 24-hour observation period, but only for physicians more sleep deprived at baseline. Other components of attention were not associated with sleep deprivation after adjusting for repetitive testing. Age, years since medical school and caffeine use did not impact changes in ANT parameters. Our study suggests that baseline sleep before 24 hours of observation impacts the accuracy of physicians' attentional testing at 24 hours. Further study is required to determine if optimising physician sleep prior to overnight call shifts is a sustainable strategy to mitigate the effects of sleep deprivation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  15. Waiting for care

    Science.gov (United States)

    Goel, Ritika; Bloch, Gary; Caulford, Paul

    2013-01-01

    Abstract Objective To describe the experiences of a group of new immigrants and caregivers of new immigrants who were subject to the 3-month waiting period for the Ontario Health Insurance Plan and needed to access health care services during that time. Design Qualitative study using a phenomenologic framework. Setting Participants were recruited through the Scarborough Community Volunteer Clinic in Toronto, Ont. Interviews were conducted in person at the clinic or by telephone. Participants Seven participants were interviewed who themselves needed to access health care during the 3-month waiting period for the Ontario Health Insurance Plan or who were caring for someone who did. Methods Seven semistructured, in-depth interviews were conducted using an interview guide; these were recorded and transcribed verbatim. Data were analyzed for themes to arrive at the essence of the participants’ experiences. Main findings Participants believed that there was a lack of clear information and a lack of help from officials. Other common themes included poor social situations, financial loss or threat of financial loss related to health care, a choice to delay seeking care owing to cost, difficulty accessing alternative care, and appreciation for those who advocated on their behalf. Other themes that arose included emotional hardship, poor health outcomes or threat of poor health outcomes resulting from not seeking care, the importance and unpredictability of health, as well as negative impressions of Canada as a country as a result of the negative experience of seeking care. Conclusion New immigrants to Ontario who need to access health care services during the 3-month waiting period for provincial health insurance and the caregivers of such newcomers can have potentially very negative experiences. They might be unable to access care without financial barriers and might, therefore, choose to delay seeking health care until the end of the waiting period; this can lead to

  16. Estimating the periodic components of a biomedical signal through inverse problem modelling and Bayesian inference with sparsity enforcing prior

    Science.gov (United States)

    Dumitru, Mircea; Djafari, Ali-Mohammad

    2015-01-01

    The recent developments in chronobiology need a periodic components variation analysis for the signals expressing the biological rhythms. A precise estimation of the periodic components vector is required. The classical approaches, based on FFT methods, are inefficient considering the particularities of the data (short length). In this paper we propose a new method, using the sparsity prior information (reduced number of non-zero values components). The considered law is the Student-t distribution, viewed as a marginal distribution of a Infinite Gaussian Scale Mixture (IGSM) defined via a hidden variable representing the inverse variances and modelled as a Gamma Distribution. The hyperparameters are modelled using the conjugate priors, i.e. using Inverse Gamma Distributions. The expression of the joint posterior law of the unknown periodic components vector, hidden variables and hyperparameters is obtained and then the unknowns are estimated via Joint Maximum A Posteriori (JMAP) and Posterior Mean (PM). For the PM estimator, the expression of the posterior law is approximated by a separable one, via the Bayesian Variational Approximation (BVA), using the Kullback-Leibler (KL) divergence. Finally we show the results on synthetic data in cancer treatment applications.

  17. 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.

  18. State anxiety during watchful waiting for urinary lithiasis.

    Science.gov (United States)

    Kalaitzi, C; Kalantzis, A; Gravas, S; Georgiadis, J; Christodoulou, C

    2006-01-01

    Guidelines on many disorders recommend a variable period of watchful waiting between diagnosis and indicated action. In this study, we assessed stress during the watchful waiting period for urinary lithiasis, a benign disorder treated with minimally invasive procedures, without the pitfall of the emotional burden of a terminal or debilitating disease or fear of impending major surgery and to assess the distress caused by waiting per se. Furthermore, we attempt to identify individual patients at risk of prolonged or debilitating psychological distress. A total of 112 lithiasis patients with stones pain during the waiting period. Clinicians should be more flexible when they face the above group of patients, as far as the duration of watchful waiting period is concerned, because a long waiting sets those patients under significant emotional burden.

  19. Bankruptcy prediction: The influence of the year prior to failure selected for model building and the effects in a period of economic decline

    NARCIS (Netherlands)

    Pompe, P.P.M.; Bilderbeek, J.

    2005-01-01

    Using large amounts of data from small and medium-sized industrial firms, this study examines two aspects of bankruptcy prediction: the influence of the year prior to failure selected for model building and the effects in a period of economic decline. The results show that especially models

  20. Waiting room oral rehydration in the paediatric emergency department.

    Science.gov (United States)

    Craven, J A; Campbell, L; Martin, C T

    2009-03-01

    Oral rehydration is well established in the treatment of acute gastroenteritis, however it is profoundly underutilised as a treatment in the hospital setting. We introduced a protocol of waiting room oral rehydration for children presenting to the Paediatric Emergency Department with vomiting and/or diarrhoea. These children were given oral rehydration from the time of triage prior to medical assessment. During the study period, 251 children presented 269 times with vomiting and/or diarrhoea, of which 205 (76%) were diagnosed with acute gastroenteritis. A similar period 1 year previously was used as comparison, during which 129 children were diagnosed with acute gastroenteritis. During the study period, 58 children (28%) were given intravenous fluids and 47 (23%) were admitted, compared with 72 (56%) given intravenous fluids and 42 (32%) admitted in the comparison group. This protocol is now part of our routine management of children presenting with symptoms of acute gastroenteritis. Waiting room oral rehydration is a simple yet successful intervention that can be implemented in any Emergency Department.

  1. 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…

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

    Directory of Open Access Journals (Sweden)

    Alejandro Letelier

    2014-07-01

    for consultation, contact of the patient, schedule of the consultation, and the medical appointment itself. Conclusion There was low level of resolution of the waiting list, with completion of only 35% of the requests for consultation. There was also evidence of incomplete administrative procedures, as well as long waiting periods for first-time consultations on patients who were seen, up to 150 days. Patients who were not seen had a mean waiting period of almost 500 days. The management model was insufficient during the period of the study. Resolution was not timely; there was no increase in human resources. There was neither standardization of processes nor effective biomedical prioritization

  3. Waiting when hospitalised

    DEFF Research Database (Denmark)

    Ludvigsen, Mette Spliid

    2004-01-01

    , and interpret the meaning of having fellow-patients during hospitalisation. Three main dimensions are explored; attitudes toward own illness, interpersonal relationships and environmental factors. Questions such as how do patients pass time, find out about illnesses, examinations, treatment, and staff members...... 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....

  4. [Waiting list registration for kidney transplants must improve

    NARCIS (Netherlands)

    Haase-Kromwijk, B.J.; Heemskerk, M.B.; Weimar, W.; Berger, S.P.; Hoitsma, A.J.

    2017-01-01

    OBJECTIVE: To investigate how the composition of the waiting list for postmortem kidney transplant has developed, and whether the waiting list reflects actual demand. DESIGN: Retrospective research and cohort study. METHOD: We used data from the period 2000-2014 from the Dutch Transplant Foundation,

  5. "Waiting and the waiting room: how do you experience them?" emotional implications and suggestions from patients with cancer.

    Science.gov (United States)

    Catania, Chiara; De Pas, Tommaso; Minchella, Ida; De Braud, Filippo; Micheli, Daniela; Adamoli, Laura; Spitaleri, Gianluca; Noberasco, Cristina; Milani, Alessandra; Zampino, Maria Giulia; Toffalorio, Francesca; Radice, Davide; Goldhirsch, Aron; Nolè, Franco

    2011-06-01

    Waiting can increase discomfort. The goal of this study was to identify moods and fears of cancer patients while in a waiting room and to capture their concrete suggestions for an anthropocentric transformation of waiting itself. A 15-item questionnaire was given to 355 patients who came to our Out-patient Oncology Clinic. Eighty-three percent of patients felt that waiting has an emotional cost, 35% were upset by talking about their condition with others while waiting, and 26% suffered a major emotional impact seeing other sick people and witnessing their clinical decline. Eighty-nine percent of patients suggested that alternative activities, such as meetings with professionals, doctors, and psychologists, be organized during the waiting period; 65% suggested fun activities (music therapy, drawing courses, library, TV). Most patients asked to have the freedom to leave the waiting room. This option, feasibly by means of IMs/"beepers," would limit their sense of having a lack of freedom or being robbed of their time. This study highlighted the complexity and heterogeneity of emotional implications that waiting causes in patients with cancer and collected many patients' suggestions about how to create a constructive, free, and personalized waiting period, overcoming the boredom, distress, and psychological suffering it causes.

  6. A Triage Approach to Managing a Two Year Wait-List in a Chronic Pain Program

    Directory of Open Access Journals (Sweden)

    Alexander J Clark

    2005-01-01

    Full Text Available OBJECTIVE: Individuals with chronic pain referred to specialist chronic pain management programs frequently wait months to years for assessment and care. In the authors' pain management program, approximately 600 patients are on the waiting list. An innovative recommendation program to encourage and educate referring physicians to continue active care of pain during this waiting period was developed.

  7. 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.

  8. The effect of waiting: A meta-analysis of wait-list control groups in trials for tinnitus distress.

    Science.gov (United States)

    Hesser, Hugo; Weise, Cornelia; Rief, Winfried; Andersson, Gerhard

    2011-04-01

    The response rates and effects of being placed on a wait-list control condition are well documented in psychiatric populations. Despite the usefulness of such estimates and the frequent use of no-treatment controls in clinical trials for tinnitus, the effect of waiting in a tinnitus trial has not been investigated systematically. The aim of the present study was to quantify the overall effect of wait-list control groups on tinnitus distress. Studies were retrieved via a systematic review of randomised controlled trials of cognitive behaviour therapy for tinnitus distress. Outcomes of psychometrically robust tinnitus-specific measures (Tinnitus Handicap Inventory, Tinnitus Questionnaire, Tinnitus Reaction Questionnaire) from wait-list control groups were quantified using meta-analytic techniques. Percentage of change and standard mean difference effect sizes were calculated using the pre and post wait period. Eleven studies involving 314 wait-list subjects with tinnitus were located. The analysis for a waiting period of 6 to 12 weeks revealed a mean decrease in scores on tinnitus-specific measures of 3% to 8%. Across studies, a statically significant small mean within-group effect size was obtained (Hedges' g=.17). The effects were moderated by methodological quality of the trial, sample characteristics (i.e., age, tinnitus duration), time of the wait-list and how diagnosis was established. Subjects in a tinnitus trial improve in tinnitus distress over a short waiting phase. The effects of waiting are highly variable and depend on the characteristics of the sample and of the trial. Copyright © 2011 Elsevier Inc. All rights reserved.

  9. Extending the duration of the voluntary waiting period from 60 to 88 days in cows that received timed artificial insemination after the Double-Ovsynch protocol affected the reproductive performance, herd exit dynamics, and lactation performance of dairy cows.

    Science.gov (United States)

    Stangaferro, M L; Wijma, R W; Masello, M; Thomas, Mark J; Giordano, J O

    2017-10-18

    This experiment evaluated the reproductive performance, herd exit dynamics, and lactation performance of dairy cows managed with a voluntary waiting period (VWP) of 60 or 88 d. Secondary objectives were evaluating VWP effect on cyclicity status, uterine health, systemic inflammation, and body condition score (BCS) before first service. Lactating Holstein cows from 3 commercial farms in New York State cows were blocked by parity group and total milk yield in their previous lactation and then randomly assigned to VWP of 60 (VWP60; n = 1,352) or 88 (VWP88; n = 1,359) days in milk (DIM). All cows received the Double-Ovsynch protocol (GnRH-7 d-PGF2α-3 d-GnRH-7 d-GnRH-7 d-PGF2α-56 h-GnRH-16 to 20 h-timed artificial insemination; TAI) for synchronization of ovulation and TAI. For second and greater artificial insemination (AI), cows received AI after detection of estrus or the Ovsynch protocol (GnRH-7 d-PGF2α-56 h-GnRH-16 to 20 h-TAI) initiated 32 ± 3 d after AI for cows not re-inseminated at detected estrus. Cyclicity status (progesterone concentration), uterine health (vaginal discharge and uterine cytology), BCS, and systemic inflammation (haptoglobin concentration) were evaluated at baseline (33 ± 3 DIM for both treatments), beginning of the Double-Ovsynch protocol, and 10 d before TAI. Effects of treatments were assessed with multivariable statistical methods relevant for each outcome variable. Extending duration of VWP from 60 to 88 DIM increased pregnancies per AI (P/AI) to first service (VWP60 = 41%; VWP88 = 47%). Nonetheless, the greatest benefit of extending VWP on first-service P/AI was for primiparous cows (VWP60 = 46%; VWP88 = 55%), as P/AI did not differ within the multiparous cow group (VWP60 = 36%; VWP88 = 40%). Physiological status more conducive to pregnancy-characterized by improved uterine health, greater BCS, reduced systemic inflammation, and to a lesser extent more time to resume ovarian cyclicity-explained the increment in P/AI to first

  10. [Improving the CMP appointment waiting time for children and adolescents].

    Science.gov (United States)

    Cani, Pascale

    2014-01-01

    The increasing activity of mental health centres for children and adolescents and longer waiting times in obtaining a first appointment have led an area of child psychiatry to question the organisation of new consultation applications. Two CMP in the sector had a waiting period of over 40 days for half of the patients. Two improvement actions were implemented:the implementation of organisation and reception nurses and the development of a new applications management process. The evaluation after one year showed a decrease of half of the appointment waiting time without changing the non showed up rate.

  11. 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

  12. Effect of emergency physician burnout on patient waiting times

    OpenAIRE

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

    2017-01-01

    International audience; 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 wa...

  13. Organ Type and Waiting Time

    Science.gov (United States)

    ... Your Child Adjust Camps Resources LIVING DONATION Facts Types Being a Living Donor About the Operation Financing Living Donation Home / Before The Transplant / About Organ Allocation / Organ Type & Waiting Time Organ Facts Heart ...

  14. 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.

  15. Mrs. Manumbu's wait: a case for reducing client waiting time.

    Science.gov (United States)

    1992-01-01

    Management Sciences for Health has published a case study on reducing client waiting time, case discussion questions, and a case analysis for training and group discussion for family planning (FP) managers. A married mother of 3 children carries her 5-week-old son as she walks for 1 hour on a hot day to a FP clinic. She wants to learn how to prevent another birth too soon. After registering, she joins at least 35 other women and children under a tree. She sits next to a good friend who has been waiting for 2 hours. They listen to another woman who tells about waiting for 3 hours only to be told she needed to return the following day because too many people wanted to visit the physician. The woman adds that she just wanted a new supply of oral contraceptives. The long walk to the clinic was not the problem, leaving her children alone by themselves was the problem. The new client begins to be concerned about waiting for 3 hours while her children are also home alone; plus, she had chores to do. The case discussion questions ask participants how the waiting time can discourage the new client from using FP, what the clinic can do to ameliorate the situation, and what programs and policies can reduce long client waits. Some solutions to improving the waiting situation include providing transportation, appointments, and fast routes for resupplying contraceptives as well as analyzing client flow and implementing the findings. Mid- and senior-level managers could begin a community-based service delivery program in villages, support a triage policy, and implement higher level training for nurses to perform more medical functions.

  16. Specific timely appointments for triage reduced waiting lists in an outpatient physiotherapy service.

    Science.gov (United States)

    Harding, K E; Bottrell, J

    2016-12-01

    Waiting lists with triage systems are commonly used in outpatient physiotherapy but may not be effective. Could an alternative model of access and triage reduce waiting times over a sustained period with no additional resources? Observational study comparing retrospective data for 11 months prior to the introduction of a new model of access compared with data for the equivalent 11 months afterwards. Patients referred to a physiotherapy outpatient department at an outer metropolitan hospital before (n=721) and after (n=707) the introduction of the new model. A model of access and triage known as 'specific timely appointments for triage' (STAT), in which appointment slots are preserved in advance specifically for new patients based on calculation of average demand. Time from referral to first assessment, number of appointments per patient, occasions of non-attendance and total length of stay in the service. Median time from referral to first appointment was 18 days [interquartile range (IQR) 11 to 33 days] in the pre-intervention group, compared with 14 days (IQR 9 to 21 days) in the post-intervention group (Pphysiotherapy appointments also reduced (IQR 2 to 6 vs IQR 1 to 4; Pphysiotherapy was 22% lower in the year following the introduction of the STAT model. While acknowledging the limitations of a pre- and post-measurement design, this model may have potential for reducing waiting times for outpatient physiotherapy without additional resources. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  17. 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. ...

  18. Waiting for diabetes

    DEFF Research Database (Denmark)

    Troughton, Jacqui; Jarvis, Janet; Skinner, Chas

    2008-01-01

    Objectives: This study sought to inform the development of an educational intervention for people with pre-diabetes in the UK by ascertaining individuals' experience of screening and diagnosis, their appraisal of the condition, and experience of health service delivery from diagnosis to 1 year post......-diagnosis. Methods: Qualitative interviews directed by framework methodology. Fifteen people diagnosed with pre-diabetes from the community (Midlands, UK) as part of a screening programme. Results: Respondents consistently expressed the need for education and support at diagnosis. Dominating all respondents......' narratives was the theme of 'uncertainty', which linked to two further themes of seriousness and taking action. These themes were influenced by respondents' prior experience and appraisal of both diabetes and pre-diabetes and their interpretation of health professionals' attitudes and actions towards them...

  19. Long-waiting outpatients: target audience for health education.

    Science.gov (United States)

    Bamgboye, E A; Jarallah, J S

    1994-04-01

    The study examines the meaning of waiting time in an outpatient department. Attention is payed to the activities of the patients and companions during the waiting time, the potential for health education programmes during the waiting time and the form such a health education programme should take. The setting was the King Khalid University Hospital Outpatient Department, Riyadh, Saudi Arabia. The study sample was selected by a systematic random sample approach of one in every 10 patients or companions visiting the clinic in a period of 2 weeks. The results showed an average waiting time of 148 min with a standard deviation of 11 min. Patients currently engage in reading, sleeping or talking during long waiting time. However, they showed a preference for health education programmes for specific diseases such as heart disease, diabetes mellitus and bowel diseases during the waiting time. Leaflets were favoured to be the most preferred mode for disseminating such information. A sizeable proportion of patients also wanted religious programmes included. We conclude that education programmes for preferred specific health topics at outpatient clinic services would be of potential benefit to patients' overall health.

  20. Review of "Waiting for Superman"

    Science.gov (United States)

    Dutro, Elizabeth

    2011-01-01

    "Waiting for Superman" offers what appear to be straightforward, commonsense solutions to inequities in schooling. The film argues that heroic action can be taken to fix what it portrays as the disaster of public schooling. The film disregards poverty as a factor in school performance and connection--and therefore never addresses anti-poverty…

  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

    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. 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

  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

    2017-07-04

    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. Indefinite waitings in MIRELA systems

    Directory of Open Access Journals (Sweden)

    Johan Arcile

    2015-06-01

    Full Text Available MIRELA is a high-level language and a rapid prototyping framework dedicated to systems where virtual and digital objects coexist in the same environment and interact in real time. Its semantics is given in the form of networks of timed automata, which can be checked using symbolic methods. This paper shows how to detect various kinds of indefinite waitings in the components of such systems. The method is experimented using the PRISM model checker.

  5. An accelerated failure time model for investigating pedestrian crossing behavior and waiting times at signalized intersections.

    Science.gov (United States)

    Yang, Xiaobao; Abdel-Aty, Mohamed; Huan, Mei; Peng, Yichuan; Gao, Ziyou

    2015-09-01

    The waiting process is crucial to pedestrians in the street-crossing behavior. Once pedestrians terminate their waiting behavior during the red light period, they would cross against the red light and put themselves in danger. A joint hazard-based duration model is developed to investigate the effect of various covariates on pedestrian crossing behavior and to estimate pedestrian waiting times at signalized intersections. A total of 1181 pedestrians approaching the intersections during red light periods were observed in Beijing, China. Pedestrian crossing behaviors are classified into immediate crossing behavior and waiting behavior. The probability and effect of various covariates for pedestrians' immediate crossing behavior are identified by a logit model. Four accelerated failure time duration models based on the exponential, Weibull, lognormal and log-logistic distributions are proposed to examine the significant risk factors affecting duration times for pedestrians' waiting behavior. A joint duration model is developed to estimate pedestrian waiting times. Moreover, unobserved heterogeneity is considered in the proposed model. The results indicate that the Weibull AFT model with shared frailty is appropriate for modelling pedestrian waiting durations. Failure to account for heterogeneity would significantly underestimate the effects of covariates on waiting duration times. The proposed model provides a better understanding of pedestrian crossing behavior and more accurate estimation of pedestrian waiting times. It may be applicable in traffic system analysis in developing countries with high flow of mixed traffic. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Customer waiting times in an (R,S) inventory system with compound Poisson demand

    NARCIS (Netherlands)

    van der Heijden, Matthijs C.; de Kok, A.G.

    1992-01-01

    Besides service level and mean physical stock, customer waiting time is an important performance characteristic for an inventory system. In this paper we discuss the calculation of this waiting time in case a periodic review control policy with order-up-to-levelS is used and customers arrive

  7. In the queue for coronary artery bypass grafting: patients' perceptions of risk and 'maximal acceptable waiting time'.

    Science.gov (United States)

    Llewellyn-Thomas, H; Thiel, E; Paterson, M; Naylor, D

    1999-04-01

    To elicit patients' maximal acceptable waiting times (MAWT) for non-urgent coronary artery bypass grafting (CABG), and to determine if MAWT is related to prior expectations of waiting times, symptom burden, expected relief, or perceived risks of myocardial infarction while waiting. Seventy-two patients on an elective CABG waiting list chose between two hypothetical but plausible options: a 1-month wait with 2% risk of surgical mortality, and a 6-month wait with 1% risk of surgical mortality. Waiting time in the 6-month option was varied up if respondents chose the 6-month/lower risk option, and down if they chose the 1-month/higher risk option, until the MAWT switch point was reached. Patients also reported their expected waiting time, perceived risks of myocardial infarction while waiting, current function, expected functional improvement and the value of that improvement. Only 17 (24%) patients chose the 6-month/1% risk option, while 55 (76%) chose the 1-month/2% risk option. The median MAWT was 2 months; scores ranged from 1 to 12 months (with two outliers). Many perceived high cumulative risks of myocardial infarction if waiting for 1 (upper quartile, > or = 1.45%) or 6 (upper quartile, > or = 10%) months. However, MAWT scores were related only to expected waiting time (r = 0.47; P queue. These results suggest a need for interventions to modify patients' inaccurate risk perceptions, particularly if a scheduled surgical date must be deferred.

  8. Watchful Waiting Strategy May Reduce Low-Value Diagnostic Testing.

    Science.gov (United States)

    May, Larissa; Franks, Peter; Jerant, Anthony; Fenton, Joshua

    PCPs need effective communication strategies to address patient requests for low-value testing while sustaining patient-provider partnerships. Watchful waiting - allowing a negotiated period of time to pass before making a firm testing decision - shows promise as a tool for addressing patient requests for low-value testing. Observational analysis of data from a randomized controlled trial of a communication intervention designed to boost patient-centeredness and reduce low-value test ordering among 61 resident primary care physicians. Intervention effectiveness was assessed during follow-up encounters of unannounced standardized patients (SPs) who requested low-value tests. We examined associations between five physician counseling behaviors and overall patient-centeredness (Measure of Patient-Centered Communication) and requested test ordering. During 155 SP encounters, residents most commonly used reassurance (96% of encounters), evidence-based recommendations (97%), and watchful waiting (68 %). Resident advice to pursue watchful waiting was associated with 39% lower likelihood of test ordering (adjusted marginal effect of -38.6% [95% CI -43.6 to -33.6]). When all communication behaviors were examined together, only watchful waiting was significantly associated with test ordering (marginal effect of -38% [95% CI -44.3% to -31.7%]). Overall patient-centeredness was not associated with low-value testing. Resident physician counseling to pursue watchful waiting was associated with less ordering of requested low-value diagnostic tests, while overall patient-centeredness was not. © Copyright 2016 by the American Board of Family Medicine.

  9. 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.

  10. Physiological and performance effects of carbohydrate gels consumed prior to the extra-time period of prolonged simulated soccer match-play

    OpenAIRE

    Harper, Liam D.; Marc A Briggs; McNamee, Ged; West, Daniel J.; Liam P. Kilduff; Stevenson, Emma; Russell, Mark

    2016-01-01

    Objectives: The physiological and performance effects of carbohydrate-electrolyte gels consumed before the 30 min extra-time period of prolonged soccer-specific exercise were investigated. \\ud \\ud Design: Randomised, double-blind, crossover. \\ud \\ud Methods: Eight English Premier League academy soccer players performed 120 min of soccer-specific exercise on two occasions while consuming fluid-electrolyte beverages before exercise, at half-time and 90 min. Carbohydrate-electrolyte (0.7 ± 0.1 g...

  11. Time to Endoscopy in Patients with Colorectal Cancer: Analysis of Wait-Times

    Directory of Open Access Journals (Sweden)

    Renée M. Janssen

    2016-01-01

    Full Text Available Objective. The Canadian Association of Gastroenterology Wait Time Consensus Group recommends that patients with symptoms associated with colorectal cancer (CRC should have an endoscopic examination within 2 months. However, in a recent survey of Canadian gastroenterologists, wait-times for endoscopy were considerably longer than the current guidelines recommend. The purpose of this study was to evaluate wait-times for colonoscopy in patients who were subsequently found to have CRC through the Division of Gastroenterology at St. Paul’s Hospital (SPH. Methods. This study was a retrospective chart review of outpatients seen for consultation and endoscopy ultimately diagnosed with CRC. Subjects were identified through the SPH pathology database for the inclusion period 2010 through 2013. Data collected included wait-times, subject characteristics, cancer characteristics, and outcomes. Results. 246 subjects met inclusion criteria for this study. The mean wait-time from primary care referral to first office visit was 63 days; the mean wait-time to first endoscopy was 94 days. Patients with symptoms waited a mean of 86 days to first endoscopy, considerably longer than the national recommended guideline of 60 days. There was no apparent effect of length of wait-time on node positivity or presence of distant metastases at the time of diagnosis. Conclusion. Wait-times for outpatient consultation and endoscopic evaluation at the St. Paul’s Hospital Division of Gastroenterology exceed current guidelines.

  12. How Long Are Patients Willing to Wait in the Emergency Department Before Leaving Without Being Seen?

    Directory of Open Access Journals (Sweden)

    Michael N Brodeur

    2012-12-01

    Full Text Available Introduction: Our goal was to evaluate patients’ threshold for waiting in an emergency department(ED waiting room before leaving without being seen (LWBS. We analyzed whether willingness to wait was influenced by perceived illness severity, age, race, triage acuity level, or insurance status.Methods: We conducted this survey-based study from March to July 2010 at an urban academic medical center. After triage, patients were given a multiple-choice questionnaire, designed to as certain how long they would wait for medical care. We collected data including age, gender, race,insurance status, and triage acuity level. We looked at the association between willingness to wait and these variables, using stratified analysis and logistic regression.Results: Of the 375 patients who were approached, 340 (91% participated. One hundred seventy one(51% were willing to wait up to 2 hours before leaving, 58 (17% would wait 2 to 8 hours, and110 (32% would wait indefinitely. No association was found between willingness to wait and race,gender, insurance status, or perceived symptom severity. Patients willing to wait >2 hours tended to be older than 25, have higher acuity, and prefer the study site ED.Conclusion: Many patients have a defined, limited period that they are willing to wait for emergency care. In our study, 50% of patients were willing to wait up to 2 hours before leaving the ED without being seen. This result suggests that efforts to reduce the percentage of patients who LWBS must factor in time limits.

  13. Fission product studies at WAIT

    Energy Technology Data Exchange (ETDEWEB)

    De Laeter, J.R.; Rosman, K.J.R.; Loss, R.D. (Western Australian Inst. of Tech., South Bentley)

    1985-07-01

    A general review of fission yields is presented. The Mass Spectrometry Laboratory in the Department of Applied Physics at WAIT has been involved in a continuing programme of measuring the cumulative fission yields of the elements palladium, silver, cadmium, tin and tellurium for a variety of fissile materials (/sup 233/U, /sup 235/U, /sup 238/U and /sup 239/Pu) over a range of neutron energies. Results of studies into the isotopic composition and fission yields of samples from the Oklo natural reactor in Gabon, West Africa are summarised.

  14. Physiological and performance effects of carbohydrate gels consumed prior to the extra-time period of prolonged simulated soccer match-play.

    Science.gov (United States)

    Harper, Liam D; Briggs, Marc A; McNamee, Ged; West, Daniel J; Kilduff, Liam P; Stevenson, Emma; Russell, Mark

    2016-06-01

    The physiological and performance effects of carbohydrate-electrolyte gels consumed before the 30min extra-time period of prolonged soccer-specific exercise were investigated. Randomised, double-blind, crossover. Eight English Premier League academy soccer players performed 120min of soccer-specific exercise on two occasions while consuming fluid-electrolyte beverages before exercise, at half-time and 90min. Carbohydrate-electrolyte (0.7±0.1gkg(-1) BM) or energy-free placebo gels were consumed ∼5min before extra-time. Blood samples were taken before exercise, at half-time and every 15min during exercise. Physical (15-m and 30-m sprint speed, 30-m sprint maintenance and countermovement jump height) and technical (soccer dribbling) performance was assessed throughout each trial. Carbohydrate-electrolyte gels improved dribbling precision (+29±20%) and raised blood glucose concentrations by 0.7±0.8mmoll(-1) during extra-time (both p3% during half-time (all pCarbohydrate-electrolyte gel ingestion raised blood glucose concentrations and improved dribbling performance during the extra-time period of simulated soccer match-play. Supplementation did not attenuate reductions in physical performance and hydration status that occurred during extra-time. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  15. 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...... 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...... derive steady-state waiting-time distributions for both models. The results are illustrated with numerical examples....

  16. RNA-stabilized whole blood samples but not peripheral blood mononuclear cells can be stored for prolonged time periods prior to transcriptome analysis.

    Science.gov (United States)

    Debey-Pascher, Svenja; Hofmann, Andrea; Kreusch, Fatima; Schuler, Gerold; Schuler-Thurner, Beatrice; Schultze, Joachim L; Staratschek-Jox, Andrea

    2011-07-01

    Microarray-based transcriptome analysis of peripheral blood as surrogate tissue has become an important approach in clinical implementations. However, application of gene expression profiling in routine clinical settings requires careful consideration of the influence of sample handling and RNA isolation methods on gene expression profile outcome. We evaluated the effect of different sample preservation strategies (eg, cryopreservation of peripheral blood mononuclear cells or freezing of PAXgene-stabilized whole blood samples) on gene expression profiles. Expression profiles obtained from cryopreserved peripheral blood mononuclear cells differed substantially from those of their nonfrozen counterpart samples. Furthermore, expression profiles in cryopreserved peripheral blood mononuclear cell samples were found to undergo significant alterations with increasing storage period, whereas long-term freezing of PAXgene RNA stabilized whole blood samples did not significantly affect stability of gene expression profiles. This report describes important technical aspects contributing toward the establishment of robust and reliable guidance for gene expression studies using peripheral blood and provides a promising strategy for reliable implementation in routine handling for diagnostic purposes. Copyright © 2011 American Society for Investigative Pathology and the Association for Molecular Pathology. Published by Elsevier Inc. All rights reserved.

  17. 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.

  18. 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 ...

  19. Consumer Perception and Evaluation of Waiting Time

    NARCIS (Netherlands)

    G. Antonides (Gerrit); P.C. Verhoef (Peter)

    2000-01-01

    textabstractTelephone waiting times for a commercial service were varied in two different experiments. In the first experiment, the telephone rate was either zero or fixed at Dfl.1.- (approx. $0.40) per minute. Consumer perceptions of waiting times could be described best by a psychophysical power

  20. 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…

  1. Waiting for scheduled surgery: A complex patient experience.

    Science.gov (United States)

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

    2017-03-01

    The aim of this study was to understand experiences of wait time among patients awaiting scheduled orthopaedic or cardiac surgery. Using a qualitative approach, 32 patients completed two interviews each regarding their wait time experiences, including effects of waiting. Patient experiences of wait time varied regardless of actual wait time and included reports of restriction, uncertainty, resignation, coping and opportunity. Participants' waiting experiences indicate a complex relationship between greater symptom severity and less tolerance for wait time. We suggest healthcare resources focus on alleviating the deleterious effects of waiting for certain patients rather than reducing absolute wait times.

  2. 75 FR 57109 - Premerger Notification; Reporting and Waiting Period Requirements

    Science.gov (United States)

    2010-09-17

    ... (December 12, 2005). A number of filers have taken advantage of this change and provide Internet links in... classes of voting securities to be acquired and Item 5(a) requires the reporting of revenues by Department... person to report, based on its knowledge or belief, all its associates' holdings of voting securities and...

  3. 78 FR 41293 - Premerger Notification; Reporting and Waiting Period Requirements

    Science.gov (United States)

    2013-07-10

    ... certain mergers and acquisitions to file reports with the Federal Trade Commission (``the Commission... of Management and Budget (``OMB'') and obtain clearance before instituting them. Such collections of...

  4. 78 FR 10574 - Premerger Notification; Reporting and Waiting Period Requirements

    Science.gov (United States)

    2013-02-14

    ... parties to certain mergers and acquisitions to file reports with the Federal Trade Commission (``the... agencies to submit ``collections of information'' to the Office of Management and Budget (``OMB'') and...

  5. 77 FR 50057 - Premerger Notification; Reporting and Waiting Period Requirements

    Science.gov (United States)

    2012-08-20

    ... database. While each situation in the database is factually unique, the questions from practitioners... license to all of B's patent rights for all veterinary indications. B retains all patent rights for all human indications. The exclusive license to all commercially significant rights for all veterinary...

  6. 78 FR 68705 - Premerger Notification; Reporting and Waiting Period Requirements

    Science.gov (United States)

    2013-11-15

    ... the evolution of pharmaceutical patent licenses, the ``make, use, and sell'' approach is no longer... regulatory mind.'') (quotation, quotation marks, and brackets omitted). Effect on Pharmaceutical Industry...

  7. 76 FR 42471 - Premerger Notification; Reporting and Waiting Period Requirements

    Science.gov (United States)

    2011-07-19

    ..., Department of Justice (together the ``Agencies'') conduct their initial review of a proposed transaction's... additional information that would significantly assist the Agencies in their initial review. Finally, minor changes are being made to address minor omissions from the FTC's 2005 rulemaking involving unincorporated...

  8. Waiting for permission to enter the labour ward world: first time parents' experiences of the first encounter on a labour ward.

    Science.gov (United States)

    Nyman, Viola; Downe, Soo; Berg, Marie

    2011-08-01

    For women and their partners, the first meeting with professional staff on the labour ward is important. This initial encounter is a short but sensitive meeting. It may be particularly crucial for first time parents, most of whom have no prior experience of the birth environment. The objective of this study was to explore the meaning of first time mothers' and their partners' first encounter with midwives and other maternity care staff when they arrive on a hospital labour ward. A hermeneutic, reflective lifeworld research approach was chosen to identify patterns of meanings, comprehension and explanations. Participants from Western Sweden were interviewed in the postnatal period; 37 individually, and 28 in focus groups. Four themes were identified: 'timing it right ', 'waiting to be informed', 'being in an inferior position', and 'facing reality with a mosaic of emotions'. The final interpretation of the phenomenon is captured as 'waiting for permission to enter the labour ward world'. The findings demonstrate the parents' efforts trying to determine the appropriateness of arrival to the labour ward. An asymmetric power relationship was expressed in the obedient acceptance of the waiting for attention in an unfamiliar situation. These findings suggest that the labour ward entry process is not parent centred. As entry to the labour ward sets the tone for the rest of the birth, this period in the labour process needs more attention in future research and practice from the maternity care professionals perspective. Copyright © 2011 Elsevier B.V. All rights reserved.

  9. Effect of an audiovisual message for tetanus booster vaccination broadcast in the waiting room.

    Science.gov (United States)

    Eubelen, Caroline; Brendel, Fannette; Belche, Jean-Luc; Freyens, Anne; Vanbelle, Sophie; Giet, Didier

    2011-09-28

    General practitioners (GPs) often lack time and resources to invest in health education; audiovisual messages broadcast in the waiting room may be a useful educational tool. This work was designed to assess the effect of a message inviting patients to ask for a tetanus booster vaccination. A quasi experimental study was conducted in a Belgian medical practice consisting of 6 GPs and 4 waiting rooms (total: 20,000 contacts/year). A tetanus booster vaccination audiovisual message was continuously broadcast for 6 months in 2 randomly selected waiting rooms (intervention group--3 GPs) while the other 2 waiting rooms remained unequipped (control group--3 GPs). At the end of the 6-month period, the number of vaccine adult-doses delivered by local pharmacies in response to GPs' prescriptions was recorded. As a reference, the same data were also collected retrospectively for the general practice during the same 6-month period of the previous year. During the 6-month reference period where no audiovisual message was broadcast in the 4 waiting rooms, the number of prescriptions presented for tetanus vaccines was respectively 52 (0.44%) in the intervention group and 33 (0.38%) in the control group (p = 0.50). By contrast, during the 6-month study period, the number of prescriptions differed between the two groups (p Broadcasting an audiovisual health education message in the GPs' waiting room was associated with a significant increase in the number of adult tetanus booster vaccination prescriptions delivered by local pharmacies.

  10. Waiting time care guarantees: necessity or nemesis?

    Science.gov (United States)

    Joshi, N P; Noseworthy, F T; Noseworthy, T W

    2006-01-01

    One of the priorities of governments in Canada is to reduce long waiting times for health services. This has raised the prospect of introducing waiting time care guarantees. Such guarantees affirm the healthcare system's social contract with the public and provide an entitlement to Canadians to receive timely care. There are clinical, legal and political implications, which must be considered and well managed before introduction. Other countries have ventured down this path. They teach us that waiting time care guarantees are good policy and make good sense. Correspondingly, they remind us not to make a promise we are not ready to keep.

  11. 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.

  12. Improving wait times to care for individuals with multimorbidities and complex conditions using value stream mapping.

    Science.gov (United States)

    Sampalli, Tara; Desy, Michel; Dhir, Minakshi; Edwards, Lynn; Dickson, Robert; Blackmore, Gail

    2015-04-05

    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. 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. 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. 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. © 2015 by Kerman University of Medical Sciences.

  13. Improving wait times to care for individuals with multimorbidities and complex conditions using value stream mapping

    Science.gov (United States)

    Sampalli, Tara; Desy, Michel; Dhir, Minakshi; Edwards, Lynn; Dickson, Robert; Blackmore, Gail

    2015-01-01

    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. PMID:26188810

  14. 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.

  15. Restricting kidney transplant wait-listing for obese patients: let's stop defending the indefensible.

    Science.gov (United States)

    Kovesdy, Csaba P; Molnar, Miklos Z

    2014-01-01

    The allocation of limited medical resources represents an ethical dilemma that continues to generate lively debates. While the allocation of allografts to wait-listed patients is done in a transparent manner, with its rules open to public debate and prone to continuous improvement, the practice of wait-listing is not centrally regulated, and its rules are often less scrutinized. Denial of kidney transplant wait-listing to obese individuals has been a common practice by most transplant centers. On the face of it, this practice is justified by commonly accepted ethical standards, yet there is now mounting evidence that these justifications do not withstand closer scrutiny. A candid and open debate in the Nephrology and Transplant community is needed to examine the true motivations that underlie the practice of denying wait-listing to obese individuals, and to find a solution that is truly in the best interest of our patients. © 2014 Wiley Periodicals, Inc.

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

    African Journals Online (AJOL)

    satisfied with the care received is strongly related to the quality ... clinic wait.[1] Failure to incorporate consumer‑driven features into the design of wait experience could lead to patient and provider dissatisfaction. Waiting time ... respondents waited for 90‑180 min in the clinic, whereas 36.1% (35/96) of the patients spent.

  17. Willing to wait?: The influence of patient wait time on satisfaction with primary care

    Directory of Open Access Journals (Sweden)

    Balkrishnan Rajesh

    2007-02-01

    Full Text Available Abstract Background This study examined the relationship between patient waiting time and willingness to return for care and patient satisfaction ratings with primary care physicians. Methods Cross-sectional survey data on a convenience sample of 5,030 patients who rated their physicians on a web-based survey developed to collect detailed information on patient experiences with health care. The survey included self-reported information on wait times, time spent with doctor, and patient satisfaction. Results Longer waiting times were associated with lower patient satisfaction (p Conclusion The time spent with the physician is a stronger predictor of patient satisfaction than is the time spent in the waiting room. These results suggest that shortening patient waiting times at the expense of time spent with the patient to improve patient satisfaction scores would be counter-productive.

  18. 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.

  19. 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.

  20. Waiting times for radiation therapy in Ontario.

    Science.gov (United States)

    Benk, Veronique; Przybysz, Raymond; McGowan, Tom; Paszat, Lawrence

    2006-02-01

    The mass media and clinical journals have reported lengthy waiting times after surgery before initiation of radiation therapy (RT) for cancer across Canada. We aimed to describe the length of time between the last date of surgery or biopsy or chemotherapy and first date of RT. This is a population-based study measuring waiting times for RT in Ontario among all patients with potentially curable cancer of the cervix, tonsil and larynx and a random sample of women who had had breast cancer resection, whose first date of RT fell between Sept. 1, 2001, and Aug. 31, 2002. Abstraction of original health care records provided each patient's demographics, cancer stage and cancer treatment (last surgery, consultation, simulation, first RT). Last dates of chemotherapy before RT were obtained from abstraction or from Ontario Health Insurance Plan (OHIP) files, and last dates of surgery before RT were compared with dates in the Canadian Institute for Health Information (CIHI) Discharge Abstract Database. Waiting times between the last date of surgery or chemotherapy and the first date of RT varied significantly among the health regions of Ontario. Increasing age, but not the presence of comorbidity, was associated with longer waiting times. Women who did not receive postoperative chemotherapy before RT for breast cancer waited significantly longer than all others. Measurement of waiting times for cancer RT must discount time during which adjuvant intravenous chemotherapy is administered after surgery and before RT. There appears to be a formal or informal process by which those at highest risk begin RT most rapidly.

  1. Patterns and predictors of help-seeking contacts with health services and general practitioner detection of suicidality prior to suicide: a cohort analysis of suicides occurring over a two-year period.

    Science.gov (United States)

    Leavey, Gerard; Rosato, Michael; Galway, Karen; Hughes, Lynette; Mallon, Sharon; Rondon, Janeet

    2016-04-30

    Contact with primary care and psychiatric services prior to suicide may be considerable, presenting opportunities for intervention. However, there is scant knowledge on the frequency, nature and determinants of contact. Retrospective cohort study-an analysis of deaths recorded as suicide by the Northern Ireland Coroner's Office linked with data from General Practice patient records over a 2 year period Eighty-seven per cent of suicides were in contact with General Practice services in the 12 months before suicide. The frequency of contact with services was considerable, particularly among patients with a common mental disorder or substance misuse problems. A diagnosis of psychiatric problems was absent in 40% of suicides. Excluding suicide attempts, the main predictors of a noted general practitioner concern for patient suicidality are male gender, frequency of consultations, diagnosis of mental illness and substance misuse. Despite widespread and frequent contact, a substantial proportion of suicidal people were undiagnosed and untreated for mental health problems. General Practitioner alertness to suicidality may be too narrowly focused.

  2. 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.

  3. Time to wait: a systematic review of strategies that affect out-patient waiting times.

    Science.gov (United States)

    Naiker, Ugenthiri; FitzGerald, Gerry; Dulhunty, Joel M; Rosemann, Michael

    2017-03-30

    Objective Out-patient waiting times pose a significant challenge for public patients in need of specialist evaluation and intervention. The aim of the present study was to identify and categorise effective strategies to reduce waiting times for specialist out-patient services with a focus on the Australian healthcare system.Methods A systematic review of major health databases was conducted using the key terms 'outpatient*' AND 'waiting time', 'process*' AND 'improvement in outpatient clinics'. Identified articles were assessed for their relevance by sequential review of the title, abstract and full text. References of the selected manuscripts were scanned for additional relevant articles. Selected articles were evaluated for consistent and emerging themes.Results In all, 152 articles were screened, of which 38 were included in the present review. Numerous strategies identified in the articles were consolidated into 26 consistent approaches. Three overarching themes were identified as significantly affecting waiting times: resource realignment, operational efficiency and process improvement.Conclusions Strategies to align resources, increase operational efficiency and improve processes provide a comprehensive approach that may reduce out-patient waiting times.What is known about the topic? Out-patient waiting times are a challenge in most countries that seek to provide universal access to health care for all citizens. Although there has been extensive research in this area, many patients still experience extensive delays accessing specialist care, particularly in the public health sector. The multiple factors that contribute to bottlenecks and inefficiencies in the referral process and affect patient waiting times are often poorly understood.What does this paper add? This paper reviews the published healthcare literature to identify strategies that affect specialist out-patient waiting times for patients. The findings suggest that there are numerous operational

  4. Prior data for non-normal priors.

    Science.gov (United States)

    Greenland, Sander

    2007-08-30

    Data augmentation priors facilitate contextual evaluation of prior distributions and the generation of Bayesian outputs from frequentist software. Previous papers have presented approximate Bayesian methods using 2x2 tables of 'prior data' to represent lognormal relative-risk priors in stratified and regression analyses. The present paper describes extensions that use the tables to represent generalized-F prior distributions for relative risks, which subsume lognormal priors as a limiting case. The method provides a means to increase tail-weight or skew the prior distribution for the log relative risk away from normality, while retaining the simple 2x2 table form of the prior data. When prior normality is preferred, it also provides a more accurate lognormal relative-risk prior in for the 2x2 table format. For more compact representation in regression analyses, the prior data can be compressed into a single data record. The method is illustrated with historical data from a study of electronic foetal monitoring and neonatal death.

  5. 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

  6. Radiotherapy waiting times for women with breast cancer: a population-based cohort study.

    Science.gov (United States)

    Jack, Ruth H; Davies, Elizabeth A; Robinson, David; Sainsbury, Richard; Møller, Henrik

    2007-05-01

    Waiting times for cancer patients are a national priority in the UK. Previous studies have shown variation between cancer networks in the time between diagnosis and start of radiotherapy for all cancer patients. Studies of the relationship between delay in receiving treatment and survival of breast cancer patients have been inconsistent. This study aimed to examine factors associated with waiting times for radiotherapy for breast cancer patients. 35,354 women resident in South East England and diagnosed with breast cancer between 1992 and 2001 who received radiotherapy within six months of diagnosis were identified from the Thames Cancer Registry. Time to radiotherapy was measured from either the date of diagnosis or the start of the previous treatment, whichever was shorter. Unadjusted and adjusted logistic regression models were fitted to examine whether patients received radiotherapy within 60 days of their diagnosis or previous treatment. The adjusted proportions of patients receiving radiotherapy within 60 days varied significantly between different cancer networks (range: 43% to 81%), and decreased from 68% in 1992 to 33% in 2001. After adjustment there was no association between deprivation of area of residence, age or stage and radiotherapy wait. Median time waited to radiotherapy increased over the study period whether measured from the start of chemotherapy, hormone therapy, surgery or the date of diagnosis. This study covered a period of time before the investment following the Cancer Plan of 2000. Results are consistent with other findings suggesting variation between cancer networks and increasing waits over time. Further studies should examine different methods of measuring waiting time, the causes and consequences of waits for radiotherapy and the effect of current initiatives and investments.

  7. Radiotherapy waiting times for women with breast cancer: a population-based cohort study

    Directory of Open Access Journals (Sweden)

    Sainsbury Richard

    2007-05-01

    Full Text Available Abstract Background Waiting times for cancer patients are a national priority in the UK. Previous studies have shown variation between cancer networks in the time between diagnosis and start of radiotherapy for all cancer patients. Studies of the relationship between delay in receiving treatment and survival of breast cancer patients have been inconsistent. This study aimed to examine factors associated with waiting times for radiotherapy for breast cancer patients. Methods 35,354 women resident in South East England and diagnosed with breast cancer between 1992 and 2001 who received radiotherapy within six months of diagnosis were identified from the Thames Cancer Registry. Time to radiotherapy was measured from either the date of diagnosis or the start of the previous treatment, whichever was shorter. Unadjusted and adjusted logistic regression models were fitted to examine whether patients received radiotherapy within 60 days of their diagnosis or previous treatment. Results The adjusted proportions of patients receiving radiotherapy within 60 days varied significantly between different cancer networks (range: 43% to 81%, and decreased from 68% in 1992 to 33% in 2001. After adjustment there was no association between deprivation of area of residence, age or stage and radiotherapy wait. Median time waited to radiotherapy increased over the study period whether measured from the start of chemotherapy, hormone therapy, surgery or the date of diagnosis. Conclusion This study covered a period of time before the investment following the Cancer Plan of 2000. Results are consistent with other findings suggesting variation between cancer networks and increasing waits over time. Further studies should examine different methods of measuring waiting time, the causes and consequences of waits for radiotherapy and the effect of current initiatives and investments.

  8. Effective anxiety treatment prior to diagnostic cardiac catheterization.

    Science.gov (United States)

    McCaffrey, Ruth; Taylor, Natalie

    2005-01-01

    Music therapy, massage, guided imagery, therapeutic touch, and stress management instruction have been used successfully to decrease patient anxiety prior to diagnostic cardiac catheterization, providing better patient outcomes. The anxiety experienced among patients may have various causes, including not feeling cared about as an individual, too much waiting time before the procedure begins, and physical discomfort. This review determines nursing interventions that may effectively reduce anxiety prior to diagnostic cardiac catheterization.

  9. 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...

  10. A model to prioritize access to elective surgery on the basis of clinical urgency and waiting time

    Directory of Open Access Journals (Sweden)

    Santori Gregorio

    2009-01-01

    test period, fully covering the case mix of the patients referred to surgery. The software produced real time data and advanced parameters, providing patients and users useful tools to manage waiting lists and to schedule hospital admissions with ease and efficiency. The model protected patients from horizontal and vertical inequities, while positive changes in API were observed in the latest period, meaning that more patients were treated within their MTBT. Conclusion The SWALIS model achieves the purpose of providing useful data to monitor waiting lists appropriately. It allows homogeneous and standardized prioritization, enhancing transparency, efficiency and equity. Due to its applicability, it might represent a pragmatic approach towards surgical waiting lists, useful in both clinical practice and strategic resource management.

  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. 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...

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

    African Journals Online (AJOL)

    Background: Maternity waiting homes have been promoted to improve pregnant women's access to quality obstetric care. The main aim of this study was to assess the situation of maternity waiting homes and the experiences and challenges of mothers using waiting homes. Methods: A cross-sectional study was conducted ...

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

    African Journals Online (AJOL)

    Lessons learned In-house training of records staff had little long-term impact on reducing the time patients waited to collect their cards. Increased staffing and coordinating staff strength to correspond to times of peak patient load had the greatest effect in reducing outpatient waiting time. Constructive use of patient waiting ...

  15. Impact of Prior Consumption on Sour, Sweet, Salty, and Bitter Tastes.

    Science.gov (United States)

    Christina, Josephine; Palma-Salgado, Sindy; Clark, Diana; Kahraman, Ozan; Lee, Soo-Yeun

    2016-02-01

    Food sensory tests generally require panelists to abstain from food or beverage consumption 30 min to an hour before a tasting session. However, investigators do not have a complete control over panelists' intentional or unintentional consumption prior to a tasting session. Currently, it is unclear how prior consumption impacts the results of the tasting session. The aim of this study was to determine the effects of temporary and lingering mouth irritation caused by the consumption of coffee, orange juice, and gum within 1, 15, or 30 min prior to the tasting session on the perception of 4 basic tastes: sweet, salty, sour, and bitter. Fifty-two panelists were served a beverage (orange juice, coffee, and water) or were asked to chew a piece of gum, and then, remained in the waiting room for 1, 15, or 30 min. They were then asked to report taste intensities using 15-cm unstructured line scales. Mean intensities of all tastes were not significantly different when orange juice was a primer at 1, 15, and 30 min when compared to water. Mean intensities of bitter were significantly lower when coffee was a primer at 1, 15, and 30 min than when water was a primer. Mean intensities of sweet were significantly lower when gum was a primer at 1 and 15 min than when water was a primer. The findings showed that it is necessary for 30 min or more waiting period of no food or beverage consumption prior to sensory testing. © 2015 Institute of Food Technologists®

  16. Waiting to Move: Stress, Coping and the Meaning of Home in Anticipation of Relocation.

    Science.gov (United States)

    Rutman, Deborah L.; Freedman, Jonathan L.

    Research has examined the effects of relocation on the physical and psychological well-being of the elderly, but has usually neglected the pre-relocation or anticipatory period. A study was conducted to examine the experiences of older persons waiting to relocate to subsidized age-segregated apartments. Subjects were interviewed twice over a…

  17. 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.

    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

  18. 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.

  19. Stress Caused by Waiting: A Theoretical Evaluation of a Mathematical Model

    Science.gov (United States)

    Suck; Holling

    1997-09-01

    According to cognitive stress theories, stress caused by waiting is influenced by two components, the (psychological) cost of waiting, that is, a function C of time, and a probability distribution over waiting times. Osuna (1985a) suggested a model by which stress as a function of time could be calculated from these constituents. The aim of this paper is (1) to generalize the model, (2) to investigate its mathematical properties, (3) to derive predictions for experimental tests of the model, and (4) to give a precise meaning to the variability and duration hypothesis discussed in the experimental literature. In particular, several theorems are derived which specify situations in which the model enables the user to compare conditions for their stress inducing potential. Such conditions are the duration of the waiting time and the predictability of the length of a waiting period. The core of the mathematical derivations is an identity for expected stress which simplifies the calculations of the Osuna model considerably. Copyright 1997 Academic Press

  20. 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

  1. Act-and-wait time-delayed feedback control of autonomous systems

    Science.gov (United States)

    Pyragas, Viktoras; Pyragas, Kestutis

    2018-02-01

    Recently an act-and-wait modification of time-delayed feedback control has been proposed for the stabilization of unstable periodic orbits in nonautonomous dynamical systems (Pyragas and Pyragas, 2016 [30]). The modification implies a periodic switching of the feedback gain and makes the closed-loop system finite-dimensional. Here we extend this modification to autonomous systems. In order to keep constant the phase difference between the controlled orbit and the act-and-wait switching function an additional small-amplitude periodic perturbation is introduced. The algorithm can stabilize periodic orbits with an odd number of real unstable Floquet exponents using a simple single-input single-output constraint control.

  2. 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.

  3. The Nondeterministic Waiting Time Algorithm: A Review

    Directory of Open Access Journals (Sweden)

    John Jack

    2009-07-01

    Full Text Available We present briefly the Nondeterministic Waiting Time algorithm. Our technique for the simulation of biochemical reaction networks has the ability to mimic the Gillespie Algorithm for some networks and solutions to ordinary differential equations for other networks, depending on the rules of the system, the kinetic rates and numbers of molecules. We provide a full description of the algorithm as well as specifics on its implementation. Some results for two well-known models are reported. We have used the algorithm to explore Fas-mediated apoptosis models in cancerous and HIV-1 infected T cells.

  4. Emergency department waiting room nurse role: A key informant perspective.

    Science.gov (United States)

    Innes, Kelli; Jackson, Debra; Plummer, Virginia; Elliott, Doug

    2017-02-01

    Emergency departments have become overcrowded with increased waiting times. Strategies to decrease waiting times include time-based key performance indicators and introduction of a waiting room nurse role. The aim of the waiting room nurse role is to expedite care by assessing and managing patients in the waiting room. There is limited literature examining this role. This paper presents results of semi-structured interviews with five key informants to explore why and how the waiting room nurse role was implemented in Australian emergency departments. Data were thematically analysed. Five key informants from five emergency departments across two Australian jurisdictions (Victoria and New South Wales) reported that the role was introduced to reduce waiting times and improve quality and safety of care in the ED waiting room. Critical to introducing the role was defining and supporting the scope of practice, experience and preparation of the nurses. Role implementation required champions to overcome identified challenges, including funding. There has been limited evaluation of the role. The waiting room nurse role was introduced to decrease waiting times and contributed to risk mitigation. Common to all roles was standing orders, while preparation and experience varied. Further research into the role is required. Copyright © 2016 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

  5. Revisiting Waiting Times in DNA evolution

    CERN Document Server

    Nicodeme, Pierre

    2012-01-01

    Transcription factors are short stretches of DNA (or $k$-mers) mainly located in promoters sequences that enhance or repress gene expression. With respect to an initial distribution of letters on the DNA alphabet, Behrens and Vingron consider a random sequence of length $n$ that does not contain a given $k$-mer or word of size $k$. Under an evolution model of the DNA, they compute the probability $\\mathfrak{p}_n$ that this $k$-mer appears after a unit time of 20 years. They prove that the waiting time for the first apparition of the $k$-mer is well approximated by $T_n=1/\\mathfrak{p}_n$. Their work relies on the simplifying assumption that the $k$-mer is not self-overlapping. They observe in particular that the waiting time is mostly driven by the initial distribution of letters. Behrens et al. use an approach by automata that relaxes the assumption related to words overlaps. Their numerical evaluations confirms the validity of Behrens and Vingron approach for non self-overlapping words, but provides up to 44...

  6. Standardised Resting Time Prior to Blood Sampling and Diurnal Variation Associated with Risk of Patient Misclassification

    DEFF Research Database (Denmark)

    Bøgh Andersen, Ida; Brasen, Claus L.; Christensen, Henry

    2015-01-01

    BACKGROUND: According to current recommendations, blood samples should be taken in the morning after 15 minutes' resting time. Some components exhibit diurnal variation and in response to pressures to expand opening hours and reduce waiting time, the aims of this study were to investigate...... the impact of resting time prior to blood sampling and diurnal variation on biochemical components, including albumin, thyrotropin (TSH), total calcium and sodium in plasma. METHODS: All patients referred to an outpatient clinic for blood sampling were included in the period Nov 2011 until June 2014 (opening...... hours: 7am-3pm). Each patient's arrival time and time of blood sampling were registered. The impact of resting time and the time of day for all components was analysed using simple linear regression. The "maximum allowable bias" was used as quality indicator for the change in reference interval. RESULTS...

  7. Increment in beta-hCG in the 48-h period prior to treatment: a new variable predictive of therapeutic success in the treatment of ectopic pregnancy with methotrexate.

    Science.gov (United States)

    da Costa Soares, Roberto; Elito, Júlio; Camano, Luiz

    2008-10-01

    To evaluate the increment in beta-hCG levels (%) in the 48-h interval prior to treatment as a predictor of therapeutic success in the management of ectopic pregnancy with methotrexate. A prospective observational study was carried out between April 2002 and November 2006 at the Federal University of São Paulo in 65 patients with an ectopic pregnancy treated with a single dose of 50 mg/m(2) of methotrexate administered intramuscularly. The following predictive factors were evaluated: beta-hCG level on the day of hospital admission and the percent increment in beta-hCG in the 48-h interval prior to treatment. Treatment was successful in 49 cases (75.4%). In these cases, beta-hCG levels at hospitalization were lower when compared to the levels found in cases of therapeutic failure (1,928.9 vs. 4,828.6 mIU/ml, respectively; P<0.01), and the increment in beta-hCG level in the 48-h interval prior to treatment was smaller (13.1 vs. 36.3%, respectively; P=0.01). A beta-hCG measurement prior to treatment, the greater the likelihood that treatment of ectopic pregnancy with methotrexate will be successful. The margin of safety for treatment with methotrexate is high when beta-hCG measurement on the day of hospitalization is prior to treatment is

  8. Waiting for coronary angiography: is there a clinically ordered queue?

    Science.gov (United States)

    Hemingway, H; Crook, A M; Feder, G; Dawson, J R; Timmis, A

    2000-03-18

    Among over 3000 patients undergoing coronary angiography in the absence of a formal queue-management system, we found that a-priori urgency scores were strongly associated with waiting times, prevalence of coronary-artery disease, rate of revascularisation, and mortality. These data challenge the widely held assumption that such waiting lists are not clinically ordered; however, the wide variation in waiting times within urgency categories suggests the need for further improvements in clinical queueing.

  9. Hospital waiting time: the forgotten premise of healthcare service delivery?

    Science.gov (United States)

    Pillay, Datuk Ir M S; Ghazali, Roslan Johari Dato Mohd; Manaf, Noor Hazilah Abd; Abdullah, Abu Hassan Asaari; Bakar, Azman Abu; Salikin, Faisal; Umapathy, Mathyvani; Ali, Roslinah; Bidin, Noriah; Ismail, Wan Ismefariana Wan

    2011-01-01

    This is a national study which aims to determine the average waiting time in Malaysian public hospitals and to gauge the level of patient satisfaction with the waiting time. It also aims to identify factors perceived by healthcare providers which contribute to the waiting time problem. Self-administered questionnaires were the main method of data collection. Two sets of questionnaires were used. The first set solicited information from patients on their waiting time expereince. The second set elucidated information from hospital employees on the possible causes of lengthy waiting time. The questionnaires were administered in 21 public hospitals throughout all 13 states in Malaysia. A total of 13,000 responses were analysed for the patient survey and almost 3,000 were analysed for the employee survey. The findings indicate that on average, patients wait for more than two hours from registration to getting the prescription slip, while the contact time with medical personnel is only on average 15 minutes. Employee surveys on factors contributing to the lengthy waiting time indicate employee attitude and work process, heavy workload, management and supervision problems, and inadequate facilities to be among the contributory factors to the waiting time problem. Public healthcare in Malaysia is in a state of "excess demand", where demand for subsidised healthcare far outstrips supply, due to the large fee differential between public and private healthcare services. There is a need for hospital managers to reduce the boredom faced by patients while waiting, and to address the waiting time problem in a more scientific manner, as has been carried out in other countries through simulation and modelling techniques. Healthcare organisations are keen to address their waiting time problem. However, not much research has been carried out in this area. The study thus fills the lacuna in waiting time studies in healthcare organisations.

  10. 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...

  11. In the post-colonial waiting room

    DEFF Research Database (Denmark)

    Adler-Nissen, Rebecca; Gad, Ulrik Pram

    2017-01-01

    This chapter investigates this puzzle of choosing non-sovereignty in a postcolonial setting. Historically, the question of freedom from imperial hegemony has been linked to how Western colonialism involved keeping the colonized in ‘the waiting room of history’ by insisting that they were not yet...... ready for sovereignty. It explores a number of European overseas countries and territories. More specifically, it focuses on French dependencies in the Pacific and Indian Oceans, and North Atlantic Greenland constitutionally connected to Denmark. The immediate aim of anti-colonial struggles was to make...... acknowledge. A number of overseas territories take alternative routes to agency; not by resisting the norm of sovereignty - but by creatively articulating it beyond its claim to represent an 'either/or' distinction. The chapter demonstrates that territories not formally decolonized may very well perform...

  12. 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

  13. The reliability of welfare assessment according to the WelFur-protocol in the nursing period of mink (Neovison vison) is challenged by increasing welfare problems prior to weaning

    DEFF Research Database (Denmark)

    Henriksen, Britt I. F.; Møller, Steen Henrik

    2015-01-01

    The objective of this study was to test the hypothesis that the body condition of the mink dam, the frequency of dirty nests, frequency of injuries and diarrhoea change significantly with the day of assessment, post-partum, within the data collection period from parturition to weaning, influencing...

  14. Wait times, patient satisfaction scores, and the perception of care.

    Science.gov (United States)

    Bleustein, Clifford; Rothschild, David B; Valen, Andrew; Valatis, Eduardas; Schweitzer, Laura; Jones, Raleigh

    2014-05-01

    To analyze the impact of waiting time on patient satisfaction scores; not only of satisfaction with the provider in general, but also with the specific perception of the quality of care and physician abilities. Using surveys regarding patient satisfaction with provider care, data was collected from a sample of 11,352 survey responses returned by patients over the course of 1 year across all 44 ambulatory clinics within a large academic medical center. While a small minority of patients volunteered identification, the surveys were made anonymously. A questionnaire with Health Consumer Assessment of Healthcare Providers and Systems patient satisfaction and waiting time queries was administered via mail to all clinic patients-roughly 49,000-with a response rate of 23%. Employing a standard statistical approach, results were tabulated and stratified according to provider scores and wait time experience, and then analyzed using statistical modeling techniques. While it is well established that longer wait times are negatively associated with clinical provider scores of patient satisfaction, results indicated that every aspect of patient experience-specifically confidence in the care provider and perceived quality of care-correlated negatively with longer wait times. The clinical ambulatory patient experience is heavily influenced by time spent waiting for provider care. Not only are metrics regarding the likelihood to recommend and the overall satisfaction with the experience negatively impacted by longer wait times, but increased wait times also affect perceptions of information, instructions, and the overall treatment provided by physicians and other caregivers.

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

    African Journals Online (AJOL)

    Patients spend substantial amount of time in the clinics waiting for services to be delivered by physicians and other allied health professionals. The degree to which health consumers are satisfied with the care received is strongly related to the quality of the waiting experience. Healthcare organizations that strive to deliver ...

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

    African Journals Online (AJOL)

    Maternity waiting homes were introduced in Eritrea in 2007 as a strategy to mitigate against the attendant high maternal mortality rates in hard to reach regions. Objective: To assess pregnancy outcomes verified through maternal mortality and perinatal mortality rates since the introduction of maternity waiting homes in some ...

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

    African Journals Online (AJOL)

    Background: Waiting time is a major determinant of the patients' level of satisfaction. It is the average time spent by the patient from the time of presentation in the hospital to the time of contact with a health service provider. Objective: To determine the mean waiting time in the Records department/card room and the General ...

  18. 8 CFR 207.5 - Waiting lists and priority handling.

    Science.gov (United States)

    2010-01-01

    ... from these lists in a manner that will best support the policies and interests of the United States... association with the United States, compelling humanitarian concerns, and public interest factors. ... REFUGEES § 207.5 Waiting lists and priority handling. Waiting lists are maintained for each designated...

  19. Wait-Time and Multiple Representation Levels in Chemistry Lessons

    Science.gov (United States)

    Li, Winnie Sim Siew; Arshad, Mohammad Yusof

    2014-01-01

    Wait-time is an important aspect in a teaching and learning process, especially after the teacher has posed questions to students, as it is one of the factors in determining quality of students' responses. This article describes the practices of wait-time one after teacher's questions at multiple representation levels among twenty three chemistry…

  20. 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.

  1. A comparison of walk-in counselling and the wait list model for delivering counselling services().

    Science.gov (United States)

    Stalker, Carol A; Riemer, Manuel; Cait, Cheryl-Anne; Horton, Susan; Booton, Jocelyn; Josling, Leslie; Bedggood, Joanna; Zaczek, Margaret

    2016-10-01

    Walk-in counselling has been used to reduce wait times but there are few controlled studies to compare outcomes between walk-in and the traditional model of service delivery. To compare change in psychological distress by clients receiving services from two models of service delivery, a walk-in counselling model and a traditional counselling model involving a wait list. Mixed-methods sequential explanatory design including quantitative comparison of groups with one pre-test and two follow-ups, and qualitative analysis of interviews with a sub-sample. Five-hundred and twenty-four participants ≥16 years were recruited from two Family Counselling Agencies; the General Health Questionnaire-12 assessed change in psychological distress. Hierarchical linear modelling revealed clients of the walk-in model improved faster and were less distressed at the four-week follow-up compared to the traditional service delivery model. Ten weeks later, both groups had improved and were similar. Participants receiving instrumental services prior to baseline improved more slowly. The qualitative data confirmed participants highly valued the accessibility of the walk-in model, and were frustrated by the lengthy waits associated with the traditional model. This study improves methodologically on previous studies of walk-in counselling, an approach to service delivery not conducive to randomized controlled trials.

  2. Constructing priors in synesthesia.

    Science.gov (United States)

    van Leeuwen, Tessa M

    2014-01-01

    A new theoretical framework (PPSMC) applicable to synesthesia has been proposed, in which the discrepancy between the perceptual reality of (some) synesthetic concurrents and their subjective non-veridicality is being explained. The PPSMC framework stresses the relevance of the phenomenology of synesthesia for synesthesia research-and beyond. When describing the emergence and persistence of synesthetic concurrents under PPSMC, it is proposed that precise, high-confidence priors are crucial in synesthesia. I discuss the construction of priors in synesthesia.

  3. 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.

  4. [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.

  5. 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.

  6. Reducing outpatient waiting time: a simulation modeling approach.

    Science.gov (United States)

    Aeenparast, Afsoon; Tabibi, Seyed Jamaleddin; Shahanaghi, Kamran; Aryanejhad, Mir Bahador

    2013-09-01

    The objective of this study was to provide a model for reducing outpatient waiting time by using simulation. A simulation model was constructed by using the data of arrival time, service time and flow of 357 patients referred to orthopedic clinic of a general teaching hospital in Tehran. The simulation model was validated before constructing different scenarios. In this study 10 scenarios were presented for reducing outpatient waiting time. Patients waiting time was divided into three levels regarding their physicians. These waiting times for all scenarios were computed by simulation model. According to the final scores the 9th scenario was selected as the best way for reducing outpatient's waiting time. Using the simulation as a decision making tool helps us to decide how we can reduce outpatient's waiting time. Comparison of outputs of this scenario and the based- case scenario in simulation model shows that combining physician's work time changing with patient's admission time changing (scenario 9) would reduce patient waiting time about 73.09%. Due to dynamic and complex nature of healthcare systems, the application of simulation for the planning, modeling and analysis of these systems has lagged behind traditional manufacturing practices. Rapid growth in health care system expenditures, technology and competition has increased the complexity of health care systems. Simulation is a useful tool for decision making in complex and probable systems.

  7. The effects of music intervention on anxiety in the patient waiting for cardiac catheterization.

    Science.gov (United States)

    Hamel, W J

    2001-10-01

    Hospitalization causes anxiety for many patients. It increases when patients anticipate their turn for cardiac catheterization. Music therapy reduces the psychophysiologic effects of anxiety and stress through the relaxation response. To determine the effects of music therapy an anxiety, heart rate and arterial blood pressure in patients waiting for their scheduled cardiac catheterization. In a quasi-experimental, pretest-posttest design, 101 subjects were randomly assigned to either the test group: those who listened to 20 minutes of preselected music, or the control group: those who received treatment as usual. Subject anxiety levels and physiological values were measured while waiting their turn for cardiac catheterization and just prior to departure to the cardiac lab. 63 males and 38 females participated in the study. There was a statistically significant reduction in anxiety in the test group alone (P = 0.003) and in comparing the test to the control group (P = 0.004). In comparing the initial and departure physiologic values, it was noted that both heart rate and systolic blood pressure dropped in the test group, but increased in the control group. Within gender groups, there were no statistically significant differences in hemodynamics or STAI scores, but between gender groups there were significantly higher diastolic blood pressure in males and STAI initial and departure scores for females. Patients waiting for their cardiac catheterization benefit from music therapy. Anxiety and the heightened physiological values elicited by the stress response are reduced. Results also suggest that women waiting for cardiac catheterization experience a higher level of anxiety than males.

  8. Enhancing outpatient clinics management software by reducing patients' waiting time.

    Science.gov (United States)

    Almomani, Iman; AlSarheed, Ahlam

    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 the quality of health care services

  9. 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

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

    DEFF Research Database (Denmark)

    Linnet, Jakob; Pedersen, Anders Sune

    2014-01-01

    completion in gambling disorder. We compared 48 gambling disorder sufferers with a 56% completion rate (21 non-completers and 27 completers). Binomial logistic regression analysis showed that waiting time from initial contact to the first session with a therapist was a significant predictor of risk...... of attrition: longer waiting times were associated with increased risk of attrition. Age, gender, or comorbidity was not associated with an increased risk of attrition. These data suggest that gambling disorder sufferers benefit from fast access to treatment, and that longer waiting time increases the risk...

  11. Arthur Prior and 'Now'

    DEFF Research Database (Denmark)

    Blackburn, Patrick Rowan; Jørgensen, Klaus Frovin

    2016-01-01

    ’s search led him through the work of Castañeda, and back to his own work on hybrid logic: the first made temporal reference philosophically respectable, the second made it technically feasible in a modal framework. With the aid of hybrid logic, Prior built a bridge from a two-dimensional UT calculus......On the 4th of December 1967, Hans Kamp sent his UCLA seminar notes on the logic of ‘now’ to Arthur N. Prior. Kamp’s two-dimensional analysis stimulated Prior to an intense burst of creativity in which he sought to integrate Kamp’s work into tense logic using a one-dimensional approach. Prior...... to a one-dimensional tense logic containing the ‘now’ operator J. Drawing on material from the Prior archive, and the paper “‘Now”’ that detailed Prior’s findings, we retell this story. We focus on Prior’s completeness conjecture for the hybrid system and the role played by temporal reference....

  12. Designs for Testing Group-Based Interventions with Limited Numbers of Social Units: The Dynamic Wait-Listed and Regression Point Displacement Designs.

    Science.gov (United States)

    Wyman, Peter A; Henry, David; Knoblauch, Shannon; Brown, C Hendricks

    2015-10-01

    The dynamic wait-listed design (DWLD) and regression point displacement design (RPDD) address several challenges in evaluating group-based interventions when there is a limited number of groups. Both DWLD and RPDD utilize efficiencies that increase statistical power and can enhance balance between community needs and research priorities. The DWLD blocks on more time units than traditional wait-listed designs, thereby increasing the proportion of a study period during which intervention and control conditions can be compared, and can also improve logistics of implementing intervention across multiple sites and strengthen fidelity. We discuss DWLDs in the larger context of roll-out randomized designs and compare it with its cousin the Stepped Wedge design. The RPDD uses archival data on the population of settings from which intervention unit(s) are selected to create expected posttest scores for units receiving intervention, to which actual posttest scores are compared. High pretest-posttest correlations give the RPDD statistical power for assessing intervention impact even when one or a few settings receive intervention. RPDD works best when archival data are available over a number of years prior to and following intervention. If intervention units were not randomly selected, propensity scores can be used to control for non-random selection factors. Examples are provided of the DWLD and RPDD used to evaluate, respectively, suicide prevention training (QPR) in 32 schools and a violence prevention program (CeaseFire) in two Chicago police districts over a 10-year period. How DWLD and RPDD address common threats to internal and external validity, as well as their limitations, are discussed.

  13. 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.

  14. Controlling synchrony in oscillatory networks via an act-and-wait algorithm.

    Science.gov (United States)

    Ratas, Irmantas; Pyragas, Kestutis

    2014-09-01

    The act-and-wait control algorithm is proposed to suppress synchrony in globally coupled oscillatory networks in the situation when the simultaneous registration and stimulation of the system is not possible. The algorithm involves the periodic repetition of the registration (wait) and stimulation (act) stages, such that in the first stage the mean field of the free system is recorded in a memory and in the second stage the system is stimulated with the recorded signal. A modified version of the algorithm that takes into account the charge-balanced requirement is considered as well. The efficiency of our algorithm is demonstrated analytically and numerically for globally coupled Landau-Stuart oscillators and synaptically all-to-all coupled FitzHugh-Nagumo as well as Hodgkin-Huxley neurons.

  15. Is Waiting the Hardest Part? Comparing the Emotional Experiences of Awaiting and Receiving Bad News.

    Science.gov (United States)

    Sweeny, Kate; Falkenstein, Angelica

    2015-11-01

    Awaiting uncertain news is stressful, but is it more stressful than receiving bad news? We compared these emotional experiences in two studies. Participants in Study 1 reflected on a personal experience awaiting news that ultimately turned out badly, and participants in Study 2 were law graduates awaiting their results on the bar exam who ultimately failed the exam. In Study 1, participants were ambivalent as to whether awaiting or receiving bad news was more difficult, and emotion ratings in both studies confirmed this ambivalence. Anxiety was higher in anticipation of bad news (at least at the moment of truth) than in the face of it, whereas other negative emotions were more intense following the news than during the waiting period. Thus, whether waiting is "the hardest part" depends on whether one prefers to be racked with anxiety or afflicted with other negative emotions such as anger, disappointment, depression, and regret. © 2015 by the Society for Personality and Social Psychology, Inc.

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

    African Journals Online (AJOL)

    Annals of Medical and Health Sciences Research | Oct-Dec 2013 | Vol 3 | Issue 4 | ... clinic waiting time is an important indicator of quality of ... healthcare services. ... Subjects and Methods: This descriptive cross‑sectional study was carried.

  17. 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...

  18. 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......: 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...... 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...

  19. 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.

  20. Interior effects on comfort in healthcare waiting areas.

    Science.gov (United States)

    Bazley, C; Vink, P; Montgomery, J; Hedge, A

    2016-07-21

    This study compared the effects of pre-experience and expectations on participant comfort upon waking, arrival to, and after an appointment, as well as the assessment of properly placed Feng Shui elements in three healthcare waiting rooms. Participants assessed comfort levels using self-report surveys. The researcher conducted 'intention interviews' with each doctor to assess the goals of each waiting area design, and conducted a Feng Shui assessment of each waiting area for properly placed Feng Shui elements. The waiting area designed by the Feng Shui expert rated 'most comfortable', followed by the waiting area design by a doctor, and the lowest comfort rating for the conventional waiting room design. Results show a sufficiently strong effect to warrant further research. Awareness of the external environment, paired with pre-experience and expectation, influences comfort for people over time. Fostering and encouraging a holistic approach to comfort utilizing eastern and western concepts and ergonomic principles creates a sense of "placeness" and balance in the design for comfort in built environments. This is new research information on the influences of the comfort experience over time, to include pre-experience, expectations and the placement of elements in the external environment.

  1. 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.

  2. [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.

  3. The effect of superfluid hydrodynamics on pulsar glitch sizes and waiting times

    Science.gov (United States)

    Haskell, B.

    2016-09-01

    Pulsar glitches, sudden jumps in frequency observed in many radio pulsars, may be the macroscopic manifestation of superfluid vortex avalanches on the microscopic scale. Small-scale quantum mechanical simulations of vortex motion in a decelerating container have shown that such events are possible and predict power-law distributions for the size of the events, and exponential distributions for the waiting time. Despite a paucity of data, this prediction is consistent with the size and waiting time distributions of most glitching pulsars. Nevertheless, a few object appear to glitch quasi-periodically, and exhibit many large glitches, while a recent study of the Crab pulsar has suggested deviations from a power-law distribution for smaller glitches. In this Letter, we incorporate the results of quantum mechanical simulations in a macroscopic superfluid hydrodynamics simulation. We show that the effect of vortex coupling to the neutron and proton fluids in the star naturally leads to deviations from power-law distributions for sizes, and from exponential distributions for waiting times, and we predict a cutoff in the size distribution for small glitches.

  4. 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.

  5. Period Variations of RT Persei

    OpenAIRE

    Chun-Hwey Kim

    1995-01-01

    RT Per has been known as a close binary of which the orbital period has unpredictably varied so far. Although there are no agreements with the working mechanism for the changes of the period, two interpretations have been suggested and waiting for to be tested: 1)light-time effects due to the unseen 3rd and 4th bodies (Panchatsaram 1981), 2)Abrupt period-change due to internal variations of the system(e.q. mass transfer or mass loss) superimposing to the light-times effect by a 3rd body (Frie...

  6. Satisfaction and Wait Time of Patients Visiting a Family Practice Clinic

    Science.gov (United States)

    Bestvater, David; Dunn, Earl V.; Townsend, Connie; Nelson, Wendy

    1988-01-01

    Data relating to wait times and time spent with nurses and physicians were recorded for 656 patients visiting a large family-practice unit. Patients were asked to provide estimates of their wait times and ratings of the acceptability of these wait intervals. Actual wait times were usually longer than those estimated by the patient, and total wait times were considered reasonable. The results of the study show high levels of patient satisfaction and indicate that few patients are dissatisfied until total wait time exceeds forty-five minutes. Different age groups appear to have different expectations, however, and younger patients are more likely to be dissatisfied with their wait times. PMID:21264021

  7. 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.

  8. Day surgery: patients' felt abandoned during the preoperative wait.

    Science.gov (United States)

    Gilmartin, Jo; Wright, Kerrie

    2008-09-01

    The rapid expansion in day surgery has facilitated a shift in surgical nursing intervention. The evolving evidence base has a major part to play in influencing nurse-led preassessment, information provision, pain management and postoperative intervention. However, the literature is characterised by a number of deficits: poor attention to patient experience from admission to discharge, anxieties evoked and the potential needs of patients are not well articulated. The purpose of this paper is to describe and interpret patients' experiences of contemporary day surgery. This hermeneutic phenomenological approach focused on the experience of 20 adult patients. Data was collected by using unstructured interviews. The transcripts were interpreted through the identification of four prevalent themes using the phenomenological method. The themes that emerged from the data are emphasised, ranging from the feeling of empowerment during preparation, through apprehensions encountered and the feeling of abandonment in the preoperative waiting area, to recovery dynamics. The study demonstrates that the majority of the patients felt abandoned in the preoperative stage and nurses did not recognise the importance of ongoing psychological support. Therefore, it is crucial to strengthen the provision of emotional support and person-centred care in a day surgery context. There is also a need to be aware that environmental factors can impact on patient anxiety, promoting the use of music preoperatively can reduce anxiety and increase well-being. Crucially health professionals need to facilitate person-centred and continuity of care throughout the day surgery experience. Using dynamic interpersonal skills, such as active listening 'holding''containment' and attunement to reduce anxiety and feelings of abandonment in the preoperative period. Moreover, being alert to verbal utterances, para-language and non-verbal cues demonstrated by the patient. Specific information about delays regarding

  9. Prior indigenous technological species

    Science.gov (United States)

    Wright, Jason T.

    2018-01-01

    One of the primary open questions of astrobiology is whether there is extant or extinct life elsewhere the solar system. Implicit in much of this work is that we are looking for microbial or, at best, unintelligent life, even though technological artefacts might be much easier to find. Search for Extraterrestrial Intelligence (SETI) work on searches for alien artefacts in the solar system typically presumes that such artefacts would be of extrasolar origin, even though life is known to have existed in the solar system, on Earth, for eons. But if a prior technological, perhaps spacefaring, species ever arose in the solar system, it might have produced artefacts or other technosignatures that have survived to present day, meaning solar system artefact SETI provides a potential path to resolving astrobiology's question. Here, I discuss the origins and possible locations for technosignatures of such a prior indigenous technological species, which might have arisen on ancient Earth or another body, such as a pre-greenhouse Venus or a wet Mars. In the case of Venus, the arrival of its global greenhouse and potential resurfacing might have erased all evidence of its existence on the Venusian surface. In the case of Earth, erosion and, ultimately, plate tectonics may have erased most such evidence if the species lived Gyr ago. Remaining indigenous technosignatures might be expected to be extremely old, limiting the places they might still be found to beneath the surfaces of Mars and the Moon, or in the outer solar system.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    Background: Pregnant diabetic patients are often required to self- measure their blood pressure in the waiting room before consulta- tion. Currently used blood pressure devices do not guarantee valid measurements when used unsupervised. This could lead to misdi- agnosis and treatment error. The aim...... of this study was to investigate current use of blood pressure self-measurement in the waiting room in order to identify challenges that could influence the resulting data quality. Also, we wanted to investigate the potential for addressing these challenges with e-health and telemedicine technology. Subjects...... 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...

  11. Waiting lists and elective surgery: ordering the queue.

    Science.gov (United States)

    Curtis, Andrea J; Russell, Colin O H; Stoelwinder, Johannes U; McNeil, John J

    2010-02-15

    In the Australian public health system, access to elective surgery is rationed through the use of waiting lists in which patients are assigned to broad urgency categories. Surgeons are principally responsible for referring patients to waiting lists, deciding on the appropriate urgency category, and selecting patients from the waiting list to receive surgery. There are few agreed-upon criteria to help surgeons make these decisions, leading to striking differences between institutions in proportions of patients allocated to urgency categories. In other countries with publicly funded health systems, programs have been developed that aim to make prioritisation more consistent and access to surgery more equitable. As demand for health care increases, similar programs should be established in Australia using relevant clinical and psychosocial factors. Prioritisation methodology adapted for elective surgery may have a role in prioritising high-demand procedures in other areas of health care.

  12. Assessing the performance of centralized waiting lists for patients without a regular family physician using clinical-administrative data.

    Science.gov (United States)

    Breton, Mylaine; Smithman, Mélanie Ann; Brousselle, Astrid; Loignon, Christine; Touati, Nassera; Dubois, Carl-Ardy; Nour, Kareen; Boivin, Antoine; Berbiche, Djamal; Roberge, Danièle

    2017-01-05

    With 4.6 million patients who do not have a regular family physician, Canada performs poorly compared to other OECD countries in terms of attachment to a family physician. To address this issue, several provinces have implemented centralized waiting lists to coordinate supply and demand for attachment to a family physician. Although significant resources are invested in these centralized waiting lists, no studies have measured their performance. In this article, we present a performance assessment of centralized waiting lists for unattached patients implemented in Quebec, Canada. We based our approach on the Balanced Scorecard method. A committee of decision-makers, managers, healthcare professionals, and researchers selected five indicators for the performance assessment of centralized waiting lists, including both process and outcome indicators. We analyzed and compared clinical-administrative data from 86 centralized waiting lists (GACOs) located in 14 regions in Quebec, from April 1, 2013, to March 31, 2014. During the study period, although over 150,000 patients were attached to a family physician, new requests resulted in a 30% median increase in patients on waiting lists. An inverse correlation of average strength was found between the rates of patients attached to a family physician and the proportion of vulnerable patients attached to a family physician meaning that as more patients became attached to an FP through GACOs, the proportion of vulnerable patients became smaller (r = -0.31, p < 0.005). The results showed very large performance variations both among GACOs of different regions and among those of a same region for all performance indicators. Centralized waiting lists for unattached patients in Quebec seem to be achieving their twofold objective of attaching patients to a family physician and giving priority to vulnerable patients. However, the demand for attachment seems to exceed the supply and there appears to be a tension between giving

  13. Waiting Time as an Index of Quality of Nursing Care

    Science.gov (United States)

    Haussmann, R. K. Dieter

    1970-01-01

    A model of the patient care process, based on queueing theory, is described and its parameters defined empirically for application to a burn unit. For the particular case, the model is shown to provide a close approximation to observed data. The model is descriptive, with an output of expected waiting times for various priorities of patient demand. The waiting times so estimated constitute an index of the quality of nursing care and afford a means of predicting changes in quality with changes in staffing or inpatient load. The model facilitates investigation of the relationships among three factors: patient condition, nurses' activity priorities, and patient load per nurse. PMID:5482376

  14. 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.

  15. Umbilical hernias: the cost of waiting.

    Science.gov (United States)

    Strosberg, David S; Pittman, Matthew; Mikami, Dean

    2017-02-01

    Umbilical hernias are well described in the literature, but its impact on health care is less understood. The purpose of this study was to investigate the effect of non-operative management of umbilical hernias on cost, work absenteeism, and resource utilization. The Truven Health Database, consisting of 279 employers and over 3000 hospitals, was reviewed for all umbilical hernia patients, aged 18-64 who were enrolled in health plans for 12 months prior to surgery and 12 months after surgery. Patients were excluded if they had a recurrence or had been offered a "no surgery" approach within 1 year of the index date. The remaining patients were separated into surgery (open or laparoscopic repair) or no surgery (NS). Post-cost analysis at 90 and 365 days and estimated days off from work were reviewed for each group. The non-surgery cohort had a higher proportion of females and comorbidity index. Adjusted analysis showed significantly higher 90 and 365 costs for the surgery group (p cost difference did decrease over time. NS group had significantly higher estimated days of health-care utilization at both the 90 (1.99 vs. 3.58 p costs compared to open primarily due to higher index procedure costs (p costs were found to be higher in the surgery group, the majority of these were due to the surgery itself. Significantly higher days of health-care utilization and estimated days off work were experienced in the NS group. It is our belief that early operative intervention will lead to decreased costs and resource utilization.

  16. Patient Satisfaction with Wait-Times for Breast Cancer Surgery in Newfoundland and Labrador.

    Science.gov (United States)

    Mathews, Maria; Ryan, Dana; Gadag, Vereesh; West, Roy

    2016-02-01

    Do shorter waits for breast cancer surgery lead to greater wait-related patient satisfaction? Using survey and cancer clinic chart data of 99 patients with breast cancer from Newfoundland and Labrador, we found that median wait-time from first visit to a surgeon to surgery was 22.0 days and 87% were satisfied with their wait-time. Wait-related satisfaction was not associated with the length of wait but rather with the stage, severity of treatment, wait-time for a diagnosis and satisfaction with diagnosis-related wait. These findings highlight the importance of an early and timely diagnosis in patients' perceptions of breast cancer care wait-times. Copyright © 2016 Longwoods Publishing.

  17. 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.

  18. Physical activity level significantly affects the survival of patients with end-stage lung disease on a waiting list for lung transplantation.

    Science.gov (United States)

    Komatsu, Teruya; Oshima, Ayako; Chen-Yoshikawa, Toyofumi F; Harashima, Shin-Ichi; Aoyama, Akihiro; Inagaki, Nobuya; Date, Hiroshi

    2017-12-01

    Our objective was to investigate the factors predicting the survival of patients on the waiting list for lung transplantation (LT) during the waiting period, with a special emphasis on the physical activity level. The study included 70 patients with end-stage pulmonary disease who were on the waiting list for LT at Kyoto University Hospital. We examined the association between the baseline characteristics, including the body mass index and body composition, serum albumin, serum C-reactive protein (CRP), steroid administration, physical activity level (calculated by the food frequency questionnaire) and survival during the waiting period using Kaplan-Meier curves and Cox proportional hazard regression models. A physical activity level of ≤1.2 was correlated with significantly decreased survival (1-year survival: 68 vs. 90.9%, p = 0.0089), with a hazard ratio (HR) of 2.24 (95% confidence interval (CI) 1.22-4.19, p = 0.0001). Hypo-albumin (HR 2.024, 95% CI 1.339-6.009, p = 0.004), a high level of CRP (HR 2.551, CI 1.229-4.892, p = 0.02), and the administration of steroids (HR 2.258, CI 1.907-5.032, p = 0.024) were also significant predictors of survival. Low levels of physical activity during the waiting period for LT led to decreased survival times among LT candidates.

  19. Sfe: waiting for the big one

    Directory of Open Access Journals (Sweden)

    Curto Juan José

    2016-01-01

    Full Text Available Accurate measurements of the radiation delivered during the two largest solar flares ever observed are unavailable. In the case of the Carrington event (1858 the X-ray and UV radiation was not recorded, while in the case of the big flare which happened after the storm of 29–31 October 2003 we will call from now on as Halloween event (2003 the radiation saturated the X-ray radiometer. Despite many studies, a consensus regarding the real values of these events at the moment of maximum radiation has never been reached. In this paper, we used an alternative approach to try and determine these values. We estimated the values from the perturbations they produced in the Earth’s magnetism – these are known as Solar Flare Effects (Sfe. Firstly, we established an empirical relationship between the variation in the radiation (cause and its effect on the magnetism (consequence. Then, using the inverse function, we estimated the energy flux of both events. We found that both flares can actually be classified as being larger than X45. Finally, we also calculated the return period for a Carrington-like flare. Assuming that this event had an intensity of about X45 – according to our calculations – we estimated the return period to be 90 ± 60 years.

  20. Safety of assessment of patients with potential ischemic chest pain in an emergency department waiting room: a prospective comparative cohort study.

    Science.gov (United States)

    Scheuermeyer, Frank Xavier; Christenson, Jim; Innes, Grant; Boychuk, Barb; Yu, Eugenia; Grafstein, Eric

    2010-11-01

    waiting room group (0.7%; 95% CI 0% to 1.6%). Our organized approach to triage and waiting room evaluation for stable chest pain patients was safe and efficient. Although waiting room evaluation is not ideal, it may be a feasible contingency strategy for periods when ED crowding compromises access to monitored, nurse-staffed ED beds. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  1. Watchful waiting: role of disease progression on uncertainty and depressive symptoms in patients with chronic hepatitis C.

    Science.gov (United States)

    Colagreco, J P; Bailey, D E; Fitzpatrick, J J; Musil, C M; Afdhal, N H; Lai, M

    2014-10-01

    New therapies for HCV are rapidly emerging and providers are advising select patients to defer treatment and elect 'watchful waiting'. During the watchful waiting period, patients have been shown to have high rates of illness uncertainty and depression. We sought to answer the question of whether reassuring histological data (showing minimal fibrosis or no fibrosis progression over time) is associated with less illness uncertainty and depressive symptoms. This was a single-centre outpatient prospective cohort study to determine whether stage of fibrosis, fibrosis progression and reasons for treatment deferral were related to illness uncertainty and depressive symptoms in patients following watchful waiting. Illness uncertainty was significantly related to depressive symptoms (r = 0.49, P uncertainty. About 40% of the participants were at risk for clinical depression (21.7% at mild to moderate risk and 18.5% at high risk). Treatment naïve subjects had lower mean scores on both the CES-D (depressive symptoms measure) and the MUIS-A (illness uncertainty measure) total score, MUIS-A Ambiguity subscale and MUIS-A Inconsistency subscale than subjects who failed treatment or were interferon intolerant or ineligible. Surprisingly, liver fibrosis stage and progression were not significantly associated with overall illness uncertainty or depressive symptoms. Patients with chronic hepatitis C on watchful waiting are at high risk for significant illness uncertainty and depressive symptoms. Reassuring histological data does not seem to correlate with less uncertainty or depressive symptoms. © 2013 John Wiley & Sons Ltd.

  2. Pregnant and postpartum women perceptions about waiting room in a Primary Health Care Unit included in the Family Health Strategy

    Directory of Open Access Journals (Sweden)

    Juliana Ebling Brondani

    2013-03-01

    Full Text Available Objective: To analyze the perception of pregnant and postpartum women about their experiences in the waiting room. Methods: A descriptive analytic study, of qualitative approach, conducted in a Primary Health Care Unit integrated into the Family Health Strategy (Estratégia Saúde da Família-PSF in a municipality of the state of Rio Grande do Sul, Brazil. The data was collected in December 2011, through interviews with open and closed questions, and was analyzed using content analysis technique. The sample consisted of 10 women, seven of them being pregnant and three in postpartum period; all having received prenatal care and taken part in waiting room activities from September to December 2011. Results: According to the participants’ perception, the waiting room is a space of attentiveness, promoter of tranquility, understanding and clarification of questions related to pregnancy and childbirth process. Conclusions:The formation of health education groups intermediated by problem-based dialogue, aiming to promote reciprocal learning and teaching, with focus on the extensive concept of health, is a relevant issue in the waiting room. It is also important to highlight the need to accomplish continuing education initiatives involving healthcare professionals, centered on a questioning approach of social reality and services, along with the integration of managerial, educational and political aspects. This shall contribute to the real construction of politicized knowledge in health, as report the official documents of health and education sphere

  3. Wait times for breast surgical operations, 2003-2011: a report from the National Cancer Data Base.

    Science.gov (United States)

    Liederbach, Erik; Sisco, Mark; Wang, Chihsiung; Pesce, Catherine; Sharpe, Susan; Winchester, David J; Yao, Katharine

    2015-03-01

    Few large-scale multicenter studies have examined wait times for breast surgery and no benchmarks exist. Using the National Cancer Data Base, we analyzed time from diagnosis to first surgery for 819,175 non-neoadjuvant AJCC stage 0-III breast cancer patients treated from 2003 to 2011. Chi-square tests and logistic regression models were used to examine factors associated with delays to surgery and adjuvant chemotherapy. Seventy percent of patients underwent an initial lumpectomy (LP), 22% a mastectomy (MA), and 8% a mastectomy with reconstruction (MR). The median time from diagnosis to first surgery significantly increased by approximately 1 week for all three procedures over the study period. In a multivariate analysis, the following variables were independent predictors of a longer wait time to first surgery: increasing age, black or Hispanic race, Medicaid or no insurance, low-education communities and metropolitan areas, increasing comorbidities, stage 0 and grade 1 disease, academic/research facilities, high-volume facilities, and facilities located in the New England, Mid-Atlantic, and Pacific regions. In 2010-2011, patients who waited >30 days for surgery were 1.36 times more likely (OR = 1.36, 95% CI 1.30-1.43) to experience a delay to adjuvant chemotherapy >60 days compared with patients who were surgically treated within 30 days of diagnosis. Facility and socioeconomic factors are most strongly associated with longer wait times for breast operations, and delays to surgery are associated with delays to adjuvant chemotherapy initiation.

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

    African Journals Online (AJOL)

    obstetric care including the application of task shifting of higher responsibilities to relatively lowly qualified health workers markedly improved outcomes in many developing countries 4,8. While maternity waiting homes have been successfully used in reducing maternal mortality in other setups9,10, little quantitative research ...

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

    African Journals Online (AJOL)

    Surveys were done in May and September to analyse the problems causing prolonged waiting times. The implemented change included instituting a functional triage system, improvement of the process of up- and down-referrals to and from the tertiary hospital, easy access to stock, reorganisation of doctors' duty roster, ...

  6. Waiting time among acute abdominal emergencies in a Nigerian ...

    African Journals Online (AJOL)

    Background-In many patients presenting with an acute surgical abdomen, the outcome of management is determined by the promptness of the appropriate surgical intervention. The average interval the patient has to spent waiting for treatment at first presentation to hospital with an acute abdominal emergency is unknown ...

  7. The Ultimate $uperpower: Supersized Dollars Drive "Waiting for "Superman"" Agenda

    Science.gov (United States)

    Miner, Barbara

    2011-01-01

    For nearly 40 years, according to this author, "follow the money" has been an axiom in both journalism and politics--although, as Shakespeare might complain, one "more honour'd in the breach than the observance." It is useful to resurrect the axiom in analyzing the multimedia buzz and policy debates swirling around the movie "Waiting for…

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

    African Journals Online (AJOL)

    kim

    had modern corrugated iron roof and brick wall structures that were ... 123.64. Fisher's=0.00. The roof of the waiting home ..... and sometimes, we would walk in the compound which is neat and green.” The health care staff's courtesy, passion, and cooperation were an excellent experience for women staying at the MWHs.

  9. Waiting times in discrete-time cyclic-service systems

    Science.gov (United States)

    Boxma, O. J.; Groenendijk, W. P.

    1987-03-01

    Single-server, multiqueue systems with cyclic service in discrete time are considered. Nonzero switchover times between consecutive queues are assumed; the service strategies at the various queues may differ. A decomposition for the amount of work in such systems is obtained, leading to an exact expression for a weighted sum of the mean waiting times at the various queues.

  10. 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.

  11. 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.

  12. 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.

  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. Waiting for the Russians: Coetzee's The Master of Petersburg and ...

    African Journals Online (AJOL)

    A meditation on transition time and on the protracted dimension of waiting for a new world to be born, the novel also presents a model of connectivity between Russia and South Africa. It places post-apartheid culture in a special relationship to postcolonialism and the global configuration born at the end of the Cold War.

  15. 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.

  16. Info card for surgery waiting room improves satisfaction.

    Science.gov (United States)

    2015-11-01

    A hospital is reporting improved patient satisfaction from providing an information card in the surgery department. The card includes expected wait times. The card is provided by the patient transport team. Telephone numbers are included for more information. Staff update family members hourly during surgery.

  17. Waiting in the wings : New parties in the Netherlands

    NARCIS (Netherlands)

    Krouwel, Andre; Lucardie, Paul

    Even in the relatively open political system of the Netherlands, most new parties never pass the threshold of representation and keep waiting in vain in the wings of political power. Since 1989 only 10 out of 63 newcomers gained one or more seats in parliament, owing to a favourable political

  18. Waiting in the wings: New parties in the Netherlands

    NARCIS (Netherlands)

    Krouwel, A.P.M.; Lucardie, P.

    2008-01-01

    Even in the relatively open political system of the Netherlands, most new parties never pass the threshold of representation and keep waiting in vain in the wings of political power. Since 1989 only 10 out of 63 newcomers gained one or more seats in parliament, owing to a favourable political

  19. 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

  20. Public Mode Access And Waiting Time Variability In Maiduguri ...

    African Journals Online (AJOL)

    This work examines public mode access and waiting time variations in Maiduguri Metropolitan Area. Data for the study were sought through a comprehensive field survey using a travel diary questionnaire. A total of 623 households were surveyed in 342 dwelling units. The results indicate that variations in modal access and ...

  1. Tumor progression in waiting time for radiotherapy in head and neck cancer

    DEFF Research Database (Denmark)

    Jensen, Anni Ravnsbaek; Nellemann, Hanne Marie; Overgaard, Jens

    2007-01-01

    INTRODUCTION: Waiting-time prior to radiotherapy is a well-known problem. This study aims to determine the impact of time on tumor growth in a patient population with squamous-cell carcinoma of the head and neck (SCCHN). MATERIAL AND METHODS: In a consecutive cohort, all patients with both...... a diagnostic scan and a treatment-planning scan were identified. In total 648 patients were seen, and 414 treated with primary radiotherapy. Ninety-five had two scans and 61 sets were eligible for comparison. Endpoints were change in tumor volume, tumor volume doubling time (TVD) and disease progression...... measured by TNM-classification and RECIST criteria. RESULTS: Median interval between eligible scans was 28 (5-95) days. Thirty-eight (62%) had measurable increase in tumor volume, median 46% (6-495%). For all patients TVD was median 99 days, but for the half of patients with fastest growing tumors TVD...

  2. Modeling the impact of integrating HIV and outpatient health services on patient waiting times in an urban health clinic in Zambia.

    Directory of Open Access Journals (Sweden)

    Sarang Deo

    Full Text Available Rapid scale up of HIV treatment programs in sub-Saharan Africa has refueled the long-standing health policy debate regarding the merits and drawbacks of vertical and integrated system. Recent pilots of integrating outpatient and HIV services have shown an improvement in some patient outcomes but deterioration in waiting times, which can lead to worse health outcomes in the long run.A pilot intervention involving integration of outpatient and HIV services in an urban primary care facility in Lusaka, Zambia was studied. Data on waiting time of patients during two seven-day periods before and six months after the integration were collected using a time and motion study. Statistical tests were conducted to investigate whether the two observation periods differed in operational details such as staffing, patient arrival rates, mix of patients etc. A discrete event simulation model was constructed to facilitate a fair comparison of waiting times before and after integration. The simulation model was also used to develop alternative configurations of integration and to estimate the resulting waiting times.Comparison of raw data showed that waiting times increased by 32% and 36% after integration for OPD and ART patients respectively (p<0.01. Using simulation modeling, we found that a large portion of this increase could be explained by changes in operational conditions before and after integration such as reduced staff availability (p<0.01 and longer breaks between consecutive patients (p<0.05. Controlling for these differences, integration of services, per se, would have resulted in a significant decrease in waiting times for OPD and a moderate decrease for HIV services.Integrating health services has the potential of reducing waiting times due to more efficient use of resources. However, one needs to ensure that other operational factors such as staff availability are not adversely affected due to integration.

  3. Prior Elicitation, Assessment and Inference with a Dirichlet Prior

    Directory of Open Access Journals (Sweden)

    Michael Evans

    2017-10-01

    Full Text Available Methods are developed for eliciting a Dirichlet prior based upon stating bounds on the individual probabilities that hold with high prior probability. This approach to selecting a prior is applied to a contingency table problem where it is demonstrated how to assess the prior with respect to the bias it induces as well as how to check for prior-data conflict. It is shown that the assessment of a hypothesis via relative belief can easily take into account what it means for the falsity of the hypothesis to correspond to a difference of practical importance and provide evidence in favor of a hypothesis.

  4. 78 FR 17313 - Ninety-Day Waiting Period Limitation and Technical Amendments to Certain Health Coverage...

    Science.gov (United States)

    2013-03-21

    ... conditions. This could lead to lower work productivity and missed school days. Low-wage workers also are... coverage and that issuers may not have knowledge of certain plan terms, such as eligibility conditions and... this representation with any changes), and the issuer has no specific knowledge of the imposition of a...

  5. Trajectories of anxiety and depression in liver transplant candidates during the waiting-list period

    NARCIS (Netherlands)

    Annema, Coby; Roodbol, Petrie F; Van den Heuvel, Edwin R; Metselaar, Herold J; Van Hoek, Bart; Porte, Robert J; Ranchor, Adelita V

    OBJECTIVES: To explore whether distinct trajectories of anxiety and depression exist among liver transplant candidates, and to gain insight into demographic, clinical, and individual characteristics related with these trajectories. DESIGN: A multicentre, prospective cohort study among 216 liver

  6. Potential for airborne transmission of infection in the waiting areas of healthcare premises: stochastic analysis using a Monte Carlo model

    Directory of Open Access Journals (Sweden)

    Beggs Clive B

    2010-08-01

    infection during the same period was 0.1349. If the duration of the stay was increased to 60 minutes then these values increased to 0.0087, 0.0662 and 0.3094, respectively. Conclusion Under normal circumstances the risk of acquiring a TB infection during a visit to a hospital waiting area is minimal. Likewise the risks associated with the transmission of influenza, although an order of magnitude greater than those for TB, are relatively small. By comparison, the risks associated with measles are high. While the installation of air disinfection may be beneficial, when seeking to prevent the transmission of airborne viral infection it is important to first minimize waiting times and the number of susceptible individuals present before turning to expensive technological solutions.

  7. Patient satisfaction with ambulatory healthcare services: waiting time and filling time.

    Science.gov (United States)

    Dansky, K H; Miles, J

    1997-01-01

    Customer satisfaction is an important measure of service quality in healthcare organizations. This study investigated the relationship between patient waiting and satisfaction with ambulatory healthcare services, with waiting times divided into segments of the patient-care episode. Two management techniques to alter perceptions of waiting were also examined. Regression models measuring the effect of waiting times on satisfaction found that the total time spent waiting for the clinician was the most significant predictor of patient satisfaction. Informing patients how long their wait would be and being occupied during the wait were also significant predictors of patient satisfaction. These results show that waiting times, even if they cannot be shortened, can be managed more effectively to improve patient satisfaction.

  8. Effect of holding period prior to storage on the chemical attributes of Starking Delicious apples during refrigerated storage Efeito do período que antecede o armazenamento nos atributos químicos de maças Starking Delicious durante o armazenamento refrigerado

    Directory of Open Access Journals (Sweden)

    Aynur Batkan

    2012-06-01

    Full Text Available In this research, the effects of three different holding periods (6, 12 and 24 hours prior to storage on the quality attributes of Starking Delicious apples were investigated during storage of 8 months at 0.5 ± 1.0 ºC. Changes in weight loss, flesh firmness, pH values, soluble dry matter amount, titratable acidity values, ascorbic acid contents, and total and reducing sugar content were determined. According to the results, the holding period showed statistically significant changes in the quality attributes of the apples (p Neste trabalho, os efeitos de três diferentes tempos de espera (6, 12 e 24 horas antes do armazenamento sobre os atributos de qualidade de maçãs tipo Starking Delicious foram investigados durante o armazenamento de 8 meses a 0,5 ± 1,0 ºC. Alterações na perda de peso, firmeza da polpa, valores de pH, quantidade de matéria seca solúvel, valores de acidez titulável, teor de ácido ascórbico e teor de açúcar redutor e total das amostras foram determinadas. De acordo com os resultados da análise, o tempo de espera causou alterações estatisticamente significativas sobre as nos atributos de qualidade das maçãs (p < 0,05.

  9. Wait times and volume of cataract surgery in Ontario: 2000-2012.

    Science.gov (United States)

    Szigiato, Andrei-Alexandru; Trope, Graham E; Jin, Yaping; Buys, Yvonne M

    2016-02-01

    To review cataract surgery trends and wait times in Ontario. Retrospective analysis of health records. Ontario Health Insurance Plan billing service claims between 2000 and 2012 were analyzed for the yearly number of cataract surgeries, alone and in combination with other procedures. The number of Ontarians with cataracts was estimated by applying composite prevalence curves derived from published population data. This was then used to calculate the yearly number of procedures per 1000 Ontarians with cataracts. Per 1000 people with cataract, the rate of cataract extraction increased 18.9% overall from 2000 to 2012, increasing by 38.3% from 2000 to 2006 and decreasing by 14.6% from 2006 to 2012. Mean wait times for cataract surgery decreased by 45.8% from 2006 to 2009 and increased 28.5% from 2009 to 2013. The proportion of surgeries that were same-day bilateral cataract extraction increased 2.21-fold from 2000 to 2012 but represented only 0.82% of total cataract surgeries in 2012. In 2000, 3% of cataract surgeries were combined with other procedures, and this decreased to 1.8% in 2012. Of these combinations, the rates of combined glaucoma filtration procedures decreased by 44.3%, anterior vitrectomy decreased by 32.5%, posterior vitrectomy increased by 58.3%, and corneal transplantation decreased by 10.7% during this time period. The yearly rate of cataract surgery has decreased since 2006, and wait times have increased from 2009. Same-day bilateral cataract extraction represented less than 1% of the total cataract surgical volume. Rates of cataract combined with posterior vitrectomy have increased (58%), whereas anterior vitrectomy at the time of cataract surgery decreased (33%). Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  10. Perceptions of cardiac rehabilitation patients, specialists and rehabilitation programs regarding cardiac rehabilitation wait times

    Directory of Open Access Journals (Sweden)

    Grace Sherry L

    2012-08-01

    Full Text Available Abstract Background In 2006, the Canadian Cardiovascular Society (CCS Access to Care Working Group recommended a 30-day wait time benchmark for cardiac rehabilitation (CR. The objectives of the current study were to: (1 describe cardiac patient perceptions of actual and ideal CR wait times, (2 describe and compare cardiac specialist and CR program perceptions of wait times, as well as whether the recommendations are appropriate and feasible, and (3 investigate actual wait times and factors that CR programs perceive to affect these wait times. Methods Postal and online surveys to assess perceptions of CR wait times were administered to CR enrollees at intake into 1 of 8 programs, all CCS member cardiac specialists treating patients indicated for CR, and all CR programs listed in Canadian directories. Actual wait times were ascertained from the Canadian Cardiac Rehabilitation Registry. The design was cross-sectional. Responses were described and compared. Results Responses were received from 163 CR enrollees, 71 cardiac specialists (9.3% response rate, and 92 CR programs (61.7% response rate. Patients reported that their wait time from hospital discharge to CR initiation was 65.6 ± 88.4 days (median, 42 days, while their ideal median wait time was 28 days. Most patients (91.5% considered their wait to be acceptable, but ideal wait times varied significantly by the type of cardiac indication for CR. There were significant differences between specialist and program perceptions of the appropriate number of days to wait by most indications, with CR programs perceiving shorter waits as appropriate (p  Conclusions Wait times following access to cardiac rehabilitation are prolonged compared with consensus recommendations, and yet are generally acceptable to most patients. Wait times following percutaneous coronary intervention in particular may need to be shortened. Future research is required to provide an evidence base for wait time

  11. The effectiveness of interventions aimed at reducing anxiety in health care waiting spaces: a systematic review of randomized and nonrandomized trials.

    Science.gov (United States)

    Biddiss, Elaine; Knibbe, Tara Joy; McPherson, Amy

    2014-08-01

    Reducing waiting anxiety is an important objective of patient-centered care. Anxiety is linked to negative health outcomes, including longer recovery periods, lowered pain thresholds, and for children in particular, resistance to treatment, nightmares, and separation anxiety. The goals of this study were (1) to systematically review published research aimed at reducing preprocedural waiting anxiety, and (2) to provide directions for future research and development of strategies to manage preprocedural waiting anxiety in health care environments. We performed a systematic review of the literature via ISI Web of Knowledge, PubMed, PsycINFO, EMBASE, CINAHL, and Medline. Included in this review were studies describing measurable outcomes in response to interventions specifically intended to improve the waiting experience of patients in health care settings. Primary outcomes of interest were stress and anxiety. Exclusion criteria included (a) studies aimed at reducing wait times and management of waiting lists only, (b) waiting in non-health care settings, (c) design of health care facilities with nonspecific strategies pertaining to waiting spaces, (d) strategies to reduce pain or anxiety during the course of medical procedures, and (e) interventions such as massage, acupuncture, or hypnosis that require dedicated staff and/or private waiting environments to administer. We identified 8690 studies. Forty-one articles met the inclusion criteria. In adult populations, 33 studies were identified, wherein the effects of music (n = 25), aromatherapy (n = 6), and interior design features (n = 2) were examined. Eight pediatric studies were identified investigating play opportunities (n = 2), media distractions (n = 2), combined play opportunities and media distractions (n = 3), and music (n = 1). Based on results from 1129 adult participants in the 14 studies that evaluated music and permitted meta-analysis, patients who listened to music before a medical procedure exhibited a

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

    African Journals Online (AJOL)

    The act of waiting as a critical feature of the human condition is the most significant and intense thematic engagement in Beckett's Waiting for Godot. The study notes that aside the circle of the absurd art in drama, the subject of waiting and time has not been given adequate dramatic representation by dramatists outside the ...

  13. Hip and knee arthroplasty waiting list – how accurate and fair ...

    African Journals Online (AJOL)

    Background. Resource-intensive procedures require the use of patient waiting lists in an attempt to increase fairness of access to surgery and improve surgical efficiency. Total hip and knee arthroplasty has waiting lists in excess of years. Objectives. To analyse our tertiary state institution's hip and knee arthroplasty waiting ...

  14. 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

  15. Waiting times and output process of a server computed via Wiener-Hopf factorization

    Science.gov (United States)

    Hasslinger, Gerhard

    1998-10-01

    Non-renewal processes are relevant in queueing analysis to include various types of traffic arising in integrated services communication networks. We consider a workload based approach to the single server queue in discrete time domain with semi-Markov arrivals (SMP/G/1). Starting from a subdivision of the busy periods, we generalize a computationally attractive algorithm for the discrete time GI/G/1 queue. The stationary distributions of the waiting and idle time as well as the moments of the busy period are computed. Performance results are given for deterministic servers with autoregressive input and the output process of a server is modeled by adapting a SMP of small size.

  16. 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.

  17. Waiting time dynamics of priority-queue networks.

    Science.gov (United States)

    Min, Byungjoon; Goh, K-I; Kim, I-M

    2009-05-01

    We study the dynamics of priority-queue networks, generalizations of the binary interacting priority-queue model introduced by Oliveira and Vazquez [Physica A 388, 187 (2009)]. We found that the original AND-type protocol for interacting tasks is not scalable for the queue networks with loops because the dynamics becomes frozen due to the priority conflicts. We then consider a scalable interaction protocol, an OR-type one, and examine the effects of the network topology and the number of queues on the waiting time distributions of the priority-queue networks, finding that they exhibit power-law tails in all cases considered, yet with model-dependent power-law exponents. We also show that the synchronicity in task executions, giving rise to priority conflicts in the priority-queue networks, is a relevant factor in the queue dynamics that can change the power-law exponent of the waiting time distribution.

  18. Accommodating Uncertainty in Prior Distributions

    Energy Technology Data Exchange (ETDEWEB)

    Picard, Richard Roy [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Vander Wiel, Scott Alan [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-01-19

    A fundamental premise of Bayesian methodology is that a priori information is accurately summarized by a single, precisely de ned prior distribution. In many cases, especially involving informative priors, this premise is false, and the (mis)application of Bayes methods produces posterior quantities whose apparent precisions are highly misleading. We examine the implications of uncertainty in prior distributions, and present graphical methods for dealing with them.

  19. Outcomes of transplants from patients with small renal tumours, live unrelated donors and dialysis wait-listed patients.

    Science.gov (United States)

    Brook, Nicholas R; Gibbons, Norma; Johnson, David W; Nicol, David L

    2010-05-01

    We report the outcomes of renal transplant patients (n = 43) who received grafts from donors (n = 41) with small (live unrelated transplants (LURTs) (n = 120) and to patient survival on the transplant waiting list for those who did not receive a kidney during this period (n = 153). Patient survival at 1, 3 and 5 years were 92%, 88% and 88% for recipients of tumourectomized kidneys (TKs), 99%, 97% and 97% for LURTs, and 98%, 92% and 74% for dialysis patients waiting for a deceased donor kidney (log rank score 10.4, P = 0.005). One patient experienced a local tumour recurrence at 9 years following transplantation. This patient declined intervention and is currently under active surveillance. Transplantation of tumourectomized kidneys from patients with small, localized, incidentally detected renal tumours results in similar outcomes to conventional LURTs and confers a significant survival advantage for patients who would otherwise be unable to receive a transplant.

  20. Intention-based therapy for autism spectrum disorder: promising results of a wait-list control study in children.

    Science.gov (United States)

    Weiner, Robert H; Greene, Roger L

    2014-01-01

    Autism is a complex neurodevelopmental disability that usually manifests during the first three years of life and typically lasts throughout a person's lifetime. The purpose of this study is to investigate the efficacy of NeuroModulation Technique (NMT), a form of intention-based therapy, in improving functioning in children diagnosed with autism. A total of 18 children who met the study criteria were selected to participate. All children completed baseline measures. The children in the experimental group (n = 9) received two sessions a week of NMT for six weeks. Then, children in the wait-list control group (n = 9) received two sessions a week of NMT for six weeks. Primary efficacy outcome measures included the Pervasive Developmental Disorder Behavioral Inventory Autism Composite Index, the Aberrant Behavior Checklist-Community Total Score, and the Autism Treatment Evaluation Checklist Total Score. Our hypotheses were that children in both groups would show significant improvement over their respective baseline scores following NMT treatment, which would reflect an improvement in adaptive behaviors as well as a decrease in maladaptive behaviors. Statistical analysis indicates a significant improvement in both the experimental and wait-list control group on all primary outcome measures following NMT treatment. The wait-list control group demonstrated no significant improvement on test measures over baseline scores during the wait period. No adverse reactions were reported. These findings suggest that NMT is a promising intervention for autism that has the potential to produce a significant reduction in maladaptive behaviors and a significant increase in adaptive behaviors within a relatively short period of time. © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

  1. 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.

  2. The effect of waiting time and distance on hospital choice for English cataract patients.

    Science.gov (United States)

    Sivey, Peter

    2012-04-01

    This paper applies latent-class multinomial logit models to the choice of hospital for cataract operations in the UK NHS. We concentrate on the effects of travel time and waiting time and especially on estimating the waiting time elasticity of demand. Models including hospital fixed effects rely on changes over time in waiting time to indentify coefficients. We show how using a latent-class multinomial logit model characterises the unobserved heterogeneity in GP practices' choice behaviour and affects the estimated elasticities of travel time and waiting time. The models estimate waiting time elasticities of demand of approximately -0.1, comparable with previous waiting time-demand models. For the average waiting time elasticity, the simple multinomial logit models are good approximations of the latent-class logit results. Copyright © 2011 John Wiley & Sons, Ltd.

  3. Acceptability of an open-label wait-listed trial design: Experiences from the PROUD PrEP study.

    Science.gov (United States)

    Gafos, Mitzy; Brodnicki, Elizabeth; Desai, Monica; McCormack, Sheena; Nutland, Will; Wayal, Sonali; White, Ellen; Wood, Gemma; Barber, Tristan; Bell, Gill; Clarke, Amanda; Dolling, David; Dunn, David; Fox, Julie; Haddow, Lewis; Lacey, Charles; Nardone, Anthony; Quinn, Killian; Rae, Caroline; Reeves, Iain; Rayment, Michael; White, David; Apea, Vanessa; Ayap, Wilbert; Dewsnap, Claire; Collaco-Moraes, Yolanda; Schembri, Gabriel; Sowunmi, Yinka; Horne, Rob

    2017-01-01

    PROUD participants were randomly assigned to receive pre-exposure prophylaxis (PrEP) immediately or after a deferred period of one-year. We report on the acceptability of this open-label wait-listed trial design. Participants completed an acceptability questionnaire, which included categorical study acceptability data and free-text data on most and least liked aspects of the study. We also conducted in-depth interviews (IDI) with a purposely selected sub-sample of participants. Acceptability questionnaires were completed by 76% (415/544) of participants. After controlling for age, immediate-group participants were almost twice as likely as deferred-group participants to complete the questionnaire (AOR:1.86;95%CI:1.24,2.81). In quantitative data, the majority of participants in both groups found the wait-listed design acceptable when measured by satisfaction of joining the study, intention to remain in the study, and interest in joining a subsequent study. However, three-quarters thought that the chance of being in the deferred-group might put other volunteers off joining the study. In free-text responses, data collection tools were the most frequently reported least liked aspect of the study. A fifth of deferred participants reported 'being deferred' as the thing they least liked about the study. However, more deferred participants disliked the data collection tools than the fact that they had to wait a year to access PrEP. Participants in the IDIs had a good understanding of the rationale for the open-label wait-listed study design. Most accepted the design but acknowledged they were, or would have been, disappointed to be randomised to the deferred group. Five of the 25 participants interviewed reported some objection to the wait-listed design. The quantitative and qualitative findings suggest that in an environment where PrEP was not available, the rationale for the wait-listed trial design was well understood and generally acceptable to most participants in

  4. Average waiting time profiles of uniform DQDB model

    Energy Technology Data Exchange (ETDEWEB)

    Rao, N.S.V. [Oak Ridge National Lab., TN (United States); Maly, K.; Olariu, S.; Dharanikota, S.; Zhang, L.; Game, D. [Old Dominion Univ., Norfolk, VA (United States). Dept. of Computer Science

    1993-09-07

    The Distributed Queue Dual Bus (DQDB) system consists of a linear arrangement of N nodes that communicate with each other using two contra-flowing buses; the nodes use an extremely simple protocol to send messages on these buses. This simple, but elegant, system has been found to be very challenging to analyze. We consider a simple and uniform abstraction of this model to highlight the fairness issues in terms of average waiting time. We introduce a new approximation method to analyze the performance of DQDB system in terms of the average waiting time of a node expressed as a function of its position. Our approach abstracts the intimate relationship between the load of the system and its fairness characteristics, and explains all basic behavior profiles of DQDB observed in previous simulation. For the uniform DQDB with equal distance between adjacent nodes, we show that the system operates under three basic behavior profiles and a finite number of their combinations that depend on the load of the network. Consequently, the system is not fair at any load in terms of the average waiting times. In the vicinity of a critical load of 1 {minus} 4/N, the uniform network runs into a state akin to chaos, where its behavior fluctuates from one extreme to the other with a load variation of 2/N. Our analysis is supported by simulation results. We also show that the main theme of the analysis carries over to the general (non-uniform) DQDB; by suitably choosing the inter-node distances, the DQDB can be made fair around some loads, but such system will become unfair as the load changes.

  5. Patients with chronic hepatitis C undergoing watchful waiting: Exploring trajectories of illness uncertainty and fatigue.

    Science.gov (United States)

    Bailey, Donald E; Barroso, Julie; Muir, Andrew J; Sloane, Richard; Richmond, Jacqui; McHutchison, John; Patel, Keyur; Landerman, Lawrence; Mishel, Merle H

    2010-10-01

    We identified trajectories of illness uncertainty in chronic hepatitis C patients and examined their association with fatigue levels during 12 months of disease monitoring without treatment (watchful waiting). Sixty-two men and 63 women completed uncertainty and fatigue measures. Groups were formed by uncertainty scores (high, medium, and low) at baseline. Baseline fatigue levels were higher in the high uncertainty group than in the medium and low groups. Over time, uncertainty levels did not change. Fatigue levels in the low uncertainty group remained constant, increased in the medium, and decreased in the high groups. Findings suggest that uncertainty and fatigue do not remit spontaneously. Being aware of this may help nurses identify those patients needing support for these two concerns. © 2010 Wiley Periodicals, Inc. Res Nurs Health 33:465-473, 2010.

  6. 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...

  7. Waiting to go into a Danish Nursing Home - Generations Review

    DEFF Research Database (Denmark)

    Kofod, Jens Erik

    2006-01-01

    that their relationship toward their home care assistant became increasingly important as they waited to go into the nursing home. Assessments for home care were constrained by municipal authorities and their regulations, and the overall attitude was that the needs of older people were not being appropriately defined......The number of older people from their own home into a nursing home is likely to increase. This study intends to examine important aspects in the transition process by applying ethnographic methods. Ten older people and their relatives were interviewed and observed. It was found...... and met. This left them barely able to maintain their homes and, as a consequence of this, their identity....

  8. Mortality on the Waiting List for Lung Transplantation in Patients with Idiopathic Pulmonary Fibrosis: A Single-Centre Experience.

    Science.gov (United States)

    Bennett, David; Fossi, Antonella; Bargagli, Elena; Refini, Rosa Metella; Pieroni, Maria; Luzzi, Luca; Ghiribelli, Claudia; Paladini, Piero; Voltolini, Luca; Rottoli, Paola

    2015-10-01

    Lung transplantation (LTX) is nowadays accepted as a treatment option for selected patients with end-stage pulmonary disease. Idiopathic pulmonary fibrosis (IPF) is characterized by the radiological and histologic appearance of usual interstitial pneumonia. It is associated with a poor prognosis, and LTX is considered an effective treatment to significantly modify the natural history of this disease. The aim of the present study was to analyse mortality during the waiting list in IPF patients at a single institution. A retrospective analysis on IPF patients (n = 90) referred to our Lung Transplant Program in the period 2001-2014 was performed focusing on patients' characteristics and associated risk factors. Diagnosis of IPF was associated with high mortality on the waiting list with respect to other diagnosis (p Pulmonary function tests failed to predict mortality and no other medical conditions were associated with survival. Patients newly diagnosed with IPF, especially in small to medium lung transplant volume centres and in Countries where a long waiting list is expected, should be immediately referred to transplantation, delay results in increased mortality. Early identification of IPF patients with a rapid progressive phenotype is strongly needed.

  9. Repeated ethanol exposure during early and late adolescence: double dissociation of effects on waiting and choice impulsivity.

    Science.gov (United States)

    Sanchez-Roige, Sandra; Peña-Oliver, Yolanda; Ripley, Tamzin L; Stephens, David N

    2014-10-01

    A strong association exists between impulsivity and binge drinking, and between adolescent alcohol exposure and alcohol abuse in humans. To understand the extent to which early-life alcohol exposure contributes to increased impulsivity, we developed an animal model of binge drinking using 2 strains of mice, C57BL/6J (B6) and DBA2/J (D2), that differ in both motor impulsivity and alcohol drinking. Mice were treated with 2 g/kg ethanol (EtOH) during their early (intermittent ethanol exposure [IEE]_Early; postnatal day [PND]30 to 45) or late (IEE_Late; PND45 to 60) adolescence or with saline (control group [CON]) throughout the adolescence period. To determine the consequences IEE on waiting impulsivity and attentional function, the number of premature responses and omissions, respectively, were evaluated in adulthood using the 5-choice serial reaction time task (5-CSRTT). To examine the effects of IEE on choice impulsivity, risky decision making was assessed in adulthood using a mouse version of the Iowa Gambling Task (mIGT). Additionally, the acute effects of EtOH in adulthood on waiting impulsivity and choice preference were investigated. We provide experimental evidence that IEE during late, but not early, adolescence disrupts waiting impulsivity and attentional abilities in the 5-CSRTT. In contrast, IEE during early, but not late, adolescence altered risky decision making in the mIGT. D2 mice consistently showed lower premature responding than B6 mice in both the mIGT and the 5-CSRTT, but greater risky decision making on the mIGT. IEE and CON mice showed similar responsiveness to the acute EtOH effects on premature responding, but increased risky choices only in B6_IEE_Early mice. Our observations suggest a direct effect of IEE during adolescence on waiting and choice impulsivity and attention later in life. Copyright © 2014 by the Research Society on Alcoholism.

  10. Patient age, ethnicity and waiting times determine the likelihood of non-attendance at a first specialist rheumatology assessment.

    Science.gov (United States)

    Milne, Valerie; Kearns, Robin; Harrison, Andrew

    2014-01-01

    To identify demographic and geographic factors associated with non-attendance for first specialist assessment (FSA) at a publicly funded rheumatology clinic and identify changes in service provision that might improve attendance rates. Administrative data for 1953 new referrals over a 2-year period was collected from a New Zealand public rheumatology unit. Patient characteristics and location variables were tested for significance and odds ratios were generated to determine the relationship between non-attendance and referrals data. Patients in the 20-29 years age-group were least likely to attend appointments (P ≤ 0.001, OR 2.81, 95%CI 1.59-4.98). Māori and Pacific Peoples were each almost twice as likely to miss a FSA (P = 0.02, OR 1.87, 95%CI 1.11-3.15 and OR 1.89, 95%CI 1.11-3.22) as New Zealand Europeans. Non-attendance was independently associated with longer waiting times to FSA; with residential location and the uneven provision of services being strong predictors of longer waiting times (P ≤ 0.001). Non-attendance is associated with ethnicity, age and waiting times. It is likely that high deprivation influences ethnic variations in attendance but reasons for young people's non-attendance were difficult to identify. Patients domiciled further from the main rheumatology clinic were also less likely to attend. The influence of ethnicity and deprivation may be underestimated in this study as high Maori and Pacific ethnic populations live closer to well-resourced clinics. Focusing administrative resources on at-risk groups and restructuring the clinical service to improve uneven waiting times would be expected to improve attendance rates across the region. © 2013 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  11. The surgical waiting time initiative: A review of the Nigerian situation.

    Science.gov (United States)

    Abdulkareem, Imran Haruna

    2014-11-01

    The concept of surgical waiting time initiative (SWAT) was introduced in developed countries to reduce elective surgery waiting lists and increase efficiency of care. It was supplemented by increasing popularity of day surgery, which shortens elective waiting lists and minimises cancellations. It is established in Western countries, but not in developing countries like Nigeria where it is still evolving. A search was carried out in Pub Med, Google, African journals online (AJOL), Athens and Ovid for relevant publications on elective surgery waiting list in Nigeria, published in English language. Words include waiting/wait time, waiting time initiative, time to surgery, waiting for operations, waiting for intervention, waiting for procedures and time before surgery in Nigeria. A total of 37 articles published from Nigeria in relation to various waiting times were found from the search and fulfilled the inclusion criteria. Among them, 11 publications (29.7%) were related to emergency surgery waiting times, 10 (27%) were related to clinic waiting times, 9 (24.3%) were related to day case surgery, 2 (5.5%) were related to investigation waiting times and only 5 (13.5%) articles were specifically published on elective surgery waiting times. A total of 9 articles (24.5%) were published from obstetrics and gynaecology (OG), 7 (19%) from general surgery, 5 (13.5%) from public health, 3 (8%) from orthopaedics, 3 (8%) from general practice (GP), 3 (8%) from paediatrics/paediatric surgery, 2 (5.5%) from ophthalmology, 1 (2.7%) from ear, nose and throat (ENT), 1 (2.7%) from plastic surgery, 1 (2.7%) from urology and only 1 (2.7%) article was published from dental/maxillofacial surgery. Waiting times mean different things to different health practitioners in Nigeria. There were only 5/37 articles (13.5%) specifically related to elective surgery waiting times in Nigerian hospitals, which show that the concept of the SWAT is still evolving in Nigeria. Of the 37, 11 (24

  12. Identity Construction In Samuel Beckett’s Waiting For Godot

    Directory of Open Access Journals (Sweden)

    Yusri Fajar

    2013-12-01

    Full Text Available This paper scrutinizes the formation of the identity of the characters in Samuel Beckett’s famous play Waiting for Godot. One of the characters whose identity is constructed is Godot, a mysterious absent figure. The other characters, such as Vladimir and Estragon actively construct Godot’s identity. Thus, the formation of identity cannot be separated from the social construction in which a lot of characteristics are attributed by the members of the large community. The theory of identity elaborated by Stuart Hall and Erikson is employed to examine the play. The study shows that Godot and other characters’ identity is unstable and fluid. The characteristics of their identity are ambiguous and even challenged. Abstrak: Artikel ini mengkaji pembentukan identitas karakter dalam drama terkenal Waiting for Godot karya Samuel Beckett. Salah satu karakter yang dikonstruksi identitasnya adalah Godot, sosok misterius yang tidak pernah muncul. Karakter lain, seperti Vladimir dan Estragon secara aktif mengonstruksi identitas Godot. Oleh sebab itu, pembentukan identitas tidak dapat dipisahkan dari konstruksi sosial yang dimasuki banyak karakteristik oleh anggota masyarakat luas. Teori identitas Stuart Hall dan Erikson digunakan untuk menganalisis drama tersebut. Hasil analisis menunjukkan bahwa identitas Godot dan karakter lain tidak stabil dan cair. Karakteristik identitas mereka ambigu dan bahkan meragukan. Kata-­Kata Kunci: identit; ambiguitas; Godot

  13. 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 ...

  14. An automaton approach for waiting times in DNA evolution

    CERN Document Server

    Behrens, S; Nicodeme, P

    2011-01-01

    In a recent article, Behrens and Vingron (JCB 17, 12, 2010) compute waiting times for k-mers to appear during DNA evolution under the assumption that the considered k-mers do not occur in the initial DNA sequence, an issue arising when studying the evolution of regulatory DNA sequences with regard to transcription factor (TF) binding site emergence. The mathematical analysis underlying their computation assumes that occurrences of words under interest do not overlap. We relax here this assumption by use of an automata approach. In an alphabet of size 4 like the DNA alphabet, most words have no or a low autocorrelation; therefore, globally, our results confirm those of Behrens and Vingron. The outcome is quite different when considering highly autocorrelated k-mers; in this case, the autocorrelation pushes down the probability of occurrence of these k-mers at generation 1 and, consequently, increases the waiting time for apparition of these k-mers up to 40%. An analysis of existing TF binding sites unveils a s...

  15. Joint optimisation of transmission and waiting times in cognitive radio

    Science.gov (United States)

    Amini, Mohammadreza; Samimi, Abouzar; Mirzavandi, Asra

    2016-04-01

    Transmission time optimisation is one of the key considerations of cognitive network design. There are many studies in cognitive radio networks (CRNs) focusing on finding the best transmission time for secondary users (SUs) to maximise transmission or energy efficiency. While longer sensing duration leads to a higher sensing accuracy and causes less interference, the SU spends less time for transmission and more energy on sensing spectrum. On the other hand, when the transmission duration becomes longer, although the SU has more opportunities to access the channel, it may encounter higher interference due to primary user (PU) returns and the probability of collision becomes higher. In this article, in a decentralised slotted protocol for CRN, the SU spectrum access is proved as a renewal process, then the interference due to PU return during SU transmission, the missed opportunities due to waiting for the channel to become idle and the energy consumed by the SU in the whole spectrum access process including idling energy, transmission energy and sensing energy consumption are formulated and integrated into newly defined efficiency to obtain the optimum transmission time and waiting time.

  16. 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.

  17. The uncertainty room: strategies for managing uncertainty in a surgical waiting room.

    Science.gov (United States)

    Stone, Anne M; Lammers, John C

    2012-01-01

    To describe experiences of uncertainty and management strategies for staff working with families in a hospital waiting room. A 288-bed, nonprofit community hospital in a Midwestern city. Data were collected during individual, semistructured interviews with 3 volunteers, 3 technical staff members, and 1 circulating nurse (n = 7), and during 40 hours of observation in a surgical waiting room. Interview transcripts were analyzed using constant comparative techniques. The surgical waiting room represents the intersection of several sources of uncertainty that families experience. Findings also illustrate the ways in which staff manage the uncertainty of families in the waiting room by communicating support. Staff in surgical waiting rooms are responsible for managing family members' uncertainty related to insufficient information. Practically, this study provided some evidence that staff are expected to help manage the uncertainty that is typical in a surgical waiting room, further highlighting the important role of communication in improving family members' experiences.

  18. Waiting for postterm in healthy women, is it an accident waiting to happen?

    Science.gov (United States)

    Bel-Ange, Anat; Harlev, Avi; Weintraub, Adi Y; Sheiner, Eyal

    2013-05-01

    To establish whether postterm pregnancies are associated with adverse perinatal outcomes in a linear fashion. A retrospective cohort study investigating perinatal outcomes in singleton term (≥ 37 weeks gestation) and postterm pregnancies was conducted. Deliveries occurred between the years 1988 and 2010. Parturients were classified into three groups according to their gestational age: 37-39 + 6, 40-41 + 6 and over 42 weeks' gestation (postterm). Statistical analysis included multiple logistic regression model to control for possible confounders. Out of 202,462 deliveries, meeting the inclusion criteria, during the study period, 47.7% occurred at 37-39 + 6 weeks, 47.4% occurred at 40-41 + 6 weeks and 4.9% were postterm. Fertility treatments, diabetes mellitus, hypertensive disorders, intrauterine growth restriction (IUGR) and premature rupture of membranes (PROM) were less likely to be associated with postterm pregnancies. However, postterm was found as a significant risk factor for labor complications and adverse perinatal outcome including perinatal mortality. Using a multivariable logistic regression model, controlling for confounders such as maternal age and macrosomia, postterm was found to be an independent risk factor for perinatal mortality (adjusted OR = 1.5; 95% CI = 1.20-2.0; p postterm pregnancies were less likely to be associated with obstetrical risk factors and complications such as fertility treatments, diabetes mellitus, hypertensive disorders, IUGR and PROM, postterm is an independent risk factor for perinatal mortality.

  19. Effectiveness and cost-effectiveness of web-based treatment for phobic outpatients on a waiting list for psychotherapy: protocol of a randomised controlled trial.

    Science.gov (United States)

    Kok, Robin N; van Straten, Annemieke; Beekman, Aartjan; Bosmans, Judith; de Neef, Manja; Cuijpers, Pim

    2012-08-31

    Phobic disorders are highly prevalent and constitute a considerable burden for patients and society. As patients wait for face-to-face psychotherapy for phobic disorders in outpatient clinics, this time can be used for guided self-help interventions. The aim of this study is to investigate a five week internet-based guided self-help programme of exposure therapy in terms of clinical effectiveness and impact on speed of recovery in psychiatric outpatients, as well as the cost-effectiveness of this pre-treatment waiting list intervention. A randomised controlled trial will be conducted among 244 Dutch adult patients recruited from waiting lists of outpatient clinics for face-to-face psychotherapy for phobic disorders. Patients suffering from at least one DSM-IV classified phobic disorder (social phobia, agoraphobia or specific phobia) are randomly allocated (at a 1:1 ratio) to either a five-week internet-based guided self-help program followed by face-to-face psychotherapy, or a control group followed by face-to-face psychotherapy. Waiting list status and duration are unchanged and actual need for further treatment is evaluated prior to face-to-face psychotherapy. Clinical and economic self-assessment measurements take place at baseline, post-test (five weeks after baseline) and at 3, 6, 9 and 12 months after baseline. Offering pre-treatment internet-based guided self-help efficiently uses time otherwise lost on a waiting list and may increase patient satisfaction. Patients are expected to need fewer face-to-face sessions, reducing total treatment cost and increasing speed of recovery. Internet-delivered treatment for phobias may be a valuable addition to psychotherapy as demand for outpatient treatment increases while budgets decrease. Netherlands Trial Register NTR2233.

  20. Effectiveness and cost-effectiveness of web-based treatment for phobic outpatients on a waiting list for psychotherapy: protocol of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Kok Robin N

    2012-08-01

    Full Text Available Abstract Background Phobic disorders are highly prevalent and constitute a considerable burden for patients and society. As patients wait for face-to-face psychotherapy for phobic disorders in outpatient clinics, this time can be used for guided self-help interventions. The aim of this study is to investigate a five week internet-based guided self-help programme of exposure therapy in terms of clinical effectiveness and impact on speed of recovery in psychiatric outpatients, as well as the cost-effectiveness of this pre-treatment waiting list intervention. Methods/design A randomised controlled trial will be conducted among 244 Dutch adult patients recruited from waiting lists of outpatient clinics for face-to-face psychotherapy for phobic disorders. Patients suffering from at least one DSM-IV classified phobic disorder (social phobia, agoraphobia or specific phobia are randomly allocated (at a 1:1 ratio to either a five-week internet-based guided self-help program followed by face-to-face psychotherapy, or a control group followed by face-to-face psychotherapy. Waiting list status and duration are unchanged and actual need for further treatment is evaluated prior to face-to-face psychotherapy. Clinical and economic self-assessment measurements take place at baseline, post-test (five weeks after baseline and at 3, 6, 9 and 12 months after baseline. Discussion Offering pre-treatment internet-based guided self-help efficiently uses time otherwise lost on a waiting list and may increase patient satisfaction. Patients are expected to need fewer face-to-face sessions, reducing total treatment cost and increasing speed of recovery. Internet-delivered treatment for phobias may be a valuable addition to psychotherapy as demand for outpatient treatment increases while budgets decrease. Trial registration Netherlands Trial Register NTR2233

  1. The surgical waiting time initiative: A review of the Nigerian situation

    OpenAIRE

    Imran Haruna Abdulkareem

    2014-01-01

    SUMMARY The concept of surgical waiting time initiative (SWAT) was introduced in developed countries to reduce elective surgery waiting lists and increase efficiency of care. It was supplemented by increasing popularity of day surgery, which shortens elective waiting lists and minimises cancellations. It is established in Western countries, but not in developing countries like Nigeria where it is still evolving. A search was carried out in Pub Med, Google, African journals online (AJOL), Athe...

  2. 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.

  3. Factors Associated with Residential Long-Term Care Wait-List Placement in North West Ontario.

    Science.gov (United States)

    Laporte, Audrey; Rohit Dass, Adrian; Kuluski, Kerry; Peckham, Allie; Berta, Whitney; Lum, Janet; Williams, A Paul

    2017-09-01

    This article is based on a study that investigated factors associated with long-term care wait list placement in Ontario, Canada. We based the study's analysis on Resident Assessment Instrument for Home Care (RAI-HC) data for 2014 in the North West Local Health Integration Network (LHIN). Our analysis quantified the contribution of three factors on the likelihood of wait list placement: (1) care recipient, (2) informal caregiver, and (3) formal system. We find that all three factors are significantly related to wait list placement. The results of this analysis could have implications for policies aimed at reducing the number of wait-listed individuals in the community.

  4. The Prior Internet Resources 2017

    DEFF Research Database (Denmark)

    Engerer, Volkmar Paul; Albretsen, Jørgen

    2017-01-01

    The Prior Internet Resources (PIR) are presented. Prior’s unpublished scientific manuscripts and his wast letter correspondence with fellow researchers at the time, his Nachlass, is now subject to transcription by Prior-researchers worldwide, and form an integral part of PIR. It is demonstrated...... that the PIR, defined as the virtual space delimited by the three content areas and Internet domains: 1) Priorstudies, 2) Prior Virtual Lab, and 3) Nachlass), contains six information systems of five distinct types. The informations systems are grouped into a “Transcriber Loop” to illustrate how unpublished...... material from the archive boxes goes through a transcription process to end in the Nachlass. A box taxonomy defines the transcription project’s hub. Together with the “Transcriber Loop” this setup makes it possible to use the boxlists in conjunction with a Priorbibliography also in PIR as a showcase...

  5. Measles transmission in health care waiting rooms: implications for public health response

    Directory of Open Access Journals (Sweden)

    Stephen Conaty

    2012-12-01

    Full Text Available Background: Seventeen cases of locally acquired measles occurred in South Western Sydney and Sydney local health districts between July and October 2011. Three of the cases were known to have at least one dose of measles-mumps-rubella (MMR vaccine. Seven cases were infected within a health care setting waiting room by five index cases. Current national protocols require follow-up of all susceptible contacts in the same waiting room for any length of time for up to two hours after the index case has left.Methods: Cases were interviewed using a standardized questionnaire. Information included: demographics, illness and activities during the exposure and infectious periods. Health care settings provided arrival and discharge times, maps of floor layouts and location of patients during stay.Results: All health care setting transmission occurred in cases who were present at the same time as their index cases, with cross-over time ranging from 20 to 254 minutes. No index case was isolated. Index cases were between day four and six of illness when transmission occurred. None of the five index cases and one of seven secondary cases had received at least one dose of MMR vaccine. Of the seven secondary cases, two were one year of age, one was 17 years old and four were between 30 and 39 years old.Conclusion: As Australia moves towards measles elimination, follow-up of cases is important; however, with limited public health resources a targeted response is vital. In this small but well-documented series of secondary cases acquired in a health care setting, all were infected following direct, proximate contact of at least 20 minutes. Changes to the national guidelines may be warranted, ensuring that limited resources are focused on following up contacts at greatest risk of disease.

  6. Do women read poster displays on breast cancer in waiting rooms?

    Science.gov (United States)

    Montazeri, Ali; Sajadian, Akram

    2004-12-01

    This study reports data from a survey carried out in the Iranian Center for Breast Cancer (ICBC) to examine whether women read poster displays in waiting rooms and whether they would have any suggestions to improve posters and thus meet their informational needs. Five specially designed posters were displayed in waiting rooms in the ICBC. The content of posters was related to risk factors, early detection, signs and symptoms, and prevention of breast cancer. During a 3 month period a self-administered questionnaire was distributed to all attendees and they were asked to complete the questionnaire. Overall, 850 women were given the questionnaire and 777 completed questionnaires (91 per cent) were returned. The mean age of the women was 37.0 years (SD = 10.7) and they mostly had secondary education (47 per cent). In all, 691 women (86 per cent) reported that they had seen the posters and 620 (80 per cent) said that they had read the displays. The vast majority of the women reported that posters were readable (89 per cent) and understandable (80 per cent). However, 25 per cent of the respondents indicated that materials on the displays created more questions rather than answering their questions and some reported that they became upset (26 per cent) or felt anxiety (42 per cent) while reading the posters. Finally, 218 women (28 per cent) had suggestions to improve posters, of whom 110 (50 per cent) believed that the posters should be simpler. The study findings suggest that despite the limitations of posters as a means of health communication, their use in public places may be useful but consideration should be given to the content of the poster displays to prevent anxiety.

  7. The Impact of Waiting List Bmi Changes on the Short-Term Outcomes of Lung Transplantation.

    Science.gov (United States)

    Jomphe, Valérie; Mailhot, Geneviève; Damphousse, Véronic; Tahir, Muhammad-Ramzan; Receveur, Olivier; Poirier, Charles; Ferraro, Pasquale

    2017-08-18

    Obesity and underweight are associated with a higher postlung transplantation (LTx) mortality. This study aims to assess the impact of the changes in BMI during the waiting period for LTx on early postoperative outcomes. Medical records of 502 consecutive cases of LTx performed at our institution between 1999 and 2015 were reviewed. Patients were stratified per change in BMI category between pre-LTx assessment (candidate BMI) and transplant BMI as follows: A-Candidate BMIBMIBMIBMI18.5-29.9, C-Candidate BMI18.5-29.9 and Transplant BMI18.5-29.9, D-Candidate BMI≥30 and Transplant BMI18.5-29.9 and E-Candidate BMI≥30 or 18.5-29.9 and Transplant BMI≥30. Our primary outcome was in-hospital (H) mortality and secondary outcomes were length of mechanical ventilation (MV), intensive care unit (ICU) length of stay (LOS), H LOS and postoperative complications. BMI variation during the waiting time was common, as 1/3 of patients experienced a change in BMI category. Length of MV (21 vs. 9 d; p=0.018), ICU LOS (26 vs. 15 d; p=0.035) and rates of surgical complications (76 vs. 44%; p=0.018) were significantly worse in patients of group E vs. D. Obese candidates who failed to decrease BMIBMI evolution had no impact on postoperative morbidity and mortality in underweight patients. Our results suggest that obese candidates with an unfavorable pretransplant BMI evolution are at greater risk of worse post-LTx outcomes.

  8. Historiske perioder

    DEFF Research Database (Denmark)

    2017-01-01

    For at forstå fortiden og fortællingerne om den, må vi skabe en form for orden og systematik. Her spiller inddelingen af fortiden i historiske perioder en afgørende rolle – og historiske perioder er da også et kompetencemål efter 6. klasse. Videoen diskuterer forskellige principper...... for periodisering. Kronologi og sammenhænge hænger naturligt sammen med historiske perioder. Videoen handler også om forståelser og brug af synkrone og diakrone sammenhænge i faget....

  9. Turn to staff for dramatic improvement in wait times, productivity.

    Science.gov (United States)

    2011-09-01

    Baylor Medical Center in Garland,TX, has been able to drastically reduce ED wait times, as well as the LWBS rate by streamlining the triage process and implementing a staff-driven improvement effort aimed at identifying inefficiencies and replacing them with solutions that work. The result is 11 beds of added capacity just from changes in patient flow. A cross section of volunteers from the ED staff reviewed metrics and devised solutions that they felt would work best to boost efficiency and eliminate bottlenecks. Solutions included letting low-acuity patients move themselves between care settings, freeing the charge nurse from patient care duties so that he or she could oversee patient flow, and empowering physician-nurse teams to see patients more quickly. ED managers say leadership is important, but letting staff drive the improvement process is key to their success.

  10. 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.

  11. 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 < 0.001), even with a volume increase of 9%. The number of bed-days occupied by nonurgent patients before surgery declined by 13.3% whereas the volume increased by 4.5%. The large-scale application of an open-block strategy significantly improved the flow of nonelective patients at MGH when OR availability was a major 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.

  12. Failure to cope: the hidden curriculum of emergency department wait times and the implications for clinical training.

    Science.gov (United States)

    Webster, Fiona; Rice, Kathleen; Dainty, Katie N; Zwarenstein, Merrick; Durant, Steve; Kuper, Ayelet

    2015-01-01

    The study explored optimal intraprofessional collaboration between physicians in the emergency department (ED) and those from general internal medicine (GIM). Prior to the study, a policy was initiated that mandated reductions in ED wait times. The researchers examined the impact of these changes on clinical practice and trainee education. In 2010-2011, an ethnographic study was undertaken to observe consults between GIM and ED at an urban teaching hospital in Ontario, Canada. Additional ad hoc interviews were conducted with residents, nurses, and faculty from both departments as well as formal one-on-one interviews with 12 physicians. Data were coded and analyzed using concepts of institutional ethnography. Participants perceived that efficiency was more important than education and was in fact the new definition of "good" patient care. The informal label "failure to cope" to describe high-needs patients suggested that in many instances, patients were experienced as a barrier to optimal efficiency. This resulted in tension during consults as well as reduced opportunities for education. The authors suggest that the emphasis on wait times resulted in more importance being placed on "getting the patient out" of the ED than on providing safe, compassionate, person-centered medical care. Resource constraints were hidden within a discourse that shifted the problem of overcrowding in the ED to patients with complex chronic conditions. The term "failure to cope" became activated when overworked physicians tried to avoid assuming care for high-needs patients, masking institutionally produced stress and possibly altering the way patients are perceived.

  13. 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.

  14. Patient perceptions regarding physician reimbursements, wait times, and out-of-pocket payments for anterior cruciate ligament reconstruction in Ontario.

    Science.gov (United States)

    Memon, Muzammil; Ginsberg, Lydia; de Sa, Darren; Nashed, Andrew; Simunovic, Nicole; Phillips, Mark; Denkers, Matthew; Ogilvie, Rick; Peterson, Devin; Ayeni, Olufemi R

    2017-12-01

    Currently, there is a lack of knowledge regarding patient perceptions surrounding physician reimbursements, appropriate wait times, and out-of-pocket payment options for anterior cruciate ligament reconstruction (ACLR). Our objective was to determine the current state of these perceptions in an Ontario setting. A survey was developed and pretested to address patient perceptions about physician reimbursements, appropriate wait times, and out-of-pocket payment options for ACLR using a focus group of experts and by reviewing prior surveys. The survey was administered to patients in a waiting room setting. Two hundred and fifty completed surveys were obtained (79.9% response rate). Participants responded that an appropriate physician reimbursement for ACLR was $1000.00 and that the Ontario Health Insurance Plan (OHIP) reimbursed physicians $700.00 for ACLR. Seventy-four percent of participants responded that the OHIP reimbursement of $615.20 for the procedure was either lower or much lower than what they considered to be an appropriate reimbursement for ACLR. Over 90% of participants responded that an ACLR should occur within 90 days of injury. Thirty-five percent of participants were willing to pay $750.00 out-of-pocket to have an ACLR done sooner, while 16.4% of participants were willing to pay $2500.00 out-of-pocket to travel outside of Canada for expedited surgery. This survey study demonstrates that patients' estimates of both appropriate and actual physician reimbursements were greater than the current reimbursement for ACLR. Further, the majority of individuals report that the surgical fee for ACLR is lower than what they consider to be an appropriate amount of compensation for the procedure. Additionally, nearly all respondents believe that a ruptured ACL should be reconstructed within 90 days of injury. Consequently, a number of patients are willing to pay out-of-pocket for expedited surgery either in Canada or abroad. However, patients' preferences for

  15. Waiting for Godot is an Irish Endgame: A Postcolonial Reading of Samuel Beckett’s Waiting for Godot and Endgame

    Directory of Open Access Journals (Sweden)

    Sayyed Rahim Moosavinia

    2013-01-01

    Full Text Available Irish National Drama is very sensitive when it comes to the issue of English Colonization, colonial forces, independence and the matter of post-colonial. In fact, a kind of Irish consciousness is present in all the dramas of this nation and all playwrights in this trend- even indirectly or by implication- have tried to portray these matters through their works. This study is an attempt to prove the claim that even a playwright like Samuel Beckett, whose works have been written out of the canon of Irish Literature because of living on exile, adopting another language or semi-taboo labels like Absurdism, Universality and Placlessness, can be read in light postcolinalism. To this aim, two of Beckett’s plays Waiting for Godot and End Game are chosen here as the representative and put into explication.

  16. Waiting Time: The De-Subjectification of Children in Danish Asylum Centres

    Science.gov (United States)

    Vitus, Kathrine

    2010-01-01

    This article analyses the relationship between time and subjectification, focusing on the temporal structures created within Danish asylum centres and politics, and on children's experiences of and reactions to open-ended waiting. Such waiting leads to existential boredom which manifests in the children as restlessness, fatigue and despair. The…

  17. 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…

  18. 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 ...

  19. Strategic Attention Deployment for Delay of Gratification in Working and Waiting Situations.

    Science.gov (United States)

    Peake, Philip K.; Hebl, Michelle; Mischel, Walter

    2002-01-01

    Two studies examined whether effects of attention to rewards during a delay of gratification task in waiting situations affects preschoolers' ability to delay gratification in working situations. Findings show that when work provides distraction, attention on rewards reduces delay time whether working or waiting; when work is not engaging,…

  20. The relationship between educational attainment and waiting time among the elderly in Norway.

    Science.gov (United States)

    Carlsen, Fredrik; Kaarboe, Oddvar Martin

    2015-11-01

    We investigate whether educational attainment affects waiting time of elderly patients in somatic hospitals. We consider three distinct pathways; that patients with different educational attainment have different disease patterns, that patients with different levels of education receive treatments at different hospitals, and that patient choice and supply of local health services within hospital catchment areas explain unequal waiting time of different educational groups. We find evidence of an educational gradient in waiting time for male patients, but not for female patients. Conditional on age, male patients with tertiary education wait 45% shorter than male patients with secondary or primary education. The first pathway is not quantitatively important as controlling for disease patters has little effect on relative waiting times. The second pathway is important. Relative to patients with primary education, variation in waiting time and education level across local hospitals contributes to higher waiting time for male patients with secondary education and female patients with secondary or tertiary education and lower waiting time for male patients with tertiary education. These effects are in the order of 15-20%. The third pathway is also quantitatively important. The educational gradients within catchment areas disappear when we control for travel distance and supply of private specialists. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. Access to Specialist Gastroenterology Care in Canada: The Practice Audit in Gastroenterology (PAGE Wait Times Program

    Directory of Open Access Journals (Sweden)

    David Armstrong

    2008-01-01

    Full Text Available BACKGROUND: Canadian wait time data are available for the treatment of cancer and heart disease, as well as for joint replacement, cataract surgery and diagnostic imaging procedures. Wait times for gastroenterology consultation and procedures have not been studied, although digestive diseases pose a greater economic burden in Canada than cancer or heart disease.

  2. Synchronization Control of Scheduled Train Services to Minimize Passenger Waiting Times

    NARCIS (Netherlands)

    Goverde, R.M.P.

    1998-01-01

    During operation a transportation service may wait on delayed feeder services to secure scheduled transfers. For low-frequent connecting services this has a major positive impact on the transfer waiting times. However, the resulting synchronization control time of the connecting service also affects

  3. 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

  4. First in Line Waiting Times as a Tool for Analysing Queueing Systems

    DEFF Research Database (Denmark)

    Koole, G. M.; Nielsen, Bo Friis; Nielsen, Thomas Bang

    2012-01-01

    We introduce a new approach to modelling queueing systems where the priority or the routing of customers depends on the time the first customer has waited in the queue. This past waiting time of the first customer in line, WFIL, is used as the primary variable for our approach. A Markov chain...

  5. Cigarette smoking and waiting time to pregnancy: results of a pilot study.

    Science.gov (United States)

    Zilaitiene, Birute; Dirzauskas, Marius; Preiksa, Romualdas Tomas; Matulevicius, Valentinas

    2007-01-01

    Waiting time to pregnancy is an important characteristic of human reproductive health, which has not been investigated in Lithuania until now. Data on waiting time to pregnancy have been collected from medical records of 111 women admitted to the Department of Obstetrics, Klaipeda Hospital. Seven women in whom pregnancy was the result of infertility treatment were excluded from the analysis, and the rest 104 cases were analyzed. We evaluated waiting time to pregnancy in respect to the age of couples, contraceptive use, cigarette smoking of both partners, and some other features of obstetric history. The mean waiting time to pregnancy in the cohort was 5.21+/-7.03 months. If both partners smoked, the mean waiting time to pregnancy was significantly longer than in nonsmoking couples (7.68+/-9.41 vs. 4.30+/-5.73, P<0.05). Risk to have waiting time to pregnancy longer than 6 months was significantly higher if both partners smoked as compared to nonsmoking couples (OR 3.32, 95% CI 1.07-10.30, P=0.03), while paternal smoking and smoking of any partner did not increase this risk significantly. The other possible factors - age, living place (rural or city), previous contraceptive use, regularity of menstrual cycle, and frequency of intercourse - did not influence waiting time to pregnancy significantly. Results obtained from this pilot study enable us to plan and implement a larger-scale study of waiting time to pregnancy in Lithuanian population.

  6. 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

  7. "Prehabilitation" prior to CABG surgery improves physical functioning and depression.

    Science.gov (United States)

    Furze, Gill; Dumville, Jo C; Miles, Jeremy N V; Irvine, Karen; Thompson, David R; Lewin, Robert J P

    2009-02-06

    Many patients demonstrate psychological distress and reduced physical activity before coronary artery bypass graft surgery (CABG). Here we evaluated the addition of a brief, cognitive-behavioural intervention (the HeartOp Programme) to routine nurse counselling for people waiting for CABG surgery. Randomised controlled trial comparing nurse counselling with the HeartOp programme to routine nurse counselling in 204 patients awaiting first time elective CABG. Primary outcome measures were: anxiety and length of hospital stay; secondary outcome measures were: depression, physical functioning, cardiac misconceptions and cost utility. Measures were collected prior to randomisation and after 8 weeks of their intervention prior to surgery, excepting length of hospital stay which was collected after discharge following surgery. 100 patients were randomised to intervention, 104 to control. At follow-up there were no differences in anxiety or length of hospital stay. There were significant differences in depression (difference=7.79, p=0.008, 95% CI=2.04-13.54), physical functioning (difference=0.82, p=0.001, 95%CI=0.34-1.3) and cardiac misconceptions (difference=2.56, pmisconceptions. The HeartOp Programme was found to have an Incremental Cost Effectiveness Ratio (ICER) of pound 288.83 per Quality-Adjusted Life Year. Nurse counselling with the HeartOp Programme reduces depression and cardiac misconceptions and improves physical functioning before bypass surgery significantly more than nurse counselling alone and meets the accepted criteria for cost efficacy.

  8. Quantum steganography using prior entanglement

    Energy Technology Data Exchange (ETDEWEB)

    Mihara, Takashi, E-mail: mihara@toyo.jp

    2015-06-05

    Steganography is the hiding of secret information within innocent-looking information (e.g., text, audio, image, video, etc.). A quantum version of steganography is a method based on quantum physics. In this paper, we propose quantum steganography by combining quantum error-correcting codes with prior entanglement. In many steganographic techniques, embedding secret messages in error-correcting codes may cause damage to them if the embedded part is corrupted. However, our proposed steganography can separately create secret messages and the content of cover messages. The intrinsic form of the cover message does not have to be modified for embedding secret messages. - Highlights: • Our steganography combines quantum error-correcting codes with prior entanglement. • Our steganography can separately create secret messages and the content of cover messages. • Errors in cover messages do not have affect the recovery of secret messages. • We embed a secret message in the Steane code as an example of our steganography.

  9. Comparing energy payback and simple payback period for solar photovoltaic systems

    Science.gov (United States)

    Kessler, Will

    2017-11-01

    Installing a solar photovoltaic (PV) array is both an environmental and a financial decision. The financial arguments often take priority over the environmental because installing solar is capital-intensive. The Simple Payback period (SPB) is often assessed prior to the adoption of solar PV at a residence or a business. Although it better describes the value of solar PV electricity in terms of sustainability, the Energy Payback period (EPB) is seldom used to gauge the merits of an installation. Using published estimates of embodied energies, EPB was calculated for four solar PV plants utilizing crystalline-Si technology: three being actual commercial installations located in the northeastern U.S., and a fourth installation based on a simulated 20-kilowatt roof-mounted system, in Wrocław, Poland. Simple Payback was calculated based on initial capital cost, and on the availability of avoided electricity costs based on net-metering tariffs, which at present in the U.S. are 1:1 credit ratio, and in Poland is 1:0.7 credit ratio. For all projects, the EPB time was estimated at between 1.9 and 2.6 years. In contrast, the SPB for installed systems in the northeastern U.S. ranged from 13.3 to 14.6 years, and was estimated at 13.5 years for the example system in Lower Silesia, Poland. The comparison between SPB and EPB shows a disparity between motivational time frames, in which the wait for financial return is considerably longer than the wait for net energy harvest and the start of sustainable power production.

  10. PERIODIC BEHAVIORS

    NARCIS (Netherlands)

    Napp, Diego; Put, Marius van der; Shankar, Shiva

    2010-01-01

    This paper studies behaviors that are defined on a torus, or equivalently, behaviors defined in spaces of periodic functions, and establishes their basic properties analogous to classical results of Malgrange, Palamodov, Oberst et al. for behaviors on R(n). These properties-in particular the

  11. Acquisition of multiple prior distributions in tactile temporal order judgment

    Directory of Open Access Journals (Sweden)

    Yasuhito eNagai

    2012-08-01

    Full Text Available The Bayesian estimation theory proposes that the brain acquires the prior distribution of a task and integrates it with sensory signals to minimize the effect of sensory noise. Psychophysical studies have demonstrated that our brain actually implements Bayesian estimation in a variety of sensory-motor tasks. However, these studies only imposed one prior distribution on participants within a task period. In this study, we investigated the conditions that enable the acquisition of multiple prior distributions in temporal order judgment (TOJ of two tactile stimuli across the hands. In Experiment 1, stimulation intervals were randomly selected from one of two prior distributions (biased to right hand earlier and biased to left hand earlier in association with color cues (green and red, respectively. Although the acquisition of the two priors was not enabled by the color cues alone, it was significant when participants shifted their gaze (above or below in response to the color cues. However, the acquisition of multiple priors was not significant when participants moved their mouths (opened or closed. In Experiment 2, the spatial cues (above and below were used to identify which eye position or retinal cue position was crucial for the eye-movement-dependent acquisition of multiple priors in Experiment 1. The acquisition of the two priors was significant when participants moved their gaze to the cues (i.e., the cue positions on the retina were constant across the priors, as well as when participants did not shift their gazes (i.e., the cue positions on the retina changed according to the priors. Thus, both eye and retinal cue positions were effective in acquiring multiple priors. Based on previous neurophysiological reports, we discuss possible neural correlates that contribute to the acquisition of multiple priors.

  12. An investigation of the relationship between cataract surgery wait times and rates of surgery.

    Science.gov (United States)

    Hodge, William G; Ramsay, Timothy; Fergusson, Dean; Si, Francie; Pan, Irene; Su, Yinghua; Buhrmann, Ralf

    2012-02-01

    The relationship between cataract surgery wait times and rates of surgery was investigated to determine whether wait times correlate with rates of surgery. Cross-sectional study. We collected 2 Ontario registries for cataract surgeries: (i) Cancer Care Ontario wait time registry; and (ii) The Ontario Health Insurance Plan billing records. Both registries were used to determine whether wait times correlated with rates of surgery, and the data were then stratified by region of the province, priority (severity) of cases, age, and sex. The total number of surgeries performed between April 2, 2007, and March 31, 2008, was 65,520. The overall mean number of wait days was 69.8 days; the mean patient age was 72.5 years; and the surgery rate was 540.3 per 100,000 members of the population. For high-priority cases (priorities 1 and 2), there was a very weak inverse correlation (p = -0.27 and -0.21) between wait time and surgery rate, whereas the overall correlation between wait time and surgical rate was close to zero in both databases, regardless of the region, the patients' ages, and the patients' genders. This study demonstrates a very weak correlation between wait times for and rates of cataract surgery, and this should be a concern for policy makers. Further study is needed to see whether this null relationship persists over time and whether it exists for other monitored wait time procedures. Reasons for this null relationship will have to be determined and remedied as the use of wait times becomes a more widespread outcome in Canadian Healthcare. Copyright © 2012 Canadian Ophthalmological Society. All rights reserved.

  13. The effects of publishing emergency department wait time on patient utilization patterns in a community with two emergency department sites: a retrospective, quasi-experiment design.

    Science.gov (United States)

    Xie, Bin; Youash, Sabrina

    2011-06-14

    Providing emergency department (ED) wait time information to the public has been suggested as a mechanism to reduce lengthy ED wait times (by enabling patients to select the ED site with shorter wait time), but the effects of such a program have not been evaluated. We evaluated the effects of such a program in a community with two ED sites. Descriptive statistics for wait times of the two sites before and after the publication of wait time information were used to evaluate the effects of the publication of wait time information on wait times. Multivariate logistical regression was used to test whether or not individual patients used published wait time to decide which site to visit. We found that the rates of wait times exceeding 4 h, and the 95th percentile of wait times in the two sites decreased after the publication of wait time information, even though the average wait times experienced a slight increase. We also found that after controlling for other factors, the site with shorter wait time had a higher likelihood of being selected after the publication of wait time information, but there was no such relationship before the publication. These findings were consistent with the hypothesis that the publication of wait time information leads to patients selecting the site with shorter wait time. While publishing ED wait time information did not improve average wait time, it reduced the rates of lengthy wait times.

  14. Advanced access: reducing waiting and delays in primary care.

    Science.gov (United States)

    Murray, Mark; Berwick, Donald M

    2003-02-26

    Delay of care is a persistent and undesirable feature of current health care systems. Although delay seems to be inevitable and linked to resource limitations, it often is neither. Rather, it is usually the result of unplanned, irrational scheduling and resource allocation. Application of queuing theory and principles of industrial engineering, adapted appropriately to clinical settings, can reduce delay substantially, even in small practices, without requiring additional resources. One model, sometimes referred to as advanced access, has increasingly been shown to reduce waiting times in primary care. The core principle of advanced access is that patients calling to schedule a physician visit are offered an appointment the same day. Advanced access is not sustainable if patient demand for appointments is permanently greater than physician capacity to offer appointments. Six elements of advanced access are important in its application balancing supply and demand, reducing backlog, reducing the variety of appointment types, developing contingency plans for unusual circumstances, working to adjust demand profiles, and increasing the availability of bottleneck resources. Although these principles are powerful, they are counter to deeply held beliefs and established practices in health care organizations. Adopting these principles requires strong leadership investment and support.

  15. Mars can wait: facing the challenges of our civilization.

    Science.gov (United States)

    Goodman, Geoffrey; Gershwin, M Eric; Bercovich, Dani

    2014-12-01

    We are overwhelmed by warnings about inevitable geophysical and human problems. Earth is beset by escalating, manmade, environmental crises and our exploding population will eventually lack water, food and vital materials. This suggests, together with increasing poverty, deepening social unrest and advanced techniques for mass killing, that civilization will break down long before atmospheric CO2 or resistant microbes become catastrophic. Despite intensive searching, life has not been found in space, even though thousands of planets have been found and life there may be as problematic and unpredictable as on Earth. The human brain is already a 'universe', with 85 billion neurons and a hundred trillion synapses, more than the stars in our galaxy. Understanding consciousness, the brain, its aging and pathologies, and eliminating the propensity for human aggression are urgent challenges. During 1958-2012, NASA spent $800 billion. In contrast, the annual cost of brain disease in the U.S. is $600 billion, more than cardiovascular disease and cancer combined. We suggest that a massive switching of financial and human resources is required to explore the full potential of the human brain. Visiting Mars can wait. We further propose a novel Two-Brain Hypothesis: the animal 'brain' evolved as two fundamentally different though interdependent, complementary organs: one electroionic (tangible, known and accessible), and the other, electromagnetic (intangible and difficult to access)--a relatively independent, stable, structured and functional 3D compendium of variously induced interacting EM fields.

  16. Cholelithiasis in patients on the kidney transplant waiting list

    Directory of Open Access Journals (Sweden)

    André Thiago Scandiuzzi Brito

    2010-01-01

    Full Text Available 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.

  17. 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.

  18. 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.

  19. 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

  20. 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.

  1. 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

  2. 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

    2012-01-01

    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...

  3. 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.

  4. 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.

  5. Wait-time, classroom discourse, and the influence of sociocultural factors in science teaching

    Science.gov (United States)

    Jegede, Olugbemiro J.; Olajide, Janet O.

    Wait-time, a variable related to questioning in a teaching-learning situation, has been found to have implications for the inquiry mode of science teaching especially in Western classroom environments. Aside from the fact that the literature is very sparse in this area about what obtains in developing countries, nothing appears to be available with regard to how wait-time interacts with the sociocultural factors within non-Western science classrooms. In a non-Western country such as Nigeria where most science programs in schools are inquiry-oriented, do teachers take notice of, and effectively use, wait-time in the teaching-learning process? Are science teachers able to effectively use the mediating role of sociocultural factors in science teaching in a traditional environment which expects children to be seen only and not heard? The main purpose of this study was to investigate the wait-time of Nigerian integrated science teachers in relation to the amount of students' participation in inquiry. This study also investigated the relationship between wait-time and sociocultural attitudinal factors prevalent in traditional societies. The instruments used for data collection were the Hough's Observational Schedule and a modified version of the Socio-Cultural Environment Scale (SCES); a stop-watch was used to measure the wait-time of audio-recorded integrated science lessons of 37 integrated science teachers from selected junior secondary schools in Kaduna State, Nigeria. The results showed that the average wait-time TT and wait-time ST of the integrated science teachers was 3.0 seconds and 0.7 seconds, respectively. The study reported the amount of student participation in the student-teacher classroom discourse to be very low. Wait-time was also shown to have a strong relationship with sociocultural factors of authoritarianism, goal structure, societal expectation, and traditional worldview. The pedagogical and curricular implications of the results have been

  6. Mindfulness-based stress reduction for the treatment of irritable bowel syndrome symptoms: a randomized wait-list controlled trial.

    Science.gov (United States)

    Zernicke, Kristin A; Campbell, Tavis S; Blustein, Philip K; Fung, Tak S; Johnson, Jillian A; Bacon, Simon L; Carlson, Linda E

    2013-09-01

    Irritable bowel syndrome (IBS) is a functional disorder of the lower gastrointestinal (GI) tract affected by stress, which may benefit from a biopsychosocial treatment approach such as mindfulness-based stress reduction (MBSR). A treatment as usual (TAU) wait-list controlled trial was conducted in Calgary, Canada to investigate the impact of MBSR on IBS symptoms. It was hypothesized that MBSR patients would experience greater reduction in overall IBS symptom severity and self-reported symptoms of stress relative to control patients. Ninety patients diagnosed with IBS using the Rome III criteria were randomized to either an immediate MBSR program (n = 43) or to wait for the next available program (n = 47). Patients completed IBS symptom severity, stress, mood, quality of life (QOL), and spirituality scales pre- and post-intervention or waiting period and at 6-month follow-up. Intent-to-treat linear mixed model analyses for repeated measures were conducted, followed by completers analyses. While both groups exhibited a decrease in IBS symptom severity scores over time, the improvement in the MBSR group was greater than the controls and was clinically meaningful, with symptom severity decreasing from constantly to occasionally present. Pre- to post-intervention dropout rates of 44 and 23 % for the MBSR and control groups, respectively, were observed. At 6-month follow-up, the MBSR group maintained a clinically meaningful improvement in overall IBS symptoms compared to the wait-list group, who also improved marginally, resulting in no statistically significant differences between groups at follow-up. Improvements in overall mood, QOL, and spirituality were observed for both groups over time. The results of this trial provide preliminary evidence for the feasibility and efficacy of a mindfulness intervention for the reduction of IBS symptom severity and symptoms of stress and the maintenance of these improvements at 6 months post-intervention. Attention and self

  7. Thought Field Therapy Compared to Cognitive Behavioral Therapy and Wait-List for Agoraphobia: A Randomized, Controlled Study with a 12-Month Follow-up

    Science.gov (United States)

    Irgens, Audun C.; Hoffart, Asle; Nysæter, Tor E.; Haaland, Vegard Ø.; Borge, Finn-Magnus; Pripp, Are H.; Martinsen, Egil W.; Dammen, Toril

    2017-01-01

    Background: Thought field therapy (TFT) is used for many psychiatric conditions, but its efficacy has not been sufficiently documented. Hence, there is a need for studies comparing TFT to well-established treatments. This study compares the efficacy of TFT and cognitive behavioral therapy (CBT) for patients with agoraphobia. Methods: Seventy-two patients were randomized to CBT (N = 24), TFT (N = 24) or a wait-list condition (WLC) (N = 24) after a diagnostic procedure including the MINI PLUS that was performed before treatment or WLC. Following a 3 months waiting period, the WL patients were randomized to CBT (n = 12) or TFT (n = 12), and all patients were reassessed after treatment or waiting period and at 12 months follow-up. At first we compared the three groups CBT, TFT, and WL. After the post WL randomization, we compared CBT (N = 12 + 24 = 36) to TFT (N = 12 + 24 = 36), applying the pre-treatment scores as baseline for all patients. The primary outcome measure was a symptom score from the Anxiety Disorders Interview Scale that was performed by an interviewer blinded to the treatment condition. For statistical comparisons, we used the independent sample’s t-test, the Fisher’s exact test and the ANOVA and ANCOVA tests. Results: Both CBT and TFT showed better results than the WLC (p agoraphobia. Trial Registration: https://clinicaltrials.gov/, identifier NCT00932919. PMID:28676782

  8. 'I'm still waiting...': barriers to accessing cardiac rehabilitation services.

    Science.gov (United States)

    Tod, A M; Lacey, E A; McNeill, F

    2002-11-01

    The United Kingdom (UK) National Service Framework for coronary heart disease challenges health services to address existing problems regarding the quality and content of cardiac rehabilitation services. Concern also exists regarding inequalities in access to services. The South Yorkshire Coalfields Health Action Zone (SYCHAZ) funded this study to harness the views and experiences of staff and patients regarding existing services. The intention is to use the information gained to develop acceptable and accessible services for the future. To explore what barriers exist for patients in accessing cardiac rehabilitation services within the South Yorkshire Coalfield locality. Patients were identified and recruited with the assistance of staff responsible for their care. Informed consent was obtained prior to participation. Approval was obtained from the relevant Ethics Committees. Qualitative methods were used, including semi-structured interviews and Framework Analysis techniques. Purposive sampling was used to select participants. Semi-structured individual interviews of 15 staff and 20 postmyocardial infarction patients. One group interview with seven health visitors and two with lay members of heart support groups. Barriers to accessing cardiac rehabilitation. This study revealed a limited service capacity. Big gaps exist between patches of service activity that most patients appear to slip through. Problems in accessing the service were categorized into five themes: absence, waiting, communication, understanding, and appropriateness. Some groups fared worse in terms of access to services, for example women, the elderly and those in traditional working class coalfields communities. Professional and more affluent participants appeared better able to negotiate their way around the system by seeking out advice or 'going private'. The omission of medical staff and ethnic minority patients. Cardiac rehabilitation in the policy targets in UK will only be met with

  9. Don't stop the clock: manipulating hospital waiting lists.

    Science.gov (United States)

    Buchanan, David A; Storey, John

    2010-01-01

    This paper aims to explore the theoretical and practical management implications of a case involving the falsification of hospital patient waiting lists for elective orthopaedic surgery. This case study is based on qualitative schedule-structured interviews with 20 senior hospital staff (managerial and clinical), including the head of the investigation team, downloads from the hospital website, and internal hospital documentation. Those data were used to construct an event narrative exploring the underlying causes and implications of the incident. The blame for misconduct pointed at three surgeons, a senior manager, a general manager, an assistant general manager, one administrative staff member, and several organizational factors. In addition to censuring some of those involved, an investigation recommended changes to training and working practices, policies and procedures, governance arrangements, and organization culture, and led to an external evaluation of the hospital board. However, one year later, another similar incident occurred. This is a single case, and events are viewed through a management lens, the individuals concerned being protected by research ethics considerations. By detailing the sequence of events, surrounding conditions, and the reactions of multiple players, this analysis reveals typified responses to incidents of this kind, and the limitations inherent in post-event investigations. If the benefits derived from national targets are to be realized in a manner which commands support from staff at all levels, then greater attention should be paid by managers and regulators to issues of transparency, responsiveness, and honesty. As core dimensions of good governance, managers must be accountable for helping to meet targets, and also for tracking how targets are met, ensuring that resources are made available, and that problematic issues raised are promptly and effectively addressed. Studies of organizational misbehaviour are rare in healthcare

  10. Extinction and anti-extinction: the "attentional waiting" hypothesis.

    Science.gov (United States)

    Watling, Rosamond; Danckert, James; Linnell, Karina J; Cocchini, Gianna

    2013-03-01

    Patients with visual extinction have difficulty detecting a single contralesional stimulus when a second stimulus is simultaneously presented on the ipsilesional side. The rarely reported phenomenon of visual anti-extinction describes the opposite behavior, in which patients show greater difficulty in reporting a stimulus presented in isolation than they do in reporting 2 simultaneously presented stimuli. S. J. Goodrich and R. Ward (1997, Anti-extinction following unilateral parietal damage, Cognitive Neuropsychology, Vol. 14, pp. 595-612) suggested that visual anti-extinction is the result of a task-specific mechanism in which processing of the ipsilesional stimulus facilitates responses to the contralesional stimulus; in contrast, G. W. Humphreys, M. J. Riddoch, G. Nys, and D. Heinke (2002, Transient binding by time: Neuropsychological evidence from anti-extinction, Cognitive Neuropsychology, Vol. 19, pp. 361-380) suggested that temporal binding groups contralesional and ipsilesional stimuli together at brief exposure durations. We investigated extinction and anti-extinction phenomena in 3 brain-damaged patients using an extinction paradigm in which the stimulus exposure duration was systematically manipulated. Two patients showed both extinction and anti-extinction depending on the exposure duration of stimuli. Data confirmed the crucial role of duration in modulating the effect of extinction and anti-extinction. However, contrary to Humphreys and colleagues' (2002) single case, our patients showed extinction for short and anti-extinction for long exposure durations, suggesting that different mechanisms might underlie our patients' pattern of data. We discuss a novel "attentional waiting" hypothesis, which proposes that anti-extinction may be observed in patients showing extinction if the exposure duration of stimuli is increased. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  11. Cardiac evaluation in pediatric patients waiting for liver transplantation

    Directory of Open Access Journals (Sweden)

    Seyed Mohsen Dehghani, Naser Honar, Hamid Amoozegar, Ahad Eshraghian, Mohammad Borzooei, Mohammad Hadi Imanieh, Seyed Ali Malek-Hosseini

    2010-01-01

    Full Text Available Background: Cardiovascular abnormalities are among common complication in patients with cirrhosis waiting for liver transplantation (LT. The aim of the present study was to investigate cardiac abnormalities among pediatric liver transplant candidates.Methods: We prospectively evaluated the pediatric patient aged less than 18 years listed for LT between 2006 and 2008. Besides history taking and physical examination all the patients underwent electrocardiogram, chest radiograph, contrast echocardiography and color Doppler echocardiography, as well as arterial blood gas analyses.Results: Totally 89 patients with mean age of 8.1±4.6 years were included in the study. The most common causes for liver disease were cryptogenic cirrhosis followed by biliary atresia and autoimmune cirrhosis. Clubbing was found in 27 out of 89 patients and was the most common abnormalities in physical examination. In 22 patients (24.7% heart murmur was heard by a pediatric cardiologist. Sixty nine patients (77.5% had normal cardiac findings in chest radiograph. Cardiomegaly was found in 17 (19.1% patients as the most common abnormal finding in chest radiograph. Electrocardiogram showed sinus tachycardia in 16 (18% patients. Eleven patients (12.4% had tricuspid regurgitation as the most common abnormal findings in echocardiography. Thirteen (14.6% patients had positive contrast echocardiography in favor of intrapulmonary shunt.Conclusion: As the leading cause of post transplant death after graft rejection are cardiovascular complications cardiac evaluation should be considered in all pediatric patients before LT to lower morbidity and mortality during and after transplantation.

  12. Does rapid HIV testing result in an early diagnosis and reduce the waiting time for patients to receive medical care?

    Science.gov (United States)

    Melo, Magaly Carvalho Vieira de; Ximenes, Ricardo Arraes de Alencar; Falcão, Ilka Veras; Miranda-Filho, Demócrito de Barros

    2018-01-01

    The implementation of rapid HIV testing in Brazil began in 2006 for specific groups, and from 2009 was extended to the Counseling and Testing Centers (CTC) in certain Brazilian capitals. The aim of this study was to compare two groups of individuals: those diagnosed with HIV infection by conventional testing and those diagnosed with rapid testing, with respect to: the waiting time before receiving medical care, the time of the first laboratory tests and the virological, immune and clinical status. This is a cross-sectional study to compare a group with individuals diagnosed by conventional testing (2006-2008) and another with those diagnosed by rapid testing (2010-2011).The median time between blood collection and diagnosis of HIV in the conventional test group was 76 days, while in the rapid test group 94.2% of the subjects received their results on the same day of blood collection (p test group, the median period of time before the first consultation with an infectious disease specialist was 99 days, and for the rapid test group the time was 14 days (p test group (p test group (472) was higher than in the conventional test group (397) (p = 0.01). The introduction of rapid HIV testing as a diagnostic strategy has reduced the waiting times for medical care and laboratory tests and also allowed earlier diagnosis of HIV infection than with the conventional test.

  13. Seasonality of service provision in hip and knee surgery: A possible contributor to waiting times? A time series analysis

    Directory of Open Access Journals (Sweden)

    Upshur Ross EG

    2006-03-01

    Full Text Available Abstract Background The question of how best to reduce waiting times for health care, particularly surgical procedures such as hip and knee replacements is among the most pressing concern of the Canadian health care system. The objective of this study was to test the hypothesis that significant seasonal variation exists in the performance of hip and knee replacement surgery in the province of Ontario. Methods We performed a retrospective, cross-sectional time series analysis examining all hip and knee replacement surgeries in people over the age of 65 in the province of Ontario, Canada between 1992 and 2002. The main outcome measure was monthly hospitalization rates per 100 000 population for all hip and knee replacements. Results There was a marked increase in the rate of hip and knee replacement surgery over the 10-year period as well as an increasing seasonal variation in surgeries. Highly significant (Fisher Kappa = 16.05, p 2Autoreg = 0.85 seasonality was identified in the data. Conclusion Holidays and utilization caps appear to exert a significant influence on the rate of service provision. It is expected that waiting times for hip and knee replacement could be reduced by reducing seasonal fluctuations in service provision and benchmarking services to peak delivery. The results highlight the importance of system behaviour in seasonal fluctuation of service delivery.

  14. Wait watchers. Smart organizations are demonstrating that while they can't erase ED wait times, they can leverage technology to keep patients better informed.

    Science.gov (United States)

    Gamble, Kate Huvane

    2010-04-01

    Increases in ED visits are significantly affecting patient access, quality, cost and care management--a trend that is expected to continue. A number of organizations are dealing with the increased demand for services by implementing technologies to keep patients better informed of wait times. Publishing ED wait times online offers hospitals a way to communicate information to patients quickly without requiring a significant investment from the IT staff. Hospitals are also utilizing visibility boards to keep both patients and staff updated on patient conditions and room status.

  15. 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.

  16. Application of a Quality Control Circle to Reduce the Wait Times between Continuous Surgeries.

    Science.gov (United States)

    Zhang, Hairong; Wang, Li; Cai, Yueye; Ye, Ronghua; Lin, Jingyi; Jiang, Dongdong

    2015-06-01

    To investigate how to shorten patient wait times between continuous ocular operations and to evaluate the influence of a quality control circle (QCC) on operating room management. QCC management was established to conduct activities. Clinical data were collected to analyze the causes of long wait times between continuous surgeries. Effective measures were undertaken correspondingly. The staff from QCC actively undertook measures that would significantly shorten patient wait times between continuous ocular surgeries (P < 0.05). Multiple measures, such as setting up a QCC, enhancing the arrangement of surgical procedures, establishing effective communication channels, optimizing human resources, and integrating the use of instruments, can effectively shorten patient wait times between continuous vitreous or retinal surgeries.

  17. 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...

  18. Study on the interaction between the food and beverage servicescape and customer waiting experience

    National Research Council Canada - National Science Library

    Yang, Chih-Yun

    2014-01-01

    .... 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...

  19. Continuous time random walk with generic waiting time and external force.

    Science.gov (United States)

    Fa, Kwok Sau; Wang, K G

    2010-05-01

    We derive an integrodifferential diffusion equation for decoupled continuous time random walk that is valid for a generic waiting time probability density function and external force. Using this equation we also study diffusion behaviors for a couple of specific waiting time probability density functions such as exponential, a combination of power law and generalized Mittag-Leffler function and a sum of exponentials under the influence of a harmonic trap. We show that first two waiting time probability density functions can reproduce the results of the ordinary and fractional diffusion equations for all the time regions from small to large times. But the third one shows a much more complicated pattern. Furthermore, from the integrodifferential diffusion equation we show that the second Einstein relation can hold for any waiting time probability density function.

  20. 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...

  1. Gender Disparity in Liver Transplant Waiting List Mortality: The Importance of Kidney Function

    Science.gov (United States)

    Mindikoglu, Ayse L.; Regev, Arie; Seliger, Stephen L.; Magder, Laurence S.

    2011-01-01

    Previous studies of men and women on the liver transplant (LT) waiting list suggested a higher risk of mortality for women while on the waiting list without taking transplantation rates into account. The objective of this study was to compare men and women with respect of dying within three years of registration on the LT waiting list taking into account both the immediate mortality risks and transplantation rates. The analysis was based on Organ Procurement and Transplantation Network data of patients with End-Stage Liver Disease (ESLD) on the waiting list registered between February 2002 and August 2009. Competing risk survival analysis was performed to assess gender disparity in waiting list mortality. 42,322 patients and 610,762 person-months of waiting list experience were included in the analysis. The risk of dying within three years of listing was 19% and 17% in women and men, respectively (P<0.0001). Among patients with kidney disease, especially those with estimated glomerular filtration rate (eGFR) ≥ 15 and < 30 ml/min/1.73m2, not on dialysis, women had a substantially higher risk of dying on the waiting list within three years of registration than men (26% vs. 20%, P=0.001). This disparity was related to lower transplantation rates in women; (transplantation rate ratio=0.68, P<0.0001). Controlling for eGFR and other variables related to mortality risk, the overall female-male disparity disappeared. In conclusion, among patients with ESLD with kidney dysfunction, not on dialysis, there is a substantial gender disparity in LT waiting list mortality. Our analysis suggests that this is explained by the fact that, in this group, women had lower transplant rates than men. The lower transplant rates can be explained, in part, by the fact that MELD scores tend to be lower for women than for men as they are based on serum creatinine rather than GFR. PMID:20879013

  2. Radiotherapy waiting times for women with breast cancer: a population-based cohort study.

    OpenAIRE

    Jack, RH; Davies, EA; Robinson, D; Sainsbury, R.; Moller, H.

    2007-01-01

    Abstract Background Waiting times for cancer patients are a national priority in the UK. Previous studies have shown variation between cancer networks in the time between diagnosis and start of radiotherapy for all cancer patients. Studies of the relationship between delay in receiving treatment and survival of breast cancer patients have been inconsistent. This study aimed to examine factors associated with waiting times for radiotherapy for breast cancer patients. Methods 35,354 women resid...

  3. Radiotherapy waiting times for women with breast cancer: a population-based cohort study

    OpenAIRE

    Jack, R H; Davies, E A; Robinson, D; Sainsbury, R.; Møller, H

    2007-01-01

    Background: Waiting times for cancer patients are a national priority in the UK. Previous studies have shown variation between cancer networks in the time between diagnosis and start of radiotherapy for all cancer patients. Studies of the relationship between delay in receiving treatment and survival of breast cancer patients have been inconsistent. This study aimed to examine factors associated with waiting times for radiotherapy for breast cancer patients. Methods: 35,354 women r...

  4. 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 ha...... 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....

  5. 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...... and umbilical/epigastric hernias. CONCLUSIONS: Watchful waiting appears to be a safe strategy in the treatment of incisional, umbilical and epigastric hernias....

  6. 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.

  7. 'He Thinks He's Entangled in a Net': the Web of Continental Associations in Waiting for Godot

    Directory of Open Access Journals (Sweden)

    Amy Burnside

    2011-01-01

    Full Text Available 'He Thinks He's Entangled in a Net': the Web of Continental Associations in Waiting for Godot Amy Burnside, Queen's University BelfastFollow Recommended Citation Burnside, Amy (2013 "'He Thinks He's Entangled in a Net': the Web of Continental Associations in Waiting for Godot," Journal of Franco-Irish Studies: Vol. 3: Iss. 1, Article 7. Available at: http://arrow.dit.ie/jofis/vol3/iss1/7

  8. Period Variations of RT Persei

    Directory of Open Access Journals (Sweden)

    Chun-Hwey Kim

    1995-12-01

    Full Text Available RT Per has been known as a close binary of which the orbital period has unpredictably varied so far. Although there are no agreements with the working mechanism for the changes of the period, two interpretations have been suggested and waiting for to be tested: 1light-time effects due to the unseen 3rd and 4th bodies (Panchatsaram 1981, 2Abrupt period-change due to internal variations of the system(e.q. mass transfer or mass loss superimposing to the light-times effect by a 3rd body (Frieboes-Conde & Herczeg 1973. In the point of view that the former interprepation models could predict the behavior of the changes of the orbital period theoretically, we checked whether the recent observed times of minimum lights follow the predictions by the first model or not. We confirmed that the observed times of minimum lights have followed the variations calculated by the light-times effects due to 3rd and 4th bodies suggested by Panchatsaram. In this paper a total of 626 times of minimum lights were reanalyzed in terms of the light-time effects by the 3rd and 4th bodies. We concluded that the eclipsing pair in SV Cam system moves in an elliptic orbit about center of mass of the triple system with a period of about 42.y2, while the mass center of the triplet is in light-time orbit about the center of mass of the quadruple system with a period of 120y. The mean masses deduced for the 3rd and 4th bodies were 0.89m⨀ and 0.82m⨀, respectively.

  9. The experience of waiting and life during breast cancer follow-up.

    Science.gov (United States)

    Gaudine, Alice; Sturge-Jacobs, Marilyn; Kennedy, Mary

    2003-01-01

    Much research exists on quality of life issues with breast cancer survivors. However, there has been little done on the waiting experience itself, and on the experience of follow-up from the women's perspective. Women who have been diagnosed and treated for breast cancer live with the condition for a minimum of 5 years, waiting for the next medical intervention; waiting for the next battery of tests; waiting for the next physician check-up. Throughout most of these years they may feel healthy, but they experience visits to cancer clinics, medical testing, and physician interactions. Women's accounts of their experiences of waiting and life during follow-up for breast cancer has not been the focus of research on the quality of life of breast cancer survivors. In particular research that uses a qualitative approach, in which women recount their experiences in their own language, has been missing. This study used a phenomenological approach, telling the stories of waiting and life throughout follow-up of nine women. The women's experiences are captured in four themes: life-changing; a sense of belonging; uncertainty; needing to know.

  10. Scaling laws of ambush predator 'waiting' behaviour are tuned to a common ecology.

    Science.gov (United States)

    Wearmouth, Victoria J; McHugh, Matthew J; Humphries, Nicolas E; Naegelen, Aurore; Ahmed, Mohammed Z; Southall, Emily J; Reynolds, Andrew M; Sims, David W

    2014-05-07

    The decisions animals make about how long to wait between activities can determine the success of diverse behaviours such as foraging, group formation or risk avoidance. Remarkably, for diverse animal species, including humans, spontaneous patterns of waiting times show random 'burstiness' that appears scale-invariant across a broad set of scales. However, a general theory linking this phenomenon across the animal kingdom currently lacks an ecological basis. Here, we demonstrate from tracking the activities of 15 sympatric predator species (cephalopods, sharks, skates and teleosts) under natural and controlled conditions that bursty waiting times are an intrinsic spontaneous behaviour well approximated by heavy-tailed (power-law) models over data ranges up to four orders of magnitude. Scaling exponents quantifying ratios of frequent short to rare very long waits are species-specific, being determined by traits such as foraging mode (active versus ambush predation), body size and prey preference. A stochastic-deterministic decision model reproduced the empirical waiting time scaling and species-specific exponents, indicating that apparently complex scaling can emerge from simple decisions. Results indicate temporal power-law scaling is a behavioural 'rule of thumb' that is tuned to species' ecological traits, implying a common pattern may have naturally evolved that optimizes move-wait decisions in less predictable natural environments.

  11. Improvement of Waiting Time for Patients Referring to Emergency Room Using Discrete Event Simulation

    Directory of Open Access Journals (Sweden)

    Y Zare Mehrjardi

    2011-07-01

    Full Text Available Introduction: Many simulation studies have been conducted in the hospitals and first in the emergency departments to increase the productivity. The first issue in the field of service quality and hence the patient right is “waiting time”. The goal of this study was to reduce patients waiting times, emergency service timing, modeling and improving using discrete event simulation. Methods: This was a descriptive - analytical study by the cross-sectional method on 150 patients referred to the emergency department in a public hospital. All necessary data were collected using questionnaire and through observation. Simulation model was designed using Arena software. Results: Our computer simulation model indicates that the maximum waiting time is the time waited for the test request till the results are received by the MD and also the time is necessary for the consultation and examination purposes. Among the five different scenarios, alternative 5 is more interesting economically since it requires only three additional staffs to bring down waiting times. Conclusion: According to research results, to reduce patient waiting time, the Triage processing in the emergency departments and the employment of emergency medicine expert, and the ordering of the diagnostic processes in the early stages of treatment as such as laboratory ordering for emergency patients are of main necessity.

  12. [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.

  13. Waiting times for surgical and diagnostic procedures in public hospitals in Mexico.

    Science.gov (United States)

    Contreras-Loya, David; Gómez-Dantés, Octavio; Puentes, Esteban; Garrido-Latorre, Francisco; Castro-Tinoco, Manuel; Fajardo-Dolci, Germán

    2015-01-01

    A retrospective evaluation of waiting times for elective procedures was conducted in a sample of Mexican public hospitals from the following institutions: the Mexican Institute for Social Security (IMSS), the Institute for Social Security and Social Services for Civil Servants (ISSSTE) and the Ministry of Health (MoH). Our aim was to describe current waiting times and identify opportunities to redistribute service demand among public institutions. We examined current waiting times and productivity for seven elective surgical and four diagnostic imaging procedures, selected on the basis of their relative frequency and comparability with other national health systems. Mean waiting time for the seven surgical procedures in the three institutions was 14 weeks. IMSS and ISSSTE hospitals showed better performance (12 and 13 weeks) than the MoH hospitals (15 weeks). Mean waiting time for the four diagnostic procedures was 11 weeks. IMSS hospitals (10 weeks) showed better average waiting times than ISSSTE (12 weeks) and MoH hospitals (11 weeks). Substantial variations were revealed, not only among institutions but also within the same institution. These variations need to be addressed in order to improve patient satisfaction.

  14. Waiting times for surgical and diagnostic procedures in public hospitals in Mexico

    Directory of Open Access Journals (Sweden)

    David Contreras-Loya

    2015-01-01

    Full Text Available Objective. A retrospective evaluation of waiting times for elective procedures was conducted in a sample of Mexican public hospitals from the following institutions: the Mexican Institute for Social Security (IMSS, the Institute for Social Security and Social Services for Civil Servants (ISSSTE and the Ministry of Health (MoH. Our aim was to describe current waiting times and identify opportunities to redistribute service demand among public institutions. Materials and methods. We examined current waiting times and productivity for seven elective surgical and four diagnostic imaging procedures, selected on the basis of their relative frequency and comparability with other national health systems. Results. Mean waiting time for the seven surgical procedures in the three institutions was 14 weeks. IMSS and ISSSTE hospitals showed better performance (12 and 13 weeks than the MoH hospitals (15 weeks. Mean waiting time for the four diagnostic procedures was 11 weeks. IMSS hospitals (10 weeks showed better average waiting times than ISSSTE (12 weeks and MoH hospitals (11 weeks. Conclusion. Substantial variations were revealed, not only among institutions but also within the same institution. These variations need to be addressed in order to improve patient satisfaction.

  15. 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.

  16. 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.

  17. Reasons military patients with primary care access leave an emergency department waiting room before seeing a provider.

    Science.gov (United States)

    Varney, Shawn M; Vargas, Toni E; Pitotti, Rebecca L; Bebarta, Vikhyat S

    2012-10-01

    Our objective was to assess patients' understanding of emergency department (ED) wait times and why patients may leave the waiting room before seeing a provider. Survey of patients in the ED waiting room of an urban tertiary care military hospital where civilian and military patients are treated. A total of 508/517 surveys (98%) were completed. Age ranges were 18 to 35 years (49%), 36 to 60 (31%), or older than 60 (20%). Education levels were high school (20%), some college (37%), or college graduate (39%). Of 503 respondents, 125 (25%) had left an ED waiting room before seeing a provider. The reasons included excessive wait times (91%) and family responsibilities (5%). Five hundred eight reported the factors that would motivate them to wait to see the physician (not leave without being seen [LWOBS]) were the severity of illness (64%), and if they received an update of wait times (26%); 82% (391/480) understood that severely ill patients were seen first. Patients attributed long wait times to doctors and nurses caring for other patients (292/583, 50%) and insufficient physician and nurse staffing (245, 42%). Of 802 responses for ideas to improve the wait, 34% said regular updates on estimated wait times, 21% said television shows or movies to view, 20% said books and magazines to read, and 11% said computers to access. Long wait times were the primary reason that patients left before seeing a provider, despite having ready access to care. Respondents attributed long wait times to patient volume and inadequate staffing. Regular updates on wait times and material for entertainment may improve the waiting experience and reduce LWOBS.

  18. Not all waits are equal: an exploratory investigation of emergency care patient pathways.

    Science.gov (United States)

    Swancutt, Dawn; Joel-Edgar, Sian; Allen, Michael; Thomas, Daniel; Brant, Heather; Benger, Jonathan; Byng, Richard; Pinkney, Jonathan

    2017-06-24

    Increasing pressure in the United Kingdom (UK) urgent care system has led to Emergency Departments (EDs) failing to meet the national requirement that 95% of patients are admitted, discharged or transferred within 4-h of arrival. Despite the target being the same for all acute hospitals, individual Trusts organise their services in different ways. The impact of this variation on patient journey time and waiting is unknown. Our study aimed to apply the Lean technique of Value Stream Mapping (VSM) to investigate care processes and delays in patient journeys at four contrasting hospitals. VSM timing data were collected for patients accessing acute care at four hospitals in South West England. Data were categorised according to waits and activities, which were compared across sites to identify variations in practice from the patient viewpoint. We included Public and Patient Involvement (PPI) to fully interpret our findings; observations and initial findings were considered in a PPI workshop. One hundred eight patients were recruited, comprising 25,432 min of patient time containing 4098 episodes of care or waiting. The median patient journey was 223 min (3 h, 43 min); just within the 4-h target. Although total patient journey times were similar between sites, the stage where the greatest proportion of waiting occurred varied. Reasons for waiting were dominated by waits for beds, investigations or results to be available. From our sample we observed that EDs without a discharge/clinical decision area exhibited a greater proportion of waiting time following an admission or discharge decision. PPI interpretation indicated that patients who experience waits at the beginning of their journey feel more anxious because they are 'not in the system yet'. The novel application of VSM analysis across different hospitals, coupled with PPI interpretation, provides important insight into the impact of care provision on patient experience. Measures that could reduce patient

  19. Emergency department waiting times: Do the raw data tell the whole story?

    Science.gov (United States)

    Green, Janette; Dawber, James; Masso, Malcolm; Eagar, Kathy

    2014-02-01

    To determine whether there are real differences in emergency department (ED) performance between Australian states and territories. Cross-sectional analysis of 2009-10 attendances at an ED contributing to the Australian non-admitted patient ED care database. The main outcome measure was difference in waiting time across triage categories. There were more than 5.8 million ED attendances. Raw ED waiting times varied by a range of factors including jurisdiction, triage category, geographic location and hospital peer group. All variables were significant in a model designed to test the effect of jurisdiction on ED waiting times, including triage category, hospital peer group, patient socioeconomic status and patient remoteness. When the interaction between triage category and jurisdiction entered the model, it was found to have a significant effect on ED waiting times (P<0.001) and triage was also significant (P<0.001). Jurisdiction was no longer statistically significant (P=0.248 using all triage categories and 0.063 using only Australian Triage Scale 2 and 3). Although the Council of Australian Governments has adopted raw measures for its key ED performance indicators, raw waiting time statistics are misleading. There are no consistent differences in ED waiting times between states and territories after other factors are accounted for. WHAT IS KNOWN ABOUT THE TOPIC? The length of time patients wait to be treated after presenting at an ED is routinely used to measure ED performance. In national health agreements with the federal government, each state and territory in Australia is expected to meet waiting time performance targets for the five ED triage categories. The raw data indicate differences in performance between states and territories. WHAT DOES THIS PAPER ADD? Measuring ED performance using raw data gives misleading results. There are no consistent differences in ED waiting times between the states and territories after other factors are taken into account

  20. Prior knowledge and entrepreneurial innovative success

    OpenAIRE

    Cantner, Uwe; Goethner, Maximilian; Meder, Andreas

    2007-01-01

    This paper is concerned with the relationship between innovative success of entrepreneurs and their prior knowledge at the stage of firm formation. We distinguish between different kinds of experience an entrepreneur can possess and find evidence that the innovative success subsequent to firm formation is enhanced by entrepreneur’s prior technological knowledge but not by prior market and organizational knowledge. Moreover we find that prior technological knowledge gathered through embeddedne...

  1. Experimental Evidence on Valuation with Multiple Priors

    NARCIS (Netherlands)

    Qiu, J.; Weitzel, G.U.

    2016-01-01

    Popular models for decision making under ambiguity assume that people use not one but multiple priors. This paper is a first attempt to experimentally elicit the min and the max of multiple priors directly. In an ambiguous scenario we measure a participant’s single prior, her min and max of multiple

  2. Asymptotically informative prior for Bayesian analysis

    NARCIS (Netherlands)

    Yuan, A.; de Gooijer, J.G.

    2011-01-01

    In classical Bayesian inference the prior is treated as fixed, it is asymptotically negligible, thus any information contained in the prior is ignored from the asymptotic first order result. However, in practice often an informative prior is summarized from previous similar or the same kind of

  3. Integrating prior knowledge and structure from motion

    DEFF Research Database (Denmark)

    Guilbert, Nicolas; Aanæs, Henrik; Larsen, Rasmus

    2001-01-01

    A new approach for formulating prior knowledge in structure form motion is presented, where the structure is viewed as a 3D stochastic variable, hereby priors are more naturally expressed. It is demonstrated that this formulation is efficient for regularizing structure reconstruction via prior...

  4. The experience of waiting for a kidney transplant: A qualitative study.

    Science.gov (United States)

    Burns, Tania; Fernandez, Ritin; Stephens, Moira

    2017-12-01

    In Australia over 1100 people are living on dialysis while waiting for a kidney transplant from a deceased donor. Worldwide there are an estimated 170,000 people who wait an average of three years before an organ becomes available. To provide an understanding of the lived experience of people waiting on dialysis for a kidney transplant from a deceased donor. A qualitative descriptive research design was used. Participants were recruited from a large metropolitan hospital. Two focus groups were conducted with six participants ranging in age from 29-63 years, with dialysis experience of 10-72 months. Data saturation was achieved and thematic analysis was used to interpret the data providing a descriptive account of the experience of waiting for a kidney transplant. Waiting for a kidney transplant takes place in the context of living on dialysis. Four main themes were identified: living on dialysis is physically and mentally demanding; living with uncertainty; altered relationship dynamics; and feelings towards the deceased donor. This study provides a descriptive summary of what it is like to live on dialysis while waiting for a kidney transplant from a deceased donor from the perspective of the person waiting. People are burdened by; uncertainty; the experience of the dialysis therapy; and the thought of the human cost of transplantation. These findings suggest that this cohort may benefit from strategies to relieve uncertainty such as effective communication from the treating team and peer support from the dialysis community. © 2017 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  5. List and liver transplant survival according to waiting time in patients with hepatocellular carcinoma.

    Science.gov (United States)

    Salvalaggio, P R; Felga, G; Axelrod, D A; Della Guardia, B; Almeida, M D; Rezende, M B

    2015-03-01

    The time that patients with hepatocellular carcinoma (HCC) can safely remain on the waiting list for liver transplantation (LT) is unknown. We investigated whether waiting time on the list impacts transplant survival of HCC candidates and transplant recipients. This is a single-center retrospective study of 283 adults with HCC. Patients were divided in groups according to waiting-list time. The main endpoint was survival. The median waiting time for LT was 4.9 months. The dropout rates at 3-, 6-, and 12-months were 6.4%, 12.4%, and 17.7%, respectively. Mortality on the list was 4.8%, but varied depending of the time on the list. Patients who waited less than 3-months had an inferior overall survival when compared to the other groups (p = 0.027). Prolonged time on the list significantly reduced mortality in this analysis (p = 0.02, HR = 0.28). Model for End Stage Liver Disease (MELD) score at transplantation did also independently impact overall survival (p = 0.03, HR = 1.06). MELD was the only factor that independently impacted posttransplant survival (p = 0.048, HR = 1.05). We conclude that waiting time had no relation with posttransplant survival. It is beneficial to prolong the waiting list time for HCC candidates without having a negative impact in posttransplant survival. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

  6. 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.

  7. Activation of dorsal raphe serotonin neurons is necessary for waiting for delayed rewards.

    Science.gov (United States)

    Miyazaki, Kayoko W; Miyazaki, Katsuhiko; Doya, Kenji

    2012-08-01

    The forebrain serotonergic system is a crucial component in the control of impulsive behaviors. We previously reported that the activity of serotonin neurons in the midbrain dorsal raphe nucleus increased when rats performed a task that required them to wait for delayed rewards. However, the causal relationship between serotonin neural activity and the tolerance for the delayed reward remained unclear. Here, we test whether the inhibition of serotonin neural activity by the local application of the 5-HT(1A) receptor agonist 8-hydroxy-2-(di-n-propylamino) tetralin in the dorsal raphe nucleus impairs rats' tolerance for delayed rewards. Rats performed a sequential food-water navigation task that required them to visit food and water sites alternately via a tone site to get rewards at both sites after delays. During the short (2 s) delayed reward condition, the inhibition of serotonin neural activity did not significantly influence the numbers of reward choice errors (nosepoke at an incorrect reward site following a conditioned reinforcer tone), reward wait errors (failure to wait for the delayed rewards), or total trials (sum of reward choice errors, reward wait errors, and acquired rewards). By contrast, during the long (7-11 s) delayed reward condition, the number of wait errors significantly increased while the numbers of total trials and choice errors did not significantly change. These results indicate that the activation of dorsal raphe serotonin neurons is necessary for waiting for long delayed rewards and suggest that elevated serotonin activity facilitates waiting behavior when there is the prospect of forthcoming rewards.

  8. Satisfacción de las mujeres con la duración del proceso de valoración adicional en el cribado mamográfico Women's satisfaction with waiting times for further investigation in breast cancer screening

    Directory of Open Access Journals (Sweden)

    Ana Molina-Barceló

    2011-10-01

    Full Text Available Objetivos: Conocer los factores asociados a la satisfacción con la duración del proceso de valoración adicional en el cribado mamográfico. Métodos: Estudio transversal descriptivo y multivariado mediante encuesta telefónica a una muestra representativa de mujeres (N=316 participantes en el Programa de Prevención del Cáncer de Mama de la Comunidad Valenciana, que requirieron valoración adicional mediante pruebas complementarias para confirmar el diagnóstico. Análisis descriptivo mediante tablas de contingencia (pObjectives: To determine the factors associated with satisfaction with waiting times for further investigation in breast cancer screening. Methods: We carried out a cross-sectional study by telephone survey of a representative sample of women (N=316 participating in the breast cancer screening program of the autonomous region of Valencia (Spain who required additional tests to confirm the diagnosis. Descriptive analysis was performed by contingency tables (p<0.05 and multivariate association by odds ratios (OR of logistic regression models (95%CI. Results: Satisfaction with the waiting time was 78.6%. A higher risk of dissatisfaction was found in women from a "high" social class (OR=3.17; 95% CI: 1.10-9.14, those who perceived that the waiting time was "more than 2 weeks", both "since the notification of the need for further investigation until completion of the first test" (OR=15,54; 95%CI: 5,87-41,12 and "since the completion of the last test until notification of the final result" (OR=11.57; 95% CI: 2.96-45.19, and in women who experienced the attention as "worse than expected" (OR=15.40; 95% CI: 1.41-168.64. The maximum waiting time acceptable to the highest percentage of women was "up to 1 week" for each waiting period (n=47, 73.5%; n=14, 45.2%. Conclusions: Waiting times of no more than 1 week and never more than 2 weeks for each waiting period are recommended. Women should be given an approximate waiting time, paying

  9. 75 FR 41201 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2010-07-15

    .... Stubblefield, III. G Controls Southeast, Inc. 20100720 G Veraz Networks, Inc. G Dialogic Corporation. G... Kettering Health Network. G Fort Hamilton Hospital Holding Company. G Fort Hamilton Hospital. 20100775 G The..., Inc. G Independence Renewable Energy Corp. G Alabama River Chip Mills, Inc. 20100787 G Terteling...

  10. 75 FR 4561 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2010-01-28

    ... Anchors, Inc. G Zest Anchors, Inc. 22-DEC-09 20100095 G Agrium Inc. G CF Industries Holdings, Inc. G CF....P. G CHS Private Equity V LP. G Suture Express Holdings, Inc. 20100295 G Valero Energy Corporation...

  11. 78 FR 76146 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2013-12-16

    .... 20140114 G Oracle Corporation; BigMachines Holdings, Inc.; Oracle Corporation. 20140120 G Regency Energy... Charlie AIV, L.P.; Forest Oil Corporation; FR XII Charlie AIV, L.P. 20140094 G Joselito D. Campos, Jr... Holdings Corporation; Covidien plc; Integra LifeSciences Holdings Corporation. 20140109 G Toray Industries...

  12. 78 FR 17207 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2013-03-20

    ... Fund VIII, L.P. 20130588 G Oracle Corporation; Acme Packet, Inc.; Oracle Corporation. 20130594 G... 02/01/2013 20130419 G NCR Corporation; Retalix Ltd.; NCR Corporation. 20130471 G Sun Pharmaceutical... Trust. 20130523 G Parkland Fuel Corporation; AvenEx Energy Corp.; Parkland Fuel Corporation. 20130533 G...

  13. 75 FR 69666 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2010-11-15

    ... Cellular Limited Partnership. G Michigan RSA 9 Limited Partnership. 20101199 G Green Plains Renewable..., Inc. G Green Mountain Energy Company. G Green Mountain Energy Company. 20101204 G Plains Exploration... Apollo Hamlet Holdings, LLC. G Hamlet Holdings LLC. G Harrahs Entertainment, Inc. 20110059 G Co-Invest...

  14. 75 FR 65632 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2010-10-26

    ... 20101032 G Hewlett-Packard Company. ] G Fortify Software, Inc. G Fortify Software, Inc. 20101047 G.... 20101124 G Taleo Corporation. G James Barrett Riley. G Learn.com , Inc. 20101130 G Targa Resources Partners... Brands Holdings, Inc. 20101156 G Clayton, Dubilier & Rice Fund VIII, L.P. G Ulysses Participation S.a.r.l...

  15. 78 FR 35931 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2013-06-14

    ...; Eastman Kodak Company; Eastman Kodak Company. 05/28/2013 20130871 G Elon Musk; Tesla Motors, Inc.; Elon Musk. 05/29/2013 20130825 G RoundTable Healthcare Partners III, L.P.; GlaxoSmithKline plc; RoundTable...

  16. 76 FR 49481 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2011-08-10

    ... International, L.P.; Gerber Scientific, Inc., Vector Capital IV International, L.P. 20111044 G Elon Musk; SolarCity Corporation; Elon Musk. 07/06/2011 20111047 G Golden Gate Capital Opportunity Fund, L.P.; EPMC...

  17. 77 FR 22318 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2012-04-13

    ... Corporation; The AES Corporation; PPL Corporation. 03/09/2012 20120540 G Elon Musk; SolarCity Corporation; Elon Musk. 20120572 G Grupo Elelctra, S.A.B. de C.V.; Advance America, Cash Advance Centers, Inc...

  18. 75 FR 53699 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2010-09-01

    ... G Patterson-UTI Energy, Inc. G Key Energy Services, Inc. G Key Energy Pressure Pumping Services, LLC. G Key Electric Wireline Services, LLC. 20100924 G Thomas H. Lee Equity Fund VI, LP. G Parthenon...Star Biotech, Inc. [[Page 53700

  19. 75 FR 60750 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2010-10-01

    ... Key Energy Services, Inc. 20100983 G Tyco Electronics Ltd. G ADC Telecommunications, Inc. G ADC.... 20100992 G Arrow Electronics, Inc. G LC Capital Offshore Fund, Ltd. G Shared Technologies Inc. 20100994 G... UK Limited. G Alcan Rolled Products--Ravenswood LLC. ] G Alcan Automotive LLC. G AIN USA LLC. G...

  20. 77 FR 69623 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2012-11-20

    ... Capital Partners III, L.P. ] 20130032 G Churchill, Downs Incorporated; High River Gaming, LLC; Churchill, Downs Incorporated. 20130033 G Wind Point Partners VII-A, L.P.; TPG Star, L.P.; Wind Point Partners VII....; Ocwen Financial Corporation; WLR Recovery Fund IV, L.P. 20130074 G Anthony G. Petrello; Nabors...

  1. 75 FR 24948 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2010-05-06

    ... 20100413 G Detroit Edison Credit Union. G NuUnion Credit Union. G NuUnion Credit Union. 20100451 G Mr... Partnership. 20100482 G Thomas H. Lee Equity Fund VI, L.P. G CKE Restaurants, Inc. G CKE Restaurants, Inc. 22...

  2. 75 FR 24953 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2010-05-06

    ..., lnc. G Brinker Restaurant Corporation. G Brinker Connecticut Corporation. G Brinker North Carolina... Targa Permian LP. G Targa Gas Marketing LLC. 21-APR-10 20100565 G Schneider Electric SA. G ALSTOM. G...

  3. 77 FR 48520 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2012-08-14

    ... Holdings LLC; Walker & Dunlop, Inc.; Galaxy PEF Holdings LLC. 20121091 G Cabot Corporation; Doughty Hanson & Co V LP No. 2; Cabot Corporation. 20121095 G Mr. Masahiro Miki; LaCrosse Footwear, Inc.; Mr. Masahiro...

  4. 75 FR 870 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2010-01-06

    .... Corr. G CWC License Holding, Inc. G Corr Wireless Communications, LLC. 20100194 G Lightyear Fund II, L... 20100108 G SPX Corporation. G Connell Limited Partnership. G Yuba Heat Transfer LLC. 20100113 G Corinthian... Hathaway Inc. G American Electric Power Company, Inc. G AEP Texas Central Company. G AEP Texas North...

  5. 78 FR 49753 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2013-08-15

    ...., Inc.; Perseus Partners VII, L.P.; Merck & Co., Inc. 20131054 G LSF VIII International Finance, L.P.; Lafarge S.A.; LSF VIII International Finance, L.P. 07/16/2013 20131019 G Nippon Telegraph and Telephone.... 07/23/2013 20131051 G Novo Nordisk Foundation; Ophthotech Corporation; Novo Nordisk Foundation...

  6. 76 FR 19993 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2011-04-11

    ...; Elliott Associates, L.P. 20110637 G Cerberus Institutional Partners, L.P.; Kevin J. Keane and Cindy M. Keane; Cerberus Institutional Partners, L.P. 20110638 G Cerberus Institutional Partners, L.P.; Shawn J. Keane and Jacquelyn M. Keane; Cerberus Institutional Partners, L.P. 03/16/2011 20110575 G Becton...

  7. 78 FR 5179 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2013-01-24

    ...Nation, Inc. 12/10/2012 20130190 G Clean Harbors, Inc.; Safety- Kleen, Inc.; Clean Harbors, Inc. 20130301...; Expedia, Inc.; Barry Diller. 20130445 G Freeport-McMoRan Copper & Gold Inc.; Plains Exploration & Production Company; Freeport-McMoRan Copper & Gold Inc. 20130446 G Freeport-McMoRan Copper & Gold Inc.; McMo...

  8. 76 FR 2115 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2011-01-12

    ... First Advantage Canada, Inc. G First Advantage Europe Ltd. G Verify Limited. G First Advantage Japan KK.... G Compagnie de Saint-Gobain. G Saint-Gobain Ceramics & Plastics, Inc. G Saint-Gobain Advanced...

  9. 75 FR 47810 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2010-08-09

    ... MLG (2009) Limited Liability Company. 01-JUL-10 20100771 G Apax Europe VII-B, L.P. G Spectrum Equity... Titherington. G Mold-Rite Plastics, LLC. 08-JUL-10 20100666 G Visa Inc. G CyberSource Corporation. G Cyber...

  10. 77 FR 61753 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2012-10-11

    ... Sanders Incorporated; Apollo Investment Fund VII, L.P. 20121366 G Journal Communications, Inc.; Landmark Media Enterprises, LLC; Journal Communications, Inc. 20121368 G Carlyle Partners V Cayman L.P.; E.I. du....; New Mountain Partners II, L.P.; Thoma Bravo Fund X, L.P. 20121322 G Nuance Communications, Inc...

  11. 75 FR 38813 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2010-07-06

    ... Gannett Satellite Information. G Network, Inc. 20100588 G Apple Inc. G Siri, Inc. G Siri, Inc. 28-APR-10... System. 20100630 G Emera Inc. G Maine & Maritimes Corporation. G Maine & Maritimes Corporation. 20100636... Sterling Financial Corporation. 17-MAY-10 20100618 G Adventist Health System Sunbelt Healthcare Corporation...

  12. 75 FR 32781 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2010-06-09

    ... Apple Inc. G Siri, Inc. G Siri, Inc. 28-APR-10 20100606 G AIG Credit Facility Trust. G Prudential plc. G... Morristown-Hamblen Healthcare System. 20100630 G Emera Inc. G Maine & Maritimes Corporation. G Maine...

  13. 78 FR 65315 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2013-10-31

    ... Scientific Corporation; C.R. Bard, Inc.; Boston Scientific Corporation. 20131136 G Cisco Systems, Inc.; Sourcefire, Inc.; Cisco Systems, Inc. 20131205 G David H. Murdock; Dole Food Company, Inc.; David H. Murdock.... 20131271 G Cisco Systems, Inc.; Whiptail Technologies, Inc.; Cisco Systems, Inc. 20131279 G Calfrac Well...

  14. 75 FR 986 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2010-01-07

    ... Berkshire Hathaway Inc. G Capmark Financial Group Inc. G Capmark Capital Inc. G Capmark Finance Inc. 04-NOV... Financial Group Inc. G Capmark Capital Inc. G Capmark Finance Inc. 06-NOV-09 20100078 G Kok Thay Lim. G... Agropur Cooperative. G Sjerp W. Ysselstein. G Green Meadows Food, LLC. 20100083 G Tellabs, Inc. G WiChorus...

  15. 77 FR 74013 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2012-12-12

    ... Master Fund LP; The ADT Corporation; Corvex Master Fund LP. 20130076 G Green Equity Investors V, L.P.; J.W. Childs Equity Partners III, L.P.; Green Equity Investors V, L.P. 20130087 G CRH plc; Trap Rock.... 20130092 G Mitsubishi UFJ Lease & Finance Company Limited; JSA International Holdings, L.P.; Mitsubishi UFJ...

  16. 77 FR 42730 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2012-07-20

    ... Movil, S.A.B. de C.V. 20120860 G Green Equity Investors V, L.P.; Savers, Inc.; Green Equity Investors V.... 20120908 G Green Equity Investors V, L.P.; Olympus Growth Fund V, L.P.; Green Equity Investors V, L.P... Holdings, Inc.; Acosta Holdco, Inc. 06/25/2012 20120896 G General Cable Corporation; Rio Tinto plc; General...

  17. 76 FR 64348 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2011-10-18

    ... Cable Inc.; Insight Communications Company, Inc.; Time Warner Cable Inc. 20111375 G International....; Alere Inc. 20111373 G ARAMARK Holdings Corporation; Green Mountain Coffee Roasters, Inc.; ARAMARK...

  18. 76 FR 41795 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2011-07-15

    ... Equity Fund; Fortune Brands, Inc.; KOFC Miraeasset Growth Champ 2010-4 Private Equity Fund. 20110935 G... & Partners Fund II, L.P.; Genstar Capital Partners V, L.P. 20110919 G Thomas H. Lee Equity Fund VI, L.P.; JLL Partners Fund VI, L.P.; Thomas H. Lee Equity Fund VI, L.P. 20110920 G Spectra Energy Corp.; EQT Corporation...

  19. 75 FR 76733 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2010-12-09

    ... 20110087 G John B. Hess. G Hess Corporation. G Hess Corporation. 02-NOV-10 20110011 G Focus Brands Holdings... Equity Partners II, L.P. G PPL Corporation. G Newco, LLC. G Safe Harbor Water Power Corporation. G PPL Wallingford Energy, LLC. 20110095 G LS Power Equity Partners II, L.P. G Constellation Energy Group, Inc. G...

  20. 76 FR 2117 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2011-01-12

    ... Orleans, L.L.C. 21-JUL-09........ 20090566........ G Shanghai Electric (Group) Corporation 21-JUL-09........... 20090655........ G Virgin Mobile USA, Inc. 21-AUG-09........ 20090655........ G Virgin Mobile USA, Inc. 21...

  1. 77 FR 14369 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2012-03-09

    ... Lightyear Fund II, L.P.; Genworth Financial, Inc.; Lightyear Fund II, L.P. 02/07/2012 20111442 G ACI... Properties Trust, Inc.; FFC Partners II, L.P.; Medical Properties Trust, Inc. 20120510 G GS Engineering & Construction Corporation; Inmobiliaria Espacio, S.A.; GS Engineering & Construction Corporation. 20120513 G...

  2. 78 FR 21604 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2013-04-11

    ...; Jenny Linden Urnes. 03/25/2013 20130643 G Berkshire Hathaway Inc.; H.J. Heinz Company; Berkshire Hathaway Inc. 20130644 G 3G Special Situations Fund III, L.P.; H.J. Heinz Company; 3G Special Situations...

  3. 77 FR 56210 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2012-09-12

    ... Partners Fund IV, L.P. 20121162 G General Atlantic Partners 90, L.P.; Box, Inc.; General Atlantic Partners... Corporation; OGE Energy Corp. 20121197 G Dayton-Cox Trust A; Providence Equity Partners VI (Umbrella U.S.) L.P.; Dayton-Cox Trust A. 08/14/2012 20121028 G Berkshire Hathaway Inc.; Jerry L. Wordsworth; Berkshire...

  4. 75 FR 52006 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2010-08-24

    ... Communications Inc. G Newco LLC. 12-JUN-09 20090504 G Clayton, Dubilier & Rice Fund VII, L.P. G Hertz Global... Teck Resources Limited. G Teck-Pogo, Inc. 20090526 G Golden Gate Capital Opportunity Fund, L.P. G Aeon...-09 20090543 G Golden Gate Capital Opportunity Fund, L.P. G SoftBrands, Inc. G SoftBrands, Inc...

  5. 76 FR 8739 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2011-02-15

    .... 20110447 G The Coca-Cola Company; Honest Tea Inc.; The Coca-Cola Company. 20110450 G Plains All American... G Aviation Industry Corporation of China; Teledyne Technologies Incorporated; Aviation Industry Corporation of China. 01/06/2011 20110421 G The GEO Group. Inc.; AEA Investors 2006 Fund L.P.; The GEO Group...

  6. 75 FR 8945 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2010-02-26

    ..., Inc. 20100306 G Admiral Beverage Corporation. G Joe G. Maloof and Company. G Maloof Distributing LLC.... ] 15-JAN-10 20100275 G A. Schulman, Inc. G ICO, Inc. G ICO, Inc. 20100319 G Chardan 2008 China... Appointed). G Texas Gulf Wind LLC. 20100344 G China National Petroleum Corporation. G ION Geophysical...

  7. 76 FR 33758 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2011-06-09

    ... Section 7A of the Clayton Act, 15 U.S.C. 18a, as added by Title II of the Hart-Scott-Rodino Antitrust...-3100. By Direction of the Commission. Donald S. Clark, Secretary. BILLING CODE 6750-01-M ...

  8. 76 FR 70452 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2011-11-14

    ... Equipment Associates, Inc.; Applied Materials, Inc. 20111419 G GTCR Fund X/A LP; Mr. Nochi Dankner; GTCR... Invest; G4S plc. 20120062 G Steiner Leisure Limited; Ideal Image Development, Inc.; Steiner Leisure...

  9. 77 FR 1690 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2012-01-11

    ..., Inc.; Warburg Pincus Private Equity IX, L.P.; WMB Holdings, Inc. 20120226 G Titan Private Holdings I....; CareGroup, Inc. 20120331 G CHS Private Equity V LP; Royall & Company Holding, Inc.; CHS Private Equity... Novo Legal LLC; Epiq Systems, Inc. 20120359 G Brazos Equity Fund III, L.P.; Global Private Equity IV...

  10. 78 FR 28219 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2013-05-14

    ... Fleischer & Lowe Capital Partners III, L.P. 20130777 G KKR Asian Fund L.P.; Warburg Pincus Private Equity IX...), L.P.; PowerTeam Services, LLC; KIA VIII (Power), L.P. 20130741 G AltaGas Ltd.; LS Power Equity...), L.P. 20130773 G Thomas H. Lee Equity Fund VI, L.P.; CompuCom Systems Holding Corp.; Thomas H. Lee...

  11. 77 FR 35387 - Granting of Request for Early Termination of the Waiting Period Under The Premerger Notification...

    Science.gov (United States)

    2012-06-13

    ... 20120781 G GTCR Fund X/A LP; Warburg Pincus Private Equity VIII, L.P.; GTCR Fund X/A LP. 05/08/2012... Warburg Pincus Private Equity X, L.P.; Quad Partners III- ALP; Warburg Pincus Private Equity X, L.P.... 20120777 G Lee Equity Partners Fund Summer MV LP; The Edelman Financial Group Inc.; Lee Equity Partners...

  12. 76 FR 56760 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2011-09-14

    ... G Warburg Pincus Private Equity X, L.P.; Credit Suisse Group AG; Warburg Pincus Private Equity X, L.... Gates III; Ecolab Inc.; William H. Gates III. 20111197 G Summit Partners Private Equity Fund VII-A, L.P.; Water Street Healthcare Partners II, L.P.; Summit Partners Private Equity Fund VII-A, L.P. 20111204 G...

  13. 76 FR 14972 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2011-03-18

    ....; Iowa RSA 10 General Partnership; Verizon Communications Inc. 20110559 G Warburg Pincus Private Equity X, L.P.; AmRest Holdings SE; Warburg Pincus Private Equity X, L.P. 20110560 G Valeant Pharmaceuticals....; Charlesbank Equity Fund V, Limited Partnership; Deerfield Capital Corp. 02/02/2011 20110353 G Wizard Parent...

  14. 78 FR 57154 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2013-09-17

    .... 20131155 G KKR North American Fund XI, L.P.; Warburg Pincus Private Equity X, L.P.; KKR North American Fund..., Carson, Anderson & Stowe XI, L.P. 20131120 G Providence Equity Partners VI L.P.; Informa plc; Providence Equity Partners VI L.P. 20131146 G Susanne Klatten; Rockwood Holdings, Inc.; Susanne Klatten. 20131150 G...

  15. 77 FR 27228 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2012-05-09

    ... Partners Private Equity Fund VII-A, L.P.; Audax Private Equity Fund II, L.P.; Summit Partners Private... Associates Private Equity III, L.P.; TorQuest Partners Fund II, L.P. 20120702 G VEPF IV MV II, L.P.; Misys... Pincus Private Equity IX, L.P.; Builders FirstSource, Inc.; Warburg Pincus Private Equity IX, L.P...

  16. 75 FR 11538 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2010-03-11

    ..., Inc. 26-FEB-10 20100420 G S.A.C. Private Equity Investors, L.P. G Spheris Holding II, Inc. a debtor.... 20100385 G Martek Biosciences Corporation G Charterhouse Equity Partners IV, L.P. G Charter Amerifit LLC 17....B. de C.V. G Carso Global Telecom, S.A.B. de C.V. 20100394 G Energy Transfer Equity, L.P. G Energy...

  17. 75 FR 24951 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2010-05-06

    ... Group, Inc. 26-FEB-10 20100420 G S.A.C. Private Equity Investors, L.P. G Spheris Holding II, Inc. a... Escentuals, Inc. 20100385 G Martek Biosciences Corporation. G Charterhouse Equity Partners IV, L.P. G Charter... Global Telecom, S.A.B. de C.V. G Carso Global Telecom, S.A.B. de C.V. 20100394 G Energy Transfer Equity...

  18. 78 FR 11187 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2013-02-15

    .... 20130462 G Donata Holding SE; Caribou Coffee Company, Inc.; Donata Holding SE. 20130472 G Gestion Audem Inc.; PEER 1 Network Enterprises, Inc.; Gestion Audem Inc. 01/03/2013 20130468 G EQT Infrastructure II...

  19. 77 FR 8869 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2012-02-15

    ... Partnership V; RTI International Metals, Inc. 20120422 G Sigma-Aldrich Corporation; Avista Capital Partners, L.P.; Sigma-Aldrich Corporation. 01/24/2012 20120151 G Oracle Corporation; RightNow Technologies, Inc... Competition, Room H-303, Washington, DC 20580, (202) 326-3100. By Direction of the Commission. Donald S. Clark...

  20. 75 FR 82026 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2010-12-29

    ....P. 20110225 G Jarden Corporation. G Avenia AG. G Quickie Holdings, Inc. 20110307 G Sigma-Aldrich...-3100. By Direction of the Commission. Donald S. Clark, Secretary. [FR Doc. 2010-32716 Filed 12-28-10; 8...

  1. 75 FR 77638 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

    Science.gov (United States)

    2010-12-13

    .... 20110263 G Arsenal Capital Partners QP II LP. G John W. Jordan, III. G Para-Chem Southern, Inc. 20110265 G....P. G Estate of Robert H. Brooks. G Hooters of America, Inc. 20110196 G Barry Diller. G Barry Diller...

  2. Wolf's Isotopic Response: Varicella Within a Prior Immunization Reaction Site.

    Science.gov (United States)

    Wu, Sam; McShane, Diana B; Burkhart, Craig N; Morrell, Dean S

    2015-01-01

    Wolf's isotopic response describes the occurrence of a dermatologic condition at the site of a prior healed unrelated condition. Our report details a case of varicella occurring as a secondary condition at the site of a prior immunization reaction; herpesvirus infection has not been reported as a secondary condition in cases of Wolf's isotopic response before. Current hypotheses favor the involvement of neurohormonal modulation of local immunity in response to various forms of injury as a model for explaining these phenomena. © 2015 Wiley Periodicals, Inc.

  3. The generalization of prior uncertainty during reaching.

    Science.gov (United States)

    Fernandes, Hugo L; Stevenson, Ian H; Vilares, Iris; Kording, Konrad P

    2014-08-20

    Bayesian statistics defines how new information, given by a likelihood, should be combined with previously acquired information, given by a prior distribution. Many experiments have shown that humans make use of such priors in cognitive, perceptual, and motor tasks, but where do priors come from? As people never experience the same situation twice, they can only construct priors by generalizing from similar past experiences. Here we examine the generalization of priors over stochastic visuomotor perturbations in reaching experiments. In particular, we look into how the first two moments of the prior--the mean and variance (uncertainty)--generalize. We find that uncertainty appears to generalize differently from the mean of the prior, and an interesting asymmetry arises when the mean and the uncertainty are manipulated simultaneously. Copyright © 2014 the authors 0270-6474/14/3411470-15$15.00/0.

  4. 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

  5. Waiting times for cancer patients in Sweden: A nationwide population-based study.

    Science.gov (United States)

    Robertson, Stephanie; Adolfsson, Jan; Stattin, Pär; Sjövall, Annika; Winnersjö, Rocio; Hanning, Marianne; Sandelin, Kerstin

    2017-05-01

    The reported long waiting times for cancer patients have mostly been related to prognostic outcome and less to patient-related experience to outcome. We assessed waiting times for patients with cancer of the breast, prostate, colon or rectum in Sweden. The median time from referral to start of treatment was assessed using data from clinical cancer registers for patients who received curative treatment during 2011, 2012 and 2013. The median overall waiting time in different counties ranged from 7 to 28 days for breast cancer, from 117 to 280 days for prostate cancer, from 27 to 64 days for colon cancer and from 48 to 80 days for rectal cancer. For the entire nation, the median time from referral to start of treatment remained unchanged from 2011 to 2013 for each cancer diagnosis. Large variations were found in waiting times between different counties in Sweden and between different types of cancer. The long waiting times identified in this study emphasize the need to improve national programmes for more rapid diagnosis and treatment.

  6. 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.

  7. 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

  8. On the control, stability, and waiting time in a slotted ALOHA random-access system

    Science.gov (United States)

    Ferguson, M. J.

    1975-01-01

    This paper explores some of the boundaries in performance of slotted ALOHA systems by analyzing a simple and almost optimal centrally supervised control. The control results in a very simple Markov chain model and allows an examination of stability, conditional waiting time distribution of transmitting terminals, and many other system measures. The key to the simplicity is to have a probability of successful packet transmission that is independent of the number of transmitting terminals. In considering waiting time, we calculate the mean and other moments of the waiting time of a terminal when it enters the system to find (n - 1) other terminals already there competing for the channel. Under this control, the average time is proportional to n. The control requires exact knowledge of the number of terminals contending for the channel, and hence is not implementable, except as an approximation.

  9. 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.

  10. 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

    ,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...... 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...... 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. CONCLUSION: Our findings suggest that wine drinkers have slightly shorter waiting times to pregnancy than both non-wine drinkers and consumers...

  11. 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

    The emergence of large, computerized pharmacoepidemiologic databases has enabled us to study drug utilization with the individual user as the statistical unit. A recurrent problem in such analyses, however, is the overwhelming volume and complexity of data. We here describe a graphical approach...... 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...

  12. Identification of waiting time distribution of M/G/1, Mx/G/1, GIr/M/1 queueing systems

    Directory of Open Access Journals (Sweden)

    A. Ghosal

    1988-01-01

    Full Text Available This paper brings out relations among the moments of various orders of the waiting time of the 1st customer and a randomly selected customer of an arrival group for bulk arrivals queueing models, and as well as moments of the waiting time (in queue for M/G/1 queueing system. A numerical study of these relations has been developed in order to find the (β1,β2 measures of waiting time distribution in a comutable form. On the basis of these measures one can look into the nature of waiting time distribution of bulk arrival queues and the single server M/G/1 queue.

  13. A new prior for bayesian anomaly detection: application to biosurveillance.

    Science.gov (United States)

    Shen, Y; Cooper, G F

    2010-01-01

    Bayesian anomaly detection computes posterior probabilities of anomalous events by combining prior beliefs and evidence from data. However, the specification of prior probabilities can be challenging. This paper describes a Bayesian prior in the context of disease outbreak detection. The goal is to provide a meaningful, easy-to-use prior that yields a posterior probability of an outbreak that performs at least as well as a standard frequentist approach. If this goal is achieved, the resulting posterior could be usefully incorporated into a decision analysis about how to act in light of a possible disease outbreak. This paper describes a Bayesian method for anomaly detection that combines learning from data with a semi-informative prior probability over patterns of anomalous events. A univariate version of the algorithm is presented here for ease of illustration of the essential ideas. The paper describes the algorithm in the context of disease-outbreak detection, but it is general and can be used in other anomaly detection applications. For this application, the semi-informative prior specifies that an increased count over baseline is expected for the variable being monitored, such as the number of respiratory chief complaints per day at a given emergency department. The semi-informative prior is derived based on the baseline prior, which is estimated from using historical data. The evaluation reported here used semi-synthetic data to evaluate the detection performance of the proposed Bayesian method and a control chart method, which is a standard frequentist algorithm that is closest to the Bayesian method in terms of the type of data it uses. The disease-outbreak detection performance of the Bayesian method was statistically significantly better than that of the control chart method when proper baseline periods were used to estimate the baseline behavior to avoid seasonal effects. When using longer baseline periods, the Bayesian method performed as well as the

  14. The One-stop trial: Does electronic referral and booking by the general practitioner (GPs to outpatient day case surgery reduce waiting time and costs? A randomized controlled trial protocol

    Directory of Open Access Journals (Sweden)

    Vonen Barthold

    2008-08-01

    feasible to use a one-stop approach for all patients undergoing surgery on an outpatient basis for inguinal hernia, pilonidal sinus and gallstones. In this study we wanted to investigate the waiting time and cost-effectiveness of direct electronic referral and booking of outpatient surgery compared to the traditional patient pathway, where the patient is seen at the outpatient clinic prior to surgery. Trial registration This trial has been registered at ClinicalTrials.gov. The trial registration number is: NCT00692497

  15. 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.

  16. Community-based birth waiting homes in Northern Sierra Leone: Factors influencing women's use.

    Science.gov (United States)

    Kyokan, Michiko; Whitney-Long, Melissa; Kuteh, Mabel; Raven, Joanna

    2016-08-01

    to explore the factors influencing women's use of birth waiting homes in the Northern Bombali district, Sierra Leone. this was a descriptive exploratory study using qualitative research methodology, which included in depth interviews, key informant interviews, focus group discussions, document review and observations. two chiefdoms in the Northern Bombali district, Sierra Leone. eight interviews were conducted with women who had delivered in the past one year and used birth waiting homes; eight key informant interviews with a project manager, birth waiting homes hosts, and community members; thirteen women who delivered in the past year without using birth waiting homes (four interviews and two focus group discussions). there are several factors influencing the use of birth waiting homes (BWHs) including: past experience of childbirth, promotion of the birth waiting homes by traditional birth attendance, distance and costs of transport to the homes, child care and other family commitments, family's views of the importance of the homes, the costs of food during women's stay, and information given to women and families about when and how to use the homes. some barriers, especially those related to family commitments and costs of food, are challenging to solve. In order to make a BWH a user-friendly and viable option, it may be necessary to adjust ways in which BWHs are used. Good linkage with the health system is strength of the programme. However, further strengthening of community participation in monitoring and managing the BWHs is needed for the long term success and sustainability of the BWHs. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Penalised Complexity Priors for Stationary Autoregressive Processes

    KAUST Repository

    Sørbye, Sigrunn Holbek

    2017-05-25

    The autoregressive (AR) process of order p(AR(p)) is a central model in time series analysis. A Bayesian approach requires the user to define a prior distribution for the coefficients of the AR(p) model. Although it is easy to write down some prior, it is not at all obvious how to understand and interpret the prior distribution, to ensure that it behaves according to the users\\' prior knowledge. In this article, we approach this problem using the recently developed ideas of penalised complexity (PC) priors. These prior have important properties like robustness and invariance to reparameterisations, as well as a clear interpretation. A PC prior is computed based on specific principles, where model component complexity is penalised in terms of deviation from simple base model formulations. In the AR(1) case, we discuss two natural base model choices, corresponding to either independence in time or no change in time. The latter case is illustrated in a survival model with possible time-dependent frailty. For higher-order processes, we propose a sequential approach, where the base model for AR(p) is the corresponding AR(p-1) model expressed using the partial autocorrelations. The properties of the new prior distribution are compared with the reference prior in a simulation study.

  18. Appoximation Formula for Estimation of Waiting-Time in Multiple-Channel Queuing Systems

    DEFF Research Database (Denmark)

    Maaløe, Erik

    1973-01-01

    The article deals with two approxiamation formulae for estimation of W, Waiting-times in a M/E/R queuing system.m First is shown how W for the multiple-channel system is approximately an Rth part of the mean waiting time in a single channel system. A second approximation applies the exact ratio...... for W(multi-channel/W(single channel) and M/M/1-systems to general M/Ek/R-systems. This is particularly illustrated in the case og M/M/R and M/D/R-systems as a general warning against general practices...

  19. Gender disparity in liver transplant waiting-list mortality: the importance of kidney function.

    Science.gov (United States)

    Mindikoglu, Ayse L; Regev, Arie; Seliger, Stephen L; Magder, Laurence S

    2010-10-01

    Previous studies of men and women on the liver transplantation (LT) waiting list, without taking transplantation rates into account, have suggested a higher risk of mortality for women on the waiting list. The objective of this study was to compare men and women with respect to dying within 3 years of registration on the LT waiting list and to take into account both the immediate mortality risks and the transplantation rates. The analysis was based on Organ Procurement and Transplantation Network data for patients with end-stage liver disease (ESLD) on the waiting list who were registered between February 2002 and August 2009. Competing risk survival analysis was performed to assess the gender disparity in waiting-list mortality; 42,322 patients and 610,762 person-months of waiting-list experience were included in the analysis. The risk of dying within 3 years of listing was 19% and 17% in women and men, respectively (P < 0.0001). Among patients with kidney disease and especially those not on dialysis with an estimated glomerular filtration rate (eGFR) ≥15 and <30 mL/minute/1.73 m(2), women had a substantially higher risk of dying on the waiting list within 3 years of registration versus men (26% versus 20%, P = 0.001). This disparity was related to lower transplantation rates in women (transplantation rate ratio = 0.68, P < 0.0001). Controlling for eGFR and other variables related to mortality risk, we found that the overall female-male disparity disappeared. In conclusion, among patients with ESLD and kidney dysfunction who are not on dialysis, there is a substantial gender disparity in LT waiting-list mortality. Our analysis suggests as an explanation the fact that women have lower transplantation rates than men in this group. The lower transplantation rates can be explained in part by the fact that Model for End-Stage Liver Disease scores tend to be lower for women versus men because they are based on serum creatinine rather than the glomerular filtration

  20. Interventions to reduce wait times for primary care appointments: a systematic review.

    Science.gov (United States)

    Ansell, Dominique; Crispo, James A G; Simard, Benjamin; Bjerre, Lise M

    2017-04-20

    Accessibility and availability are important characteristics of efficient and effective primary healthcare systems. Currently, timely access to a family physician is a concern in Canada. Adverse outcomes are associated with longer wait times for primary care appointments and often leave individuals to rely on urgent care. When wait times for appointments are too long patients may experience worse health outcomes and are often left to use emergency department resources. The primary objective of our study was to systematically review the literature to identify interventions designed to reduce wait times for primary care appointments. Secondary objectives were to assess patient satisfaction and reduction of no-show rates. We searched multiple databases, including: Medline via Ovid SP (1947 to present), Embase (from 1980 to present), PsychINFO (from 1806 to present), Cochrane Central Register of Controlled Trials (CENTRAL; all dates), Cumulative Index to Nursing and Allied Health (CINAHL; 1937 to present), and Pubmed (all dates) to identify studies that reported outcomes associated with interventions designed to reduce wait times for primary care appointments. Two independent reviewers assessed all identified studies for inclusion using pre-defined inclusion/exclusion criteria and a multi-level screening approach. Our study methods were guided by the Cochrane Handbook for Systematic Reviews of Interventions. Our search identified 3,960 articles that were eligible for inclusion, eleven of which satisfied all inclusion/exclusion criteria. Data abstraction of included studies revealed that open access scheduling is the most commonly used intervention to reduce wait times for primary care appointments. Additionally, included studies demonstrated that dedicated telephone calls for follow-up consultation, presence of nurse practitioners on staff, nurse and general practitioner triage, and email consultations were effective at reducing wait times. To our knowledge, this is

  1. 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

  2. A study on iron ore transportation model with penalty value of transportation equipment waiting

    Directory of Open Access Journals (Sweden)

    Kailing Pan

    2017-03-01

    Full Text Available As some steel enterprises are at a disadvantage in the choice of the mode of transportation, this paper made further studies of the characteristics of the iron ore logistics, taking comprehensive consideration of optimizing the waiting time under the conditions with limited loading capacity and setting up a procedural model of the iron ore logistics system with minimum cost of transportation, storage, loading, unloading, and transportation equipment waiting. Finally, taking the iron ore transport system of one steel enterprise as example, the solution and the validity of the model were analyzed and verified in this paper.

  3. A wait-list randomized controlled trial of loving-kindness meditation programme for self-criticism.

    Science.gov (United States)

    Shahar, Ben; Szsepsenwol, Ohad; Zilcha-Mano, Sigal; Haim, Netalee; Zamir, Orly; Levi-Yeshuvi, Simi; Levit-Binnun, Nava

    2015-01-01

    Self-criticism is a vulnerability risk factor for a number of psychological disorders, and it predicts poor response to psychological and pharmacological treatments. In the current study, we evaluated the efficacy of a loving-kindness meditation (LKM) programme designed to increase self-compassion in a sample of self-critical individuals. Thirty-eight individuals with high scores on the self-critical perfectionism subscale of the Dysfunctional Attitude Scale were randomized to an LKM condition (n = 19) or a wait-list (WL) condition (n = 19). Measures of self-criticism, self-compassion and psychological distress were administered before and immediately following the intervention (LKM or WL). WL participants received the intervention immediately after the waiting period. Both groups were assessed 3 months post-intervention. Intent-to-treat (n = 38) and per-protocol analyses (n = 32) showed significant reductions in self-criticism and depressive symptoms as well as significant increases in self-compassion and positive emotions in the LKM condition compared with the WL condition. A follow-up per-protocol analysis in both groups together (n = 20) showed that these gains were maintained 3 months after the intervention. These preliminary results suggest that LKM may be efficacious in alleviating self-criticism, increasing self-compassion and improving depressive symptoms among self-critical individuals. Self-criticism plays a major role in many psychological disorders and predicts poor response to brief psychological and pharmacological treatments for depression. The current study shows that loving-kindness meditation, designed to foster self-compassion, is efficacious in helping self-critical individuals become less self-critical and more self-compassionate. The study also suggests that practising loving-kindness may reduce depressive symptoms and increase positive emotions. Copyright © 2014 John Wiley & Sons, Ltd.

  4. Why Wait? Early Determinants of School Dropout in Preventive Pediatric Primary Care.

    Directory of Open Access Journals (Sweden)

    Marie-José Theunissen

    Full Text Available To answer the question of what bio-psychosocial determinants in infancy, early and middle childhood, and adolescence predict school drop-out in young adulthood, we approached the complex process towards school dropout as a multidimensional, life-course phenomenon. The aim is to find signs of heightened risks of school dropout as early as possible which will eventually help public health workers in reducing these risks.In a case-control design, we used data from both the Preventive Pediatric Primary Care (PPPC files (that contain information from birth onwards and additional questionnaires filled out by 529 youngsters, aged 18-23 years, and living in the South-east of the Netherlands. We first conducted univariate logistic regression analyses with school-dropout as the dependent variable. Backward and forward stepwise analyses with the significant variables were done with variables pertaining to the 0 to 4 year period. Remaining significant variables were forced into the next model and subsequently variables pertaining to respectively the 4 to 8, 8 to 12 and 12 to 16 year period were introduced in a stepwise analysis. All analyses were cross-validated in an exploratory and confirmatory random half of the sample.One parent families and families with a non-Western background less often attended the health examinations of the PPPC and such less attendance was related to school dropout. The birth of a sibling (OR 0.63, 95% CI 0.43-0.93 in infancy and self-efficacy (OR 0.53, 95% CI 0.38-0.74 in adolescence decreased the odds of school dropout; externalizing behavior (OR 2.81, 95% CI 1.53-5.14 in middle childhood and (sickness absence (OR 5.62, 95% CI 2.18-14.52 in adolescence increased the risks.To prevent school dropout, PPPC professionals should not wait until imminent dropout, but should identify and tackle risk factors as early as possible and actively approach youngsters who withdraw from public health care.

  5. Why Wait? Early Determinants of School Dropout in Preventive Pediatric Primary Care.

    Science.gov (United States)

    Theunissen, Marie-José; Bosma, Hans; Verdonk, Petra; Feron, Frans

    2015-01-01

    To answer the question of what bio-psychosocial determinants in infancy, early and middle childhood, and adolescence predict school drop-out in young adulthood, we approached the complex process towards school dropout as a multidimensional, life-course phenomenon. The aim is to find signs of heightened risks of school dropout as early as possible which will eventually help public health workers in reducing these risks. In a case-control design, we used data from both the Preventive Pediatric Primary Care (PPPC) files (that contain information from birth onwards) and additional questionnaires filled out by 529 youngsters, aged 18-23 years, and living in the South-east of the Netherlands. We first conducted univariate logistic regression analyses with school-dropout as the dependent variable. Backward and forward stepwise analyses with the significant variables were done with variables pertaining to the 0 to 4 year period. Remaining significant variables were forced into the next model and subsequently variables pertaining to respectively the 4 to 8, 8 to 12 and 12 to 16 year period were introduced in a stepwise analysis. All analyses were cross-validated in an exploratory and confirmatory random half of the sample. One parent families and families with a non-Western background less often attended the health examinations of the PPPC and such less attendance was related to school dropout. The birth of a sibling (OR 0.63, 95% CI 0.43-0.93) in infancy and self-efficacy (OR 0.53, 95% CI 0.38-0.74) in adolescence decreased the odds of school dropout; externalizing behavior (OR 2.81, 95% CI 1.53-5.14) in middle childhood and (sickness) absence (OR 5.62, 95% CI 2.18-14.52) in adolescence increased the risks. To prevent school dropout, PPPC professionals should not wait until imminent dropout, but should identify and tackle risk factors as early as possible and actively approach youngsters who withdraw from public health care.

  6. Prior selfing and the selfing syndrome in animals: an experimental approach in the freshwater snail Biomphalaria pfeifferi.

    Science.gov (United States)

    Tian-Bi, Yves-Nathan T; N'Goran, Eliezer K; N'Guetta, Simon-Pierre; Matthys, Barbara; Sangare, Abdourahamane; Jarne, Philippe

    2008-02-01

    Inbreeding species of hermaphroditic animals practising copulation have been characterized by few copulations, no waiting time (the time that an isolated individual waits for a partner before initiating reproduction compared with paired individuals) and limited inbreeding (self-fertilization) depression. This syndrome, which has never been fully studied before in any species, is analysed here in the highly selfing freshwater snail Biomphalaria pfeifferi. We conducted an experiment under laboratory conditions over two generations (G1 and G2) using snails sampled from two populations (100 individuals per population). G1 individuals were either isolated or paired once a week (potentially allowing for crosses), and monitored during 29 weeks for growth, fecundity and survival. Very few copulations were observed in paired snails, and there was a positive correlation in copulatory activity (e.g. number of copulations) between the male and female sexual roles. The waiting time was either null or negative, meaning that isolated individuals initiated reproduction before paired ones. G2 offspring did not differ in hatching rate and survival (to 28 days) between treatments, but offspring from paired individuals grew faster than those from isolated individuals. On the whole, the self-fertilization depression was extremely low in both populations. Another important result is that paired G1 individuals began laying (selfed) eggs several weeks prior to initiating copulation: this is the first characterization of prior selfing (selfing initiated prior to any outcrossing) in a hermaphroditic animal. A significant population effect was observed on most traits studied. Our results are discussed with regard to the maintenance of low outcrossing rates in highly inbreeding species.

  7. In the queue for total joint replacement: patients' perspectives on waiting times. Ontario Hip and Knee Replacement Project Team.

    Science.gov (United States)

    Llewellyn-Thomas, H A; Arshinoff, R; Bell, M; Williams, J I; Naylor, C D

    1998-02-01

    We assessed patients on the waiting lists of a purposive sample of orthopaedic surgeons in Ontario, Canada, to determine patients' attitudes towards time waiting for hip or knee replacement. We focused on 148 patients who did not have a definite operative date, obtaining complete information on 124 (84%). Symptom severity was assessed with the Western Ontario/McMaster Osteoarthritis Index and a disease-specific standard gamble was used to elicit patients' overall utility for their arthritic state. Next, in a trade-off task, patients considered a hypothetical choice between a 1-month wait for a surgeon who could provide a 2% risk of post-operative mortality, or a 6-month wait for joint replacement with a 1% risk of post-operative mortality. Waiting times were then shifted systematically until the patient abandoned his/her initial choice, generating a conditional maximal acceptable wait time. Patients were divided in their attitudes, with 57% initially choosing a 6-month wait with a 1% mortality risk. The overall distribution of conditional maximum acceptable wait time scores ranged from 1 to 26 months, with a median of 7 months. Utility values were independently but weakly associated with patients' tolerance of waiting times (adjusted R-square = 0.059, P = 0.004). After splitting the sample along the median into subgroups with a relatively 'low' and 'high' tolerance for waiting, the subgroup with the apparently lower tolerance for waiting reported lower utility scores (z = 2.951; P = 0.004) and shorter times since their surgeon first advised them of the need for surgery (z = 3.014; P = 0.003). These results suggest that, in the establishment and monitoring of a queue management system for quality-of-life-enhancing surgery, patients' own perceptions of their overall symptomatic burden and ability to tolerate delayed relief should be considered along with information derived from clinical judgements and pre-weighted health status instruments.

  8. Ready and waiting: Freezing as active action preparation under threat.

    Science.gov (United States)

    Gladwin, Thomas E; Hashemi, Mahur M; van Ast, Vanessa; Roelofs, Karin

    2016-04-21

    Freezing is a defensive response characterized by rigidity and bradycardia, but it is unclear whether it is a passive versus active preparatory state. We developed a shooting task in which preparation and threat were manipulated independently: Participants were either helpless or able to respond to a possible upcoming attack, and attacks were either associated with an electric shock or not. Essentially, a purely anticipatory preparatory period was used during which no stimuli occurred. Freezing was assessed during this period. In addition to heart rate, body sway was measured, using a stabilometric force platform. The efficacy of the threat manipulation was confirmed via self-report. The ability to prepare led to decreases in heart rate and postural sway, while threat led to decreased heart rate. Further, exploratory analyses suggested that aggressive participants showed reduced initial freezing for threatening opponents, but increased postural freezing when armed. The results suggest that freezing may involve active preparation. Relations to results in passive viewing tasks are discussed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Assessment of Prior Learning: An Interdisciplinary Perspective.

    Science.gov (United States)

    Preston, Kathleen

    The Assessment of Prior Learning Program at Humboldt State University, California, is described. The program enables students to gain at least token recognition, through elective units, for prior learning by taking a course and writing a portfolio that is assessed by faculty and awarded up to 10 additional units. The program began by offering…

  10. Relationship between Prior Knowledge and Reading Comprehension

    Science.gov (United States)

    Abdelaal, Noureldin Mohamed; Sase, Amal Saleh

    2014-01-01

    This study investigates the relationship between prior knowledge and reading comprehension in second language among postgraduate students in UPM. Participants in the study were 20 students who have the same level in English as a second language from several faculties. On the basis of a prior-knowledge questionnaire and test, students were…

  11. Thought Field Therapy Compared to Cognitive Behavioral Therapy and Wait-List for Agoraphobia: A Randomized, Controlled Study with a 12-Month Follow-up

    Directory of Open Access Journals (Sweden)

    Audun C. Irgens

    2017-06-01

    Full Text Available Background: Thought field therapy (TFT is used for many psychiatric conditions, but its efficacy has not been sufficiently documented. Hence, there is a need for studies comparing TFT to well-established treatments. This study compares the efficacy of TFT and cognitive behavioral therapy (CBT for patients with agoraphobia.Methods: Seventy-two patients were randomized to CBT (N = 24, TFT (N = 24 or a wait-list condition (WLC (N = 24 after a diagnostic procedure including the MINI PLUS that was performed before treatment or WLC. Following a 3 months waiting period, the WL patients were randomized to CBT (n = 12 or TFT (n = 12, and all patients were reassessed after treatment or waiting period and at 12 months follow-up. At first we compared the three groups CBT, TFT, and WL. After the post WL randomization, we compared CBT (N = 12 + 24 = 36 to TFT (N = 12 + 24 = 36, applying the pre-treatment scores as baseline for all patients. The primary outcome measure was a symptom score from the Anxiety Disorders Interview Scale that was performed by an interviewer blinded to the treatment condition. For statistical comparisons, we used the independent sample’s t-test, the Fisher’s exact test and the ANOVA and ANCOVA tests.Results: Both CBT and TFT showed better results than the WLC (p < 0.001 at post-treatment. Post-treatment and at the 12-month follow-up, there were not significant differences between CBT and TFT (p = 0.33 and p = 0.90, respectively.Conclusion: This paper reports the first study comparing TFT to CBT for any disorder. The study indicated that TFT may be an efficient treatment for patients with agoraphobia.Trial Registration:https://clinicaltrials.gov/, identifier NCT00932919.

  12. Spatial structure increases the waiting time for cancer

    DEFF Research Database (Denmark)

    Martens, Erik Andreas; Kostadinov, Rumen; Maley, Carlo C

    2011-01-01

    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 asses 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......Cancer results from a sequence of genetic and epigenetic changes which 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...

  13. 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 for -jobs, -machine, no-wait flowshop problem (NW-FSSP). A spread sheet based general purpose genetic algorithm is proposed for the NW-FSSP. The example analysis shows that the proposed approach produces results are comparable to the ...

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

    African Journals Online (AJOL)

    Background. There is currently no evidence in the South African (SA) literature to suggest how long patients with clinically suspected 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 ...

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

    Indian Academy of Sciences (India)

    approaches cited in the literature. Additionally, it is .... literature. Pan et al (2008c) presented an improved iterated greedy algorithm to minimize makespan for the no-wait flowshop scheduling problem. The superiority .... one possible chromosome according to permutation representation would be A-C-D-E-B, while another ...

  16. 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…

  17. Waiting for Superman: Neoliberal Educational Reform and the Craft of Filmic Direction

    Science.gov (United States)

    Prado, Jose; Montez de Oca, Jeffrey

    2014-01-01

    The Waiting for Superman (WFS) cultural project and its push to transform the public school system has had great appeal among those sympathetic and unsympathetic to the victims of exclusionary and exploitative school agendas. To address the workings of hegemony in the WFS cultural project the authors examine three general scenes in the WFS trailer…

  18. Popular Media Portrayals of Inequity and School Reform in "The Wire" and "Waiting for 'Superman'"

    Science.gov (United States)

    Gerstl-Pepin, Cynthia

    2015-01-01

    Two popular media forms are examined--the documentary film "Waiting for 'Superman'" and the HBO television series, "The Wire"--that present distinct, and at times conflicting, depictions of how to address educational inequity. Qualitative media content analysis was used to analyze the two media documents and to situate them…

  19. 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…

  20. 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 ...

  1. Stress reducing effects of real and artificial nature in a hospital waiting room

    NARCIS (Netherlands)

    Beukeboom, C.J.; Langeveld, D.; Tanja-Dijkstra, Karin

    2012-01-01

    Objectives: This field study investigated the potential stress-reducing effects of exposure to real or artificial nature on patients in a hospital waiting room. Additionally, it was investigated whether perceived attractiveness of the room could explain these effects. Design: In this

  2. 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 ...

  3. A delay discounting task produces a greater likelihood of waiting than a deferred gratification task.

    Science.gov (United States)

    Young, Michael E; McCoy, Anthony W

    2015-01-01

    A first-person-shooter video game was adapted for the study of choice between smaller sooner and larger later outcomes to compare the behavioral patterns produced by deferred gratification (DG) and delay discounting (DD) tasks. Participants played a game in which they could either fire their weapon sooner and do a small amount of damage or wait a few seconds to fire their weapon and do a larger amount of damage. For the DD task, a failure to fire within one second committed the player to waiting for the larger later outcome thus removing the opportunity to defect during the delay that is present in the DG task. The incentive structure changed multiple times during game play so that at times the optimal decision was to choose the smaller sooner outcome whereas at other times the optimal decision was to wait for the larger later outcome. Players assigned to the DD task showed a greater tendency to wait and lower sensitivity to the changing incentives. © Society for the Experimental Analysis of Behavior.

  4. Wait Time and Service Satisfaction at the Outpatient Clinic of a ...

    African Journals Online (AJOL)

    Background: In February 2006, Neuropsychiatric Hospital, Aro, Abeokuta launched the local charter of SERVICOM and promised the clients timely and quality services delivered with fairness, honesty, courtesy, and transparency. Implementation of this promise is yet to be evaluated. Objectives: To determine the wait time ...

  5. Corruption in The African Novels: A Study of Helon Habila's Waiting ...

    African Journals Online (AJOL)

    Corruption in The African Novels: A Study of Helon Habila's Waiting for An Angel and Ayi Kwei Armah's The Beautyful One's Are Not Yet Born. ... generation of leaders will not emulate bad leadership style from older leaders. The study will be of benefit to students, politicians and other people. The study will sensitize students ...

  6. 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.

  7. 169 Trend and Style in Habila's Waiting for an Angel Anthony ...

    African Journals Online (AJOL)

    User

    Abstract. The event of the mid 80's through the 90's in Nigeria is what Helon Habila captures in his novel Waiting for an Angel. The marriage of fiction with faction makes it a unique genre and attractive for literary scholars to explore the novel's mechanics and techniques. Consequently, this essay attempts to unravel some of ...

  8. Waiting as a determinant of store image and customer satisfaction: a ...

    African Journals Online (AJOL)

    Several studies have proposed multi-dimensional conceptualisations of service quality, store image and consumers' satisfaction with service delivery in a retail context. Although waiting time is included in a hierarchical conceptualisation of perceived service quality and is explicitly considered in the literature on service ...

  9. Quantitative modelling for wait time reduction: A comprehensive simulation applied in general surgery

    NARCIS (Netherlands)

    Vanberkel, Peter T.; Blake, J.T.

    2008-01-01

    This thesis describes the use of operational research techniques to analyze the wait list for the division of general surgery at the Capital District Health Authority (CDHA) in Halifax, Nova Scotia, Canada. A comprehensive simulation model was developed to facilitate capacity planning decisions and

  10. A comprehensive simulation for wait time reduction and capacity planning applied in general surgery

    NARCIS (Netherlands)

    Vanberkel, P.T.; Blake, John T.

    2007-01-01

    This paper describes the use of operational research techniques to analyze the wait list for the Division of General Surgery at the Capital District Health Authority in Halifax, Nova Scotia, Canada. A discrete event simulation model was developed to aid capacity planning decisions and to analyze the

  11. 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 ...

  12. Adult tonsillectomy – are long waiting lists putting patients at risk?

    African Journals Online (AJOL)

    patients had been booked for surgery between January 2000 and December 2003. Only those patients who had been waiting for at least 1½ years were included in the study. Patients were questioned on the following: (i) the number of episodes of tonsillitis per year at time of booking; (ii) number of episodes of tonsillitis per ...

  13. Hip and knee arthroplasty waiting list – how accurate and fair?

    African Journals Online (AJOL)

    Orthopaedic surgery is an expensive procedure with high patient demand for reconstructive service. This mismatch between patient demand and available service results in the requirement for surgical waiting lists. Hip- and knee-joint replacement surgery (arthroplasty) is a life-changing procedure in terms of pain reduction ...

  14. 77 FR 75253 - Culturally Significant Objects Imported for Exhibition Determinations: “Wait, Later This Will Be...

    Science.gov (United States)

    2012-12-19

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE Culturally Significant Objects Imported for Exhibition Determinations: ``Wait, Later This Will Be Nothing..., 2003), I hereby determine that the objects to be included in the exhibition ``Wait, Later This Will Be...

  15. Determinants of treatment waiting times for head and neck cancer in the Netherlands and their relation to survival.

    Science.gov (United States)

    van Harten, Michel C; Hoebers, Frank J P; Kross, Kenneth W; van Werkhoven, Erik D; van den Brekel, Michiel W M; van Dijk, Boukje A C

    2015-03-01

    Waiting to start treatment has been shown to be associated with tumor progression and upstaging in head and neck squamous cell carcinomas (HNSCCs). This diminishes the chance of cure and might lead to unnecessary mortality. We investigated the association between waiting times and survival in the Netherlands and assessed which factors were associated to longer waiting times. Patient (age, sex, socioeconomic status (SES), tumor (site, stage) and treatment (type, of institute of diagnosis/treatment) characteristics for patients with HNSCC who underwent treatment were extracted from the Netherlands Cancer Registry (NCR) for 2005-2011. Waiting time was defined as the number of days between histopathological diagnosis and start of treatment. Univariable and multivariable Cox regression was used to evaluate survival. In total, 13,140 patients were included, who had a median waiting time of 37days. Patients who were more likely to wait longer were men, patients with a low SES, oropharynx tumors, stage IV tumors, patients to be treated with radiotherapy or chemoradiation, and patients referred for treatment to a Head and Neck Oncology Center (HNOC) from another hospital. The 5-year overall survival was 58% for all patients. Our multivariable Cox regression model showed that longer waiting time, was significantly related to a higher hazard of dying (p<0.0001). This is the first large population-based study showing that longer waiting time for surgery, radiotherapy or chemoradiation is a significant negative prognostic factor for HNSCC patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. 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.

  17. Changing Course: Exploring Impacts of "Waiting for Superman" on Future Teachers' Perspectives on the State of Education

    Science.gov (United States)

    Jensen, Aaron; Janak, Edward; Slater, Timothy F.

    2012-01-01

    The controversial video documentary "Waiting for Superman," released in 2010, has helped to ignite a firestorm of national debate on current educational reforms in the United States. The purpose of this study is to determine the possible impacts of the video documentary "Waiting for Superman" potentially influencing pre-service…

  18. 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

  19. 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.

  20. Using administrative databases to measure waiting times for patients undergoing major cancer surgery in Ontario, 1993-2000.

    Science.gov (United States)

    Simunovic, Marko; Thériault, Marc-Erick; Paszat, Lawrence; Coates, Angela; Whelan, Timothy; Holowaty, Eric; Levine, Mark

    2005-04-01

    To determine how long patients in Ontario waited for major breast, colorectal, lung or prostate cancer surgery in the years 1993-2000. "Surgical waiting time" was defined as the interval from date of preoperative surgeon consult to date of hospital admission for surgery. We created patient cohorts by linking appropriate diagnosis and procedure codes from Canadian Institutes of Health Information data. Scrambled unique surgeon identifiers were obtained from Ontario Health Insurance Plan data. Changes in median surgical waiting times were assessed with univariate time-trend analyses and multilevel models. Models were controlled for year of surgery and other patient (age, gender, comorbid conditions, income level, area of residence) and hospital level characteristics (teaching status, procedure volume status). Compared with 1993, median surgical waiting times in the year 2000 increased 36% for patients with breast cancer (to 19 d), 46% with colorectal (to 19 d), 36% with lung (to 34 d) and 4% with prostate cancer (to 83 d). Multilevel models confirmed significant increases in waiting times for all procedures. There were no concerning or consistent differences in waiting times among the categories of hospitals and patients examined. There were significant increases in surgical waiting times among patients undergoing breast, colorectal, lung or prostate cancer surgery in Ontario over years 1993-2000. Administrative databases can be used to efficiently measure such waits.

  1. 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

    BACKGROUND: Monitoring wait times and defining targets for care have been advocated to improve health care delivery related to cancer, heart, diagnostic imaging, joint replacements and sight restoration. There are few data on access to care for digestive diseases, although they pose a greater economic burden than cancer or heart disease in Canada. The present study compared wait times for specialist gastroenterology care with recent, evidence-based, consensus-defined benchmark wait times for a range of digestive diseases. METHODS: Total wait times from primary care referral to investigation were measured for seven digestive disease indications by using the Practice Audit in Gastroenterology program, and were benchmarked against consensus recommendations. RESULTS: Total wait times for 1903 patients who were undergoing investigation exceeded targets for those with probable cancer (median 26 days [25th to 75th percentiles eight to 56 days] versus target of two weeks); probable inflammatory bowel disease (101 days [35 to 209 days] versus two weeks); documented iron deficiency anemia (71 days [19 to 142 days] versus two months); positive fecal occult blood test (73 days [36 to 148 days] versus two months); dyspepsia with alarm symptoms (60 days [23 to 140 days] versus two months); refractory dyspepsia without alarm symptoms (126 days [42 to 225 days] versus two months); and chronic constipation and diarrhea (141 days [68 to 264 days] versus two months). A minority of patients were seen within target times: probable cancer (33% [95% CI 20% to 47%]); probable inflammatory bowel disease (12% [95% CI 1% to 23%]); iron deficiency anemia (46% [95% CI 37% to 55%]); positive occult blood test (41% [95% CI 28% to 54%]); dyspepsia with alarm symptoms (51% [95% CI 41% to 60%]); refractory dyspepsia without alarm symptoms (33% [95% CI 19% to 47%]); and chronic constipation and diarrhea (21% [95% CI 14% to 29%]). DISCUSSION: Total wait times for the seven indications exceeded the

  2. Inferring visuomotor priors for sensorimotor learning.

    Directory of Open Access Journals (Sweden)

    Edward J A Turnham

    2011-03-01

    Full Text Available Sensorimotor learning has been shown to depend on both prior expectations and sensory evidence in a way that is consistent with Bayesian integration. Thus, prior beliefs play a key role during the learning process, especially when only ambiguous sensory information is available. Here we develop a novel technique to estimate the covariance structure of the prior over visuomotor transformations--the mapping between actual and visual location of the hand--during a learning task. Subjects performed reaching movements under multiple visuomotor transformations in which they received visual feedback of their hand position only at the end of the movement. After experiencing a particular transformation for one reach, subjects have insufficient information to determine the exact transformation, and so their second reach reflects a combination of their prior over visuomotor transformations and the sensory evidence from the first reach. We developed a Bayesian observer model in order to infer the covariance structure of the subjects' prior, which was found to give high probability to parameter settings consistent with visuomotor rotations. Therefore, although the set of visuomotor transformations experienced had little structure, the subjects had a strong tendency to interpret ambiguous sensory evidence as arising from rotation-like transformations. We then exposed the same subjects to a highly-structured set of visuomotor transformations, designed to be very different from the set of visuomotor rotations. During this exposure the prior was found to have changed significantly to have a covariance structure that no longer favored rotation-like transformations. In summary, we have developed a technique which can estimate the full covariance structure of a prior in a sensorimotor task and have shown that the prior over visuomotor transformations favor a rotation-like structure. Moreover, through experience of a novel task structure, participants can

  3. Developmental changes in anger expression and attention focus: learning to wait.

    Science.gov (United States)

    Cole, Pamela M; Tan, Patricia Z; Hall, Sarah E; Zhang, Yiyun; Crnic, Keith A; Blair, Clancy B; Li, Runze

    2011-07-01

    Being able to wait is an essential part of self-regulation. In the present study, the authors examined the developmental course of changes in the latency to and duration of target-waiting behaviors by following 65 boys and 55 girls from rural and semirural economically strained homes from ages 18 months to 48 months. Age-related changes in latency to and duration of children's anger expressions and attention focus (e.g., self-initiated distraction) during an 8-min wait for a gift were found. On average, at 18 and 24 months of age, children were quick to react angrily and slower to shift attention away from the desired object than they were at later ages. Over time, children were quicker to distract themselves. By 36 months, distractions occurred before children expressed anger, and anger expressions were briefer. At 48 months, children typically made a quick bid to their mothers about having to wait before distracting themselves; on average, they did not appear angry until the latter half of the wait. Unexpectedly, children bid to their mothers as much at age 48 months as they had at 18 months; however, bids became less angry as children got older. Developmental changes in distraction and bidding predicted age-related changes in the latency to anger. Findings are discussed in terms of the neurocognitive control of attention around age 30 months, the limitations of children's self-regulatory efforts at age 48 months, and the importance of fostering children's ability to forestall, as well as modulate, anger. PsycINFO Database Record (c) 2011 APA, all rights reserved

  4. "No Cross, No Crown": An Ethos of Presence in Margaret Prior's "Walks of Usefulness"

    Science.gov (United States)

    Shaver, Lisa

    2012-01-01

    In 1837, Margaret Prior became the first female missionary for the American Female Moral Reform Society. She traveled throughout the poorest neighborhoods in New York City--entering barrooms, brothels, and sickrooms. Based on an analysis of Prior's missionary reports, published in the society's periodical and included in her memoir, this essay…

  5. Terminology for pregnancy loss prior to viability

    DEFF Research Database (Denmark)

    Kolte, A M; Bernardi, L A; Christiansen, O B

    2015-01-01

    Pregnancy loss prior to viability is common and research in the field is extensive. Unfortunately, terminology in the literature is inconsistent. The lack of consensus regarding nomenclature and classification of pregnancy loss prior to viability makes it difficult to compare study results from...... different centres. In our opinion, terminology and definitions should be based on clinical findings, and when possible, transvaginal ultrasound. With this Early Pregnancy Consensus Statement, it is our goal to provide clear and consistent terminology for pregnancy loss prior to viability....

  6. The Dynamic Multi-Period Vehicle Routing Problem

    DEFF Research Database (Denmark)

    Wen, Min; Cordeau, Jean-Francois; Laporte, Gilbert

    This paper considers the Dynamic Multi-Period Vehicle Routing Problem which deals with the distribution of orders from a depot to a set of customers over a multi-period time horizon. Customer orders and their feasible service periods are dynamically revealed over time. The objectives are to minim......This paper considers the Dynamic Multi-Period Vehicle Routing Problem which deals with the distribution of orders from a depot to a set of customers over a multi-period time horizon. Customer orders and their feasible service periods are dynamically revealed over time. The objectives...... are to minimize total travel costs and customer waiting, and to balance the daily workload over the planning horizon. This problem originates from a large distributor operating in Sweden. It is modeled as a mixed integer linear program, and solved by means of a three-phase heuristic that works over a rolling...

  7. How do Patients Trade-Off Surgeon Choice and Waiting Times for Total Joint Replacement: A Discrete Choice Experiment.

    Science.gov (United States)

    Marshall, Deborah A; Deal, Ken; Conner-Spady, Barbara; Bohm, Eric; Hawker, Gillian; Loucks, Lynda; MacDonald, Karen V; Noseworthy, Tom

    2018-02-06

    Patients face significant waiting times for hip and knee total joint replacement (TJR) in publicly funded healthcare systems. We aimed to assess how surgeon selection and reputation affect patients' willingness to wait for TJR. We assessed patient preferences using a discrete choice experiment questionnaire with 12 choice scenarios administered to patients referred for TJR. Based on qualitative research, pre- and pilot-testing, we characterized each scenario by five attributes: surgeon reputation, surgeon selection, waiting time to surgeon visit (initial consultation), waiting time to surgery, and travel time to hospital. Preferences were assessed using hierarchical Bayes analysis and evaluated for goodness-of-fit. We conducted simulation analyses to understand how patients value surgeon reputation and surgeon selection in terms of willingness to wait for surgeon visit and surgery. Of 422 participants, 68% were referred for knee TJR. The most important attribute was surgeon reputation followed by waiting times, surgeon selection process and travel time. Patients appear willing to wait 10 months for a visit with an excellent reputation surgeon before switching to a good reputation surgeon. Patients in the highest pain category were willing to wait 7.3 months before accepting the next available surgeon, compared to 12 months for patients experiencing the least pain. Our findings confirm that patients value surgeon reputation in the context of wait times and surgeon selection. We suggest opportunities to reduce wait times by explicitly offering the next available surgeon to increase patient choice, and by reporting surgeon performance to reduce potential misinformation about reputation. Copyright © 2018 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  8. [Nutritional assessment of patients candidates for waiting list simultaneous kidney pancreas transplantation].

    Science.gov (United States)

    Iglesias, Ma L; Koll, F; Delfante, A; Sun Ho, H; Grosembacher, L; Rodota, L

    2010-01-01

    Simultaneous Kidney Pancreas transplantation is currently the treatment of choice for patients with type 1 diabetes ERD advanced. Scientific studies on the therapeutic benefits of this guarantee acceptance of it as the most suitable for patients. The independence of dialysis and insulin therapy after the transplant represents a significant increase in the quality of life for these patients. In recent years, the importance of nutritional assessment in patients with chronic diseases has increased. There is increasing evidence that malnutrition is associated with an increased risk of morbidity and mortality after surgery. Given the therapeutic choice for these patients and the importance of nutritional status as an independent risk factor for post-transplant complications objective of our work is to describe the nutritional status of patients who are candidates for transplant through objective and subjective parameters of evaluation nutritional. We included 45 patients with type 1 diabetes ERD interned in the Hospital Italiano of Buenos Aires for assessing pre Transplantation during the period June 2007-June 2008. They collected data through a sheet produced by themselves. As parameter anthropometric was calculated body mass index (BMI) by the formula Quetelet (post dialysis Weight (kg) / height 2 (m)) and was ranked as the ranges proposed by the committee of experts from WHO. As a subjective argument took place the Subjective Global Valuation (VGS), which ranked patients in well-nourished (A), mild malnourished (B), moderately malnourished (C) and severely malnourished (D). As biochemical parameters of the data was recorded serum albumin (g/dl) to hospitalizations and this data was obtained from the patient's medical history. The value of the average BMI of the total population was 21.83+/-2.65. According to the sex values were: 21.83+/-2.39 and 21.82+/-2.95 for male and female respectively. The nutritional status according to this indicator was anthropometric Normal

  9. Quality management: reduction of waiting time and efficiency enhancement in an ENT-university outpatients' department

    Directory of Open Access Journals (Sweden)

    Helbig Matthias

    2009-01-01

    Full Text Available Abstract Background Public health systems are confronted with constantly rising costs. Furthermore, diagnostic as well as treatment services become more and more specialized. These are the reasons for an interdisciplinary project on the one hand aiming at simplification of planning and scheduling patient appointments, on the other hand at fulfilling all requirements of efficiency and treatment quality. Methods As to understanding procedure and problem solving activities, the responsible project group strictly proceeded with four methodical steps: actual state analysis, analysis of causes, correcting measures, and examination of effectiveness. Various methods of quality management, as for instance opinion polls, data collections, and several procedures of problem identification as well as of solution proposals were applied. All activities were realized according to the requirements of the clinic's ISO 9001:2000 certified quality management system. The development of this project is described step by step from planning phase to inauguration into the daily routine of the clinic and subsequent control of effectiveness. Results Five significant problem fields could be identified. After an analysis of causes the major remedial measures were: installation of a patient telephone hotline, standardization of appointment arrangements for all patients, modification of the appointments book considering the reason for coming in planning defined working periods for certain symptoms and treatments, improvement of telephonic counselling, and transition to flexible time planning by daily updates of the appointments book. After implementation of these changes into the clinic's routine success could be demonstrated by significantly reduced waiting times and resulting increased patient satisfaction. Conclusion Systematic scrutiny of the existing organizational structures of the outpatients' department of our clinic by means of actual state analysis and analysis of

  10. Prior Authorization of PMDs Demonstration - Status Update

    Data.gov (United States)

    U.S. Department of Health & Human Services — CMS implemented a Prior Authorization process for scooters and power wheelchairs for people with Fee-For-Service Medicare who reside in seven states with high...

  11. Quantization of Prior Probabilities for Hypothesis Testing

    OpenAIRE

    Varshney, Kush R.; Varshney, Lav R.

    2008-01-01

    Bayesian hypothesis testing is investigated when the prior probabilities of the hypotheses, taken as a random vector, are quantized. Nearest neighbor and centroid conditions are derived using mean Bayes risk error as a distortion measure for quantization. A high-resolution approximation to the distortion-rate function is also obtained. Human decision making in segregated populations is studied assuming Bayesian hypothesis testing with quantized priors.

  12. Attentional and Contextual Priors in Sound Perception.

    Directory of Open Access Journals (Sweden)

    Michael Wolmetz

    Full Text Available Behavioral and neural studies of selective attention have consistently demonstrated that explicit attentional cues to particular perceptual features profoundly alter perception and performance. The statistics of the sensory environment can also provide cues about what perceptual features to expect, but the extent to which these more implicit contextual cues impact perception and performance, as well as their relationship to explicit attentional cues, is not well understood. In this study, the explicit cues, or attentional prior probabilities, and the implicit cues, or contextual prior probabilities, associated with different acoustic frequencies in a detection task were simultaneously manipulated. Both attentional and contextual priors had similarly large but independent impacts on sound detectability, with evidence that listeners tracked and used contextual priors for a variety of sound classes (pure tones, harmonic complexes, and vowels. Further analyses showed that listeners updated their contextual priors rapidly and optimally, given the changing acoustic frequency statistics inherent in the paradigm. A Bayesian Observer model accounted for both attentional and contextual adaptations found with listeners. These results bolster the interpretation of perception as Bayesian inference, and suggest that some effects attributed to selective attention may be a special case of contextual prior integration along a feature axis.

  13. Inference with the Median of a Prior

    Directory of Open Access Journals (Sweden)

    Ali Mohammad-Djafari

    2006-06-01

    Full Text Available We consider the problem of inference on one of the two parameters of a probability distribution when we have some prior information on a nuisance parameter. When a prior probability distribution on this nuisance parameter is given, the marginal distribution is the classical tool to account for it. If the prior distribution is not given, but we have partial knowledge such as a fixed number of moments, we can use the maximum entropy principle to assign a prior law and thus go back to the previous case. In this work, we consider the case where we only know the median of the prior and propose a new tool for this case. This new inference tool looks like a marginal distribution. It is obtained by first remarking that the marginal distribution can be considered as the mean value of the original distribution with respect to the prior probability law of the nuisance parameter, and then, by using the median in place of the mean.

  14. Observable Priors: Limiting Biases in Estimated Parameters for Incomplete Orbits

    Science.gov (United States)

    Kosmo, Kelly; Martinez, Gregory; Hees, Aurelien; Witzel, Gunther; Ghez, Andrea M.; Do, Tuan; Sitarski, Breann; Chu, Devin; Dehghanfar, Arezu

    2017-01-01

    Over twenty years of monitoring stellar orbits at the Galactic center has provided an unprecedented opportunity to study the physics and astrophysics of the supermassive black hole (SMBH) at the center of the Milky Way Galaxy. In order to constrain the mass of and distance to the black hole, and to evaluate its gravitational influence on orbiting bodies, we use Bayesian statistics to infer black hole and stellar orbital parameters from astrometric and radial velocity measurements of stars orbiting the central SMBH. Unfortunately, most of the short period stars in the Galactic center have periods much longer than our twenty year time baseline of observations, resulting in incomplete orbital phase coverage--potentially biasing fitted parameters. Using the Bayesian statistical framework, we evaluate biases in the black hole and orbital parameters of stars with varying phase coverage, using various prior models to fit the data. We present evidence that incomplete phase coverage of an orbit causes prior assumptions to bias statistical quantities, and propose a solution to reduce these biases for orbits with low phase coverage. The explored solution assumes uniformity in the observables rather than in the inferred model parameters, as is the current standard method of orbit fitting. Of the cases tested, priors that assume uniform astrometric and radial velocity observables reduce the biases in the estimated parameters. The proposed method will not only improve orbital estimates of stars orbiting the central SMBH, but can also be extended to other orbiting bodies with low phase coverage such as visual binaries and exoplanets.

  15. Absent menstrual periods - primary

    Science.gov (United States)

    Primary amenorrhea; No periods - primary; Absent periods - primary; Absent menses - primary; Absence of periods - primary ... nutrition Tumors In many cases, the cause of primary amenorrhea is not known.

  16. The Sit-and-Wait Hypothesis in Bacterial Pathogens: A Theoretical Study of Durability and Virulence

    Science.gov (United States)

    Wang, Liang; Liu, Zhanzhong; Dai, Shiyun; Yan, Jiawei; Wise, Michael J.

    2017-01-01

    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 host

  17. The Sit-and-Wait Hypothesis in Bacterial Pathogens: A Theoretical Study of Durability and Virulence.

    Science.gov (United States)

    Wang, Liang; Liu, Zhanzhong; Dai, Shiyun; Yan, Jiawei; Wise, Michael J

    2017-01-01

    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 host-mortality are

  18. The Sit-and-Wait Hypothesis in Bacterial Pathogens: A Theoretical Study of Durability and Virulence

    Directory of Open Access Journals (Sweden)

    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

  19. Assessing the impact of a waiting time survey on reducing waiting times in urban primary care clinics in Cape Town, South Africa

    Directory of Open Access Journals (Sweden)

    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.

  20. Learning to wait for more likely or just more: greater tolerance to delays of reward with increasingly longer delays.

    Science.gov (United States)

    Rung, Jillian M; Young, Michael E

    2015-01-01

    Little research has focused on training greater tolerance to delays of rewards in the context of delayed gratification. In delayed gratification, waiting for a delayed outcome necessitates the ability to resist defection for a continuously available smaller, immediate outcome. The present research explored the use of a fading procedure for producing greater waiting in a video-game based, delayed gratification task. Participants were assigned to conditions in which either the reward magnitude, or the probability of receiving a reward, was a function of time waited and the delay to the maximum reward was gradually increased throughout this training. Waiting increased for all participants but less for those waiting for a greater reward magnitude than a greater reward probability. All participants showed a tendency to wait in a final testing phase, but training with probabilistic outcomes produced a significantly greater likelihood of waiting during testing. The behavioral requirements of delay discounting versus delay gratification are discussed, as well as the benefits of training greater self-control in a variety of contexts. © Society for the Experimental Analysis of Behavior.

  1. Clinical Impact and Risk Factors of Portal Vein Thrombosis for Patients on Wait List for Liver Transplant.

    Science.gov (United States)

    Montenovo, Martin; Rahnemai-Azar, Amir; Reyes, Jorge; Perkins, James

    2017-06-16

    The effect of portal vein thrombosis on the progression of liver disease is controversial, with no consensus on optimal treatment. We aimed to assess how portal vein thrombosis affects wait list outcomes, identify risk factors associated with its development while on a wait list, and assess its effects on patient and graft survival. This US-based retrospective cohort study analyzed 134 109 adult patients on wait lists for or undergoing primary orthotopic liver transplant between January 2002 and June 2014. Rate of portal vein thrombosis development, time from entry on wait list to transplant, comparisons of wait list drop-off rates between patients with versus those without portal vein thrombosis, risk factors associated with its development while on a wait list, and its effects on patient and graft survival were analyzed. We found that the rate of portal vein thrombosis at listing increased. Patients with the disease at listing were more likely to be removed from wait lists because of being too sick. Portal vein thrombosis at listing was an independent risk factor for being removed from a wait list. Of 63 265 patients who underwent primary orthotopic liver transplant, those with the disease were more likely to have higher Model for End-Stage Liver Disease scores and incidence of nonalcoholic steatohepatitis and diabetes mellitus. Portal vein thrombosis had a negative effect on patient and graft survival. Nonalcoholic steatohepatitis, body mass index, diabetes, and hepatocellular carcinoma were identified as risk factors for its development. Portal vein thrombosis represents an increasing management and outcome burden in liver transplant. Having this disease at listing and/or at time of transplant is associated with worse patient and graft survival. Nonalcoholic steatohepatitis and hepatocellular carcinoma are among the biggest risk factors for its development while on a wait list.

  2. 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.

  3. Evolution of periodicity in periodical cicadas.

    Science.gov (United States)

    Ito, Hiromu; Kakishima, Satoshi; Uehara, Takashi; Morita, Satoru; Koyama, Takuya; Sota, Teiji; Cooley, John R; Yoshimura, Jin

    2015-09-14

    Periodical cicadas (Magicicada spp.) in the USA are famous for their unique prime-numbered life cycles of 13 and 17 years and their nearly perfectly synchronized mass emergences. Because almost all known species of cicada are non-periodical, periodicity is assumed to be a derived state. A leading hypothesis for the evolution of periodicity in Magicicada implicates the decline in average temperature during glacial periods. During the evolution of periodicity, the determinant of maturation in ancestral cicadas is hypothesized to have switched from size dependence to time (period) dependence. The selection for the prime-numbered cycles should have taken place only after the fixation of periodicity. Here, we build an individual-based model of cicadas under conditions of climatic cooling to explore the fixation of periodicity. In our model, under cold environments, extremely long juvenile stages lead to extremely low adult densities, limiting mating opportunities and favouring the evolution of synchronized emergence. Our results indicate that these changes, which were triggered by glacial cooling, could have led to the fixation of periodicity in the non-periodical ancestors.

  4. Dynamic emotion perception and prior expectancy.

    Science.gov (United States)

    Dzafic, Ilvana; Martin, Andrew K; Hocking, Julia; Mowry, Bryan; Burianová, Hana

    2016-06-01

    Social interactions require the ability to rapidly perceive emotion from various incoming dynamic, multisensory cues. Prior expectations reduce incoming emotional information and direct attention to cues that are aligned with what is expected. Studies to date have investigated the prior expectancy effect using static emotional images, despite the fact that dynamic stimuli would represent greater ecological validity. The objective of the study was to create a novel functional magnetic resonance imaging (fMRI) paradigm to examine the influence of prior expectations on naturalistic emotion perception. For this purpose, we developed a dynamic emotion perception task, which consisted of audio-visual videos that carry emotional information congruent or incongruent with prior expectations. The results show that emotional congruency was associated with activity in prefrontal regions, amygdala, and putamen, whereas emotional incongruency was associated with activity in temporoparietal junction and mid-cingulate gyrus. Supported by the behavioural results, our findings suggest that prior expectations are reinforced after repeated experience and learning, whereas unexpected emotions may rely on fast change detection processes. The results from the current study are compatible with the notion that the ability to automatically detect unexpected changes in complex dynamic environments allows for adaptive behaviours in potentially advantageous or threatening situations. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Delayed gratification: A grey parrot (Psittacus erithacus) will wait for a better reward.

    Science.gov (United States)

    Koepke, Adrienne E; Gray, Suzanne L; Pepperberg, Irene M

    2015-11-01

    Delay of gratification, the ability to forgo an immediate reward to gain either better quality or quantity, has been used as a metric for temporal discounting, self-control, and the ability to plan for the future in both humans (particularly children) and nonhumans. The task involved can be parsed in several ways, such that the subjects can be required to wait, not only for a better or a larger reward, but also such that the rewards can either be in view or hidden during the delay interval. We have demonstrated that a Grey parrot (Psittacus erithacus) trained in the use of English speech could respond to the label "wait" for up to 15 min, in a task that has many similarities to those used with young children, to receive a better quality reward, whether or not the better quality reward or the experimenter was in view. (c) 2015 APA, all rights reserved).

  6. Kidney transplantation: experience of men in hemodialysis entered on the waiting list

    Directory of Open Access Journals (Sweden)

    Ana Mariele de Souza

    2016-04-01

    Full Text Available Objective: to know the experiences of men with chronic renal failure under hemodialysis treatment entered on the kidney transplant waiting list. Method: qualitative study based on the principles of the National Policy for Integral Attention to Men’s Health and Masculinity, conducted with 11 participants in a hemodialysis service, through serial semi-structured interviews and inductive data analysis. Results: the following categories emerged: Gaps between the health policies and the reality of the male population and Challenges and possibilities of change in the life process. Conclusion: although many of these men see hemodialysis as synonym of imprisonment, others understand it as the possibility of maintaining survival and this help them waiting for the kidney transplant.

  7. Outcome Probability versus Magnitude: When Waiting Benefits One at the Cost of the Other

    Science.gov (United States)

    Young, Michael E.; Webb, Tara L.; Rung, Jillian M.; McCoy, Anthony W.

    2014-01-01

    Using a continuous impulsivity and risk platform (CIRP) that was constructed using a video game engine, choice was assessed under conditions in which waiting produced a continuously increasing probability of an outcome with a continuously decreasing magnitude (Experiment 1) or a continuously increasing magnitude of an outcome with a continuously decreasing probability (Experiment 2). Performance in both experiments reflected a greater desire for a higher probability even though the corresponding wait times produced substantive decreases in overall performance. These tendencies are considered to principally reflect hyperbolic discounting of probability, power discounting of magnitude, and the mathematical consequences of different response rates. Behavior in the CIRP is compared and contrasted with that in the Balloon Analogue Risk Task (BART). PMID:24892657

  8. Outcome probability versus magnitude: when waiting benefits one at the cost of the other.

    Directory of Open Access Journals (Sweden)

    Michael E Young

    Full Text Available Using a continuous impulsivity and risk platform (CIRP that was constructed using a video game engine, choice was assessed under conditions in which waiting produced a continuously increasing probability of an outcome with a continuously decreasing magnitude (Experiment 1 or a continuously increasing magnitude of an outcome with a continuously decreasing probability (Experiment 2. Performance in both experiments reflected a greater desire for a higher probability even though the corresponding wait times produced substantive decreases in overall performance. These tendencies are considered to principally reflect hyperbolic discounting of probability, power discounting of magnitude, and the mathematical consequences of different response rates. Behavior in the CIRP is compared and contrasted with that in the Balloon Analogue Risk Task (BART.

  9. Outcome probability versus magnitude: when waiting benefits one at the cost of the other.

    Science.gov (United States)

    Young, Michael E; Webb, Tara L; Rung, Jillian M; McCoy, Anthony W

    2014-01-01

    Using a continuous impulsivity and risk platform (CIRP) that was constructed using a video game engine, choice was assessed under conditions in which waiting produced a continuously increasing probability of an outcome with a continuously decreasing magnitude (Experiment 1) or a continuously increasing magnitude of an outcome with a continuously decreasing probability (Experiment 2). Performance in both experiments reflected a greater desire for a higher probability even though the corresponding wait times produced substantive decreases in overall performance. These tendencies are considered to principally reflect hyperbolic discounting of probability, power discounting of magnitude, and the mathematical consequences of different response rates. Behavior in the CIRP is compared and contrasted with that in the Balloon Analogue Risk Task (BART).

  10. Not all waits are equal: An exploratory investigation of emergency care patient pathways

    OpenAIRE

    Swancutt, D; Joel-Edgar, S; Allen, M; Thomas, D.; Brant, H; Benger, J.; Byng, R.; Pinkney, J.

    2017-01-01

    BACKGROUND: Increasing pressure in the United Kingdom (UK) urgent care system has led to Emergency Departments (EDs) failing to meet the national requirement that 95% of patients are admitted, discharged or transferred within 4-h of arrival. Despite the target being the same for all acute hospitals, individual Trusts organise their services in different ways. The impact of this variation on patient journey time and waiting is unknown. Our study aimed to apply the Lean technique of Value Strea...

  11. Patients with Chronic Hepatitis C Undergoing Watchful Waiting: Exploring Trajectories of Illness Uncertainty and Fatigue

    OpenAIRE

    Bailey, Donald E.; Barroso, Julie; Muir, Andrew J.; Sloane, Richard; Richmond, Jacqui; McHutchison, John; Patel, Keyur; Landerman, Lawrence; Mishel, Merle H.

    2010-01-01

    We identified trajectories of illness uncertainty in chronic hepatitis C patients and examined their association with fatigue levels during 12 months of disease monitoring without treatment (watchful waiting). Sixty-two men and 63 women completed uncertainty and fatigue measures. Groups were formed by uncertainty scores (high, medium, low) at baseline. Baseline fatigue levels were higher in the high uncertainty group than in the medium and low groups. Over time, uncertainty levels did not cha...

  12. Waiting-time distributions of magnetic discontinuities: clustering or Poisson process?

    Science.gov (United States)

    Greco, A; Matthaeus, W H; Servidio, S; Dmitruk, P

    2009-10-01

    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.

  13. A marketing perspective on the influences of waiting time and servicescape on perceived value

    OpenAIRE

    Costinel DOBRE; Anca Cristina DRAGOMIR; Anca-Maria MILOVAN-CIUTA

    2013-01-01

    Customer’s value perception of products and services is a variable with important implications on the marketing performance of the organizations. In this article we intend to analyse influences of waiting time and servicescape perception on the perceived value of customers of a dental clinic. The empirical research carried out for the elaboration of this article is part of a wider research concerning the multidimensional approach of the service value perceived by clients. Survey findings show...

  14. 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 and id...... and statistical tests, including a simple bootstrap two-sample test for comparing patience distributions. A small simulation study and a real data example are presented....

  15. GENERAL ASPECTS REGARDING THE PRIOR DISCIPLINARY RESEARCH

    Directory of Open Access Journals (Sweden)

    ANDRA PURAN (DASCĂLU

    2012-05-01

    Full Text Available Disciplinary research is the first phase of the disciplinary action. According to art. 251 paragraph 1 of the Labour Code no disciplinary sanction may be ordered before performing the prior disciplinary research.These regulations provide an exception: the sanction of written warning. The current regulations in question, kept from the old regulation, provides a protection for employees against abuses made by employers, since sanctions are affecting the salary or the position held, or even the development of individual employment contract. Thus, prior research of the fact that is a misconduct, before a disciplinary sanction is applied, is an essential condition for the validity of the measure ordered. Through this study we try to highlight some general issues concerning the characteristics, processes and effects of prior disciplinary research.

  16. Bridging and downstaging treatments for hepatocellular carcinoma in patients on the waiting list for liver transplantation.

    Science.gov (United States)

    Pompili, Maurizio; Francica, Giampiero; Ponziani, Francesca Romana; Iezzi, Roberto; Avolio, Alfonso Wolfango

    2013-11-21

    Several therapeutic procedures have been proposed as bridging treatments for patients with hepatocellular carcinoma (HCC) awaiting liver transplantation (LT). The most used treatments include transarterial chemoembolization and radiofrequency ablation. Surgical resection has also been successfully used as a bridging procedure, and LT should be considered a rescue treatment in patients with previous HCC resection who experience tumor recurrence or post-treatment severe decompensation of liver function. The aims of bridging treatments include decreasing the waiting list dropout rate before transplantation, reducing HCC recurrence after transplantation, and improving post-transplant overall survival. To date, no data from prospective randomized studies are available; however, for HCC patients listed for LT within the Milan criteria, prolonging the waiting time over 6-12 mo is a risk factor for tumor spread. Bridging treatments are useful in containing tumor progression and decreasing dropout. Furthermore, the response to pre-LT treatments may represent a surrogate marker of tumor biological aggressiveness and could therefore be evaluated to prioritize HCC candidates for LT. Lastly, although a definitive conclusion can not be reached, the experiences reported to date suggest a positive impact of these treatments on both tumor recurrence and post-transplant patient survival. Advanced HCC may be downstaged to achieve and maintain the current conventional criteria for inclusion in the waiting list for LT. Recent studies have demonstrated that successfully downstaged patients can achieve a 5-year survival rate comparable to that of patients meeting the conventional criteria without requiring downstaging.

  17. Improving the waiting list by using 75-year-old donors for recipients with hepatocellular carcinoma.

    Science.gov (United States)

    Cascales Campos, P A; Romero, P R; Gonzalez, R; Zambudio, A R; Martinez Frutos, I M; de la Peña, J; Bueno, F S; Robles Campos, R; Miras, M; Pons Miñano, J A; Sanmartin Monzo, A; Domingo, J; Bixquert Montagud, V; Parrilla Paricio, P

    2010-03-01

    The best treatment for hepatocellular carcinoma (HCC) associated with liver cirrhosis is liver transplantation and the best results are obtained when the tumors fulfill the Milan criteria. However, although the number of transplants is increasing, the organ deficit is growing, which lengthens time on the waiting list, increasing the risk of tumor progression of and exclusion from the list. The use of elderly donors is a valid option for patients on the transplant waiting list with HCC, reducing time on the waiting list. We report our experience with patients transplanted for HCC associated with hepatic cirrhosis using livers from donors >75 years of age. Our preliminary results supported the use of elderly suboptimal donors making it possible to give priority to these patients. All patients in the series achieved good graft function after a follow-up of 2 years with a 100% disease-free survival rate. More extensive long-term studies are needed to confirm these findings. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  18. A Scheduling Method to Reduce Waiting Time for Close-Range Broadcasting

    Directory of Open Access Journals (Sweden)

    Yusuke Gotoh

    2012-01-01

    Full Text Available Due to the recent popularization of digital broadcasting systems, close-range broadcasting using continuous media data, i.e. audio and video, has attracted great attention. For example, in a drama, after a user watches interesting content such as a highlight scene, he/she will watch the main program continuously. In close-range broadcasting, the necessary bandwidth for continuously playing the two types of data increases. Conventional methods reduce the necessary bandwidth by producing an effective broadcast schedule for continuous media data. However, these methods do not consider the broadcast schedule for two types of continuous media data. When the server schedules two types of continuous media data, waiting time that occurs from finishing the highlight scene to starting the main scene, may increase. In this paper, we propose a scheduling method to reduce the waiting time for close-range broadcasting. In our proposed method, by dividing two types of data and producing an effective broadcast schedule considering the available bandwidth, we can reduce the waiting time.

  19. Numbers and prior knowledge in sentence comprehension

    Directory of Open Access Journals (Sweden)

    Pedro Macizo

    2013-01-01

    Full Text Available We evaluated whether the comprehension of sentences that contained numerical information could benefit from presenting numbers in Arabic format and from using prior knowledge. Participants read sentences including numbers (Arabic digits or number words while the comprehension accuracy was evaluated. In addition, the sentences were biased or unbiased by people's prior knowledge about quantities. The results showed better comprehension for sentences that contained Arabic digits as compared to number words. Moreover, biased sentences were understood more accurately than unbiased sentences. These results indicate that information about magnitude in sentence context is comprehended better when quantities are presented in Arabic format and when they are associated with participants' world knowledge.

  20. Validity in assessment of prior learning

    DEFF Research Database (Denmark)

    Wahlgren, Bjarne; Aarkrog, Vibe

    2015-01-01

    , the article discusses the need for specific criteria for assessment. The reliability and validity of the assessment procedures depend on whether the competences are well-defined, and whether the teachers are adequately trained for the assessment procedures. Keywords: assessment, prior learning, adult......The article deals with the results of a study of school-based assessment of adults who have enrolled as students at a vocational college in order to qualify for occupations as skilled workers. Based on examples of methods for assessing the students’ prior learning in a programme for hairdressers...

  1. What made you wait so long? Delays in presentation of retinal detachment: knowledge is related to an attached macula.

    Science.gov (United States)

    Eijk, Eva S V; Busschbach, Jan J V; Timman, Reinier; Monteban, Helma C; Vissers, Jan M H; van Meurs, Jan C

    2016-08-01

    In rhegmatogenous retinal detachment, the time between first symptoms and reattachment surgery is critical to prevent macular detachment. We explored which determinants discriminate between 'macula-ON' and 'macula-OFF' retinal detachments to improve timely treatment. Eight-hundred patients with rhegmatogenous retinal detachment admitted for surgery at the Rotterdam Eye Hospital in the Netherlands were eligible to complete a questionnaire to explore the following determinants: (i) patient's delay and doctor's delay; (ii) patient-reported causes for delay; (iii) symptoms as early warning signals; (iv) patient's prior knowledge about retinal detachment; and (v) trait anxiety. Five hundred and twenty-one questionnaires (65%) were analysed. Median interval between first symptoms and surgery was 14 days. Macula-ON/OFF ratio was 46/54. Patient's delay in macula-ON patients (median 3 days) was shorter than in macula-OFF (5 days, p = 0.026). No difference was found in doctor's delay except for 'waiting time for surgery': macula-ON patients were operated on faster (median 1 day) than macula-OFF (median 5 days, p Macula-ON patients more often attributed symptoms to retinal problems. Except floaters, no symptoms were determined as early warning signals for macula-ON. Macula-ON patients more often reported knowing that prognosis would be worse when treated later, even when controlled for previous experience with retinal detachment. Macula-ON patients seem to self-refer faster to a healthcare provider, seem more sensitive to floaters and seem more informed. This suggests that increasing awareness, especially about floaters, might increase the proportion of patients with macula still on at the moment of referral to the ophthalmologist. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  2. Effects of Positive Psychology Interventions on Risk Biomarkers in Coronary Patients: A Randomized, Wait-List Controlled Pilot Trial.

    Science.gov (United States)

    Nikrahan, Gholam Reza; Laferton, Johannes A C; Asgari, Karim; Kalantari, Mehrdad; Abedi, Mohammad Reza; Etesampour, Ali; Rezaei, Abbas; Suarez, Laura; Huffman, Jeff C

    2016-01-01

    Among cardiac patients, positive psychologic factors are consistently linked with superior clinical outcomes and improvement in key markers of inflammation and hypothalamic-pituitary-adrenal axis functioning. Further, positive psychology interventions (PPI) have effectively increased psychologic well-being in a wide variety of populations. However, there has been minimal study of PPIs in cardiac patients, and no prior study has evaluated their effect on key prognostic biomarkers of cardiac outcome. Accordingly, we investigated the effect of 3 distinct PPIs on risk biomarkers in cardiac patients. In an exploratory trial, 69 patients with recent coronary artery bypass graft surgery or percutaneous intervention were randomized to (1) one of three 6-week in-person PPIs (based on the work of Seligman, Lyubomirsky, or Fordyce) or (2) a wait-list control group. Risk biomarkers were assessed at baseline, postintervention (7 weeks), and at 15-week follow-up. Between-group differences in change from baseline biomarker levels were examined via random effects models. Compared with the control group, participants randomized to the Seligman (B = -2.06; p = 0.02) and Fordyce PPI (B = -1.54; p = 0.04) had significantly lower high-sensitivity C-reactive protein levels at 7 weeks. Further, the Lyubomirsky PPI (B = -245.86; p = 0.04) was associated with a significantly lower cortisol awakening response at 7 weeks when compared with control participants. There were no other significant between-group differences. Despite being an exploratory pilot study with multiple between-group comparisons, this initial trial offers the first suggestion that PPIs might be effective in reducing risk biomarkers in high-risk cardiac patients. Copyright © 2016 The Academy of Psychosomatic Medicine. All rights reserved.

  3. Ablation therapy in containing extension of hepatocellular carcinoma: a simulative analysis of dropout from the waiting list for liver transplantation.

    Science.gov (United States)

    Yamashiki, Noriyo; Tateishi, Ryosuke; Yoshida, Haruhiko; Shiina, Shuichiro; Teratani, Takuma; Sato, Shinpei; Mine, Norio; Kondo, Yuji; Kawabe, Takao; Omata, Masao

    2005-05-01

    The dropout from the waiting list for liver transplantation among patients with hepatocellular carcinoma (HCC) is reportedly as high as 12% to 40% per year, mostly due to tumor progression. Considering the scarcity of donor organs, it would be beneficial if we could retain them within the Milan criteria with a bridging therapy. We retrospectively analyzed the prognosis of 288 HCC patients with relatively preserved liver function we treated with ablation therapy between 1997 and 2001, concentrating on whether they subsequently remained in the criteria, and analyzed the risk factors of dropout with Cox proportional hazards model. During a median follow-up period of 39 months (range, 1-86 months), 33 (11%) died without tumor progression, while 85 (30%) dropped out due to tumor progression. The overall dropout rate was 9.0% and 32.8% at 1 and 3 years, respectively, and that due to tumor progression was 6.2% and 23.0%. Cox regression analysis indicated that a high serum level of alpha-fetoprotein or des-gamma-carboxy prothrombin, and a tumor size exceeding 3 cm in diameter affected the dropout due to tumor progression, while low albumin concentration was a risk factor of death independently of tumor progression. In conclusion, local ablation therapy for HCC was effective in containing the tumor progression within the Milan criteria in selected patients.

  4. Using Social Media While Waiting in Pain: A Clinical 12-Week Longitudinal Pilot Study.

    Science.gov (United States)

    Merolli, Mark; Gray, Kathleen; Martin-Sanchez, Fernando; Mantopoulos, Steven; Hogg, Malcolm

    2015-08-07

    Chronic pain places an enormous burden on health care systems. Multidisciplinary pain management services are well documented as an effective means to improve patient outcomes. However, waiting lists to access these services are long and outcomes deteriorate. Innovative solutions such as social media are gaining attention as a way to decrease this burden and improve outcomes. It is a challenge to design research that demonstrates whether social media are acceptable to patients and clinically effective. The aim was to conduct a longitudinal pilot study to understand what aspects of research design are key to the success of running a larger-scale study of social media use in the clinical management of chronic pain. A 12-week study examined social media use by patients on the waiting list for the Royal Melbourne Hospital Pain Management Service. Selected social media resources were suggested for use by patients waiting for an appointment at the clinic. Patients filled out measures for pain interference and pain self-efficacy before and after the study. Follow-up was conducted at monthly intervals via telephone semistructured interviews to discuss engagement and garner individual perceptions towards social media use. A social media-use instrument was also administered as part of the after-study questionnaire. Targeted recruitment refined 235 patient referrals to 138 (58.7%) suitable potential participants. Contact was made with 84 out of 138 (60.9%) patients. After a further exclusion of 54 out of 84 (64%) patients for various reasons, this left 30 out of 84 (36%) patients fitting the inclusion criteria and interested in study participation. A final study cohort of 17 out of 30 (57%) was obtained. Demographics of the 17 patients were mixed. Low back pain was the primary condition reported as leading to chronic pain. Semistructured interviews collected data from 16 out of 17 (94%) patients who started the trial, and at final follow-up 9 out of 17 (53%) patients

  5. Recognition of Prior Learning: The Participants' Perspective

    Science.gov (United States)

    Miguel, Marta C.; Ornelas, José H.; Maroco, João P.

    2016-01-01

    The current narrative on lifelong learning goes beyond formal education and training, including learning at work, in the family and in the community. Recognition of prior learning is a process of evaluation of those skills and knowledge acquired through life experience, allowing them to be formally recognized by the qualification systems. It is a…

  6. Student Models for Prior Knowledge Estimation

    Science.gov (United States)

    Nižnan, Juraj; Pelánek, Radek; Rihák, Jirí

    2015-01-01

    Intelligent behavior of adaptive educational systems is based on student models. Most research in student modeling focuses on student learning (acquisition of skills). We focus on prior knowledge, which gets much less attention in modeling and yet can be highly varied and have important consequences for the use of educational systems. We describe…

  7. Reichenbach, Prior and Hybrid Tense Logic

    DEFF Research Database (Denmark)

    Blackburn, Patrick Rowan; Jørgensen, Klaus Frovin

    2016-01-01

    In this paper we combine central insights of Prior and Reichenbach in the framework of hybrid tense logic. We do so in a way that overcomes a well-known defect of Reichenbach’s original tense schema, namely that it gives multiple representations to sentences in the Future perfect and the Future...

  8. Prior learning assessment and quality assurance practice ...

    African Journals Online (AJOL)

    ... Prior Learning) in higher education to assess RPL candidates for admission into programmes of study met with a lot of criticism from faculty academics. Lecturers viewed the possibility of admitting large numbers of under-qualified adult learners, as a threat to the institution's reputation, or an erosion of academic standards.

  9. Respiratory risk assessment prior to extrathoracic surgery

    African Journals Online (AJOL)

    2011-04-11

    Apr 11, 2011 ... after surgery, including early hypoxemia and unplanned reintubation.10 While the literature is still emerging, OSA should be considered to be a probable risk factor for pulmonary complications after surgery. At present, it is unknown whether patients without OSA should be screened prior to elective surgery.

  10. Models for Validation of Prior Learning (VPL)

    DEFF Research Database (Denmark)

    Ehlers, Søren

    would have been categorized as utopian can become realpolitik. Validation of Prior Learning (VPL) was in Europe mainly regarded as utopian while universities in the United States of America (USA) were developing ways to obtain credits to those students which was coming with experiences from working life....

  11. Prior Learning Assessment with Latent Semantic Analysis

    NARCIS (Netherlands)

    Kalz, Marco; Van Bruggen, Jan; Giesbers, Bas; Koper, Rob

    2007-01-01

    Kalz, M., Van Bruggen, J., Giesbers, B., & Koper, R. (2007). Prior Learning Assessment with Latent Semantic Analysis. In F. Wild, M. Kalz, J. Van Bruggen & R. Koper (Eds.). Proceedings of the First European Workshop on Latent Semantic Analysis in Technology Enhanced Learning (pp. 24-25). Heerlen,

  12. Prior Learning Assessment with Latent Semantic Analysis

    OpenAIRE

    Kalz, Marco; van Bruggen, Jan; Giesbers, Bas; Koper, Rob

    2007-01-01

    Kalz, M., Van Bruggen, J., Giesbers, B., & Koper, R. (2007). Prior Learning Assessment with Latent Semantic Analysis. In F. Wild, M. Kalz, J. Van Bruggen & R. Koper (Eds.). Proceedings of the First European Workshop on Latent Semantic Analysis in Technology Enhanced Learning (pp. 24-25). Heerlen, The Netherlands: Open University of the Netherlands.

  13. Prior listening in rooms improves speech intelligibility.

    Science.gov (United States)

    Brandewie, Eugene; Zahorik, Pavel

    2010-07-01

    Although results from previous studies have demonstrated that the acoustic effects of a single reflection are perceptually suppressed after repeated exposure to a particular configuration of source and reflection, the extent to which this dynamic echo suppression might generalize to speech understanding in room environments with multiple reflections and reverberation is largely unknown. Here speech intelligibility was measured using the coordinate response measure corpus both with and without prior listening exposure to a reverberant room environment, which was simulated using virtual auditory space techniques. Prior room listening exposure was manipulated by presenting either a two-sentence carrier phrase that preceded the target speech, or no carrier phrase within the room environment. Results from 14 listeners indicate that with prior room exposure, masked speech reception thresholds were on average 2.7 dB lower than thresholds without exposure, an improvement in intelligibility of over 18 percentage points on average. This effect, which is shown to be absent in anechoic space and greatly reduced under monaural listening conditions, demonstrates that prior binaural exposure to reverberant rooms can improve speech intelligibility, perhaps due to a process of perceptual adaptation to the acoustics of the listening room.

  14. The prior statistics of object colors

    NARCIS (Netherlands)

    Koenderink, J.J.

    2010-01-01

    The prior statistics of object colors is of much interest because extensive statistical investigations of reflectance spectra reveal highly non-uniform structure in color space common to several very different databases. This common structure is due to the visual system rather than to the statistics

  15. Offending prior to first psychiatric contact

    DEFF Research Database (Denmark)

    Stevens, Hanne; Agerbo, Esben; Dean, K

    2012-01-01

    There is a well-established association between psychotic disorders and subsequent offending but the extent to which those who develop psychosis might have a prior history of offending is less clear. Little is known about whether the association between illness and offending exists in non-psychot...

  16. Short Report Biochemical derangements prior to emergency ...

    African Journals Online (AJOL)

    The aim of this study was to examine biochemical investigations not routinely performed prior to emergency laparotomy in patients at Queen Elizabeth. Central Hospital, a low-resource public hospital in Blantyre, Malawi.. Methods. A prospective cross-sectional study of adults (N = 15) needing emergency laparotomy over a ...

  17. 19 CFR 162.74 - Prior disclosure.

    Science.gov (United States)

    2010-04-01

    ..., so informed the person of the type of or circumstances of the disclosed violation; or (ii) A Customs... 19 Customs Duties 2 2010-04-01 2010-04-01 false Prior disclosure. 162.74 Section 162.74 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY...

  18. An Estimation Method of Waiting Time for Health Service at Hospital by Using a Portable RFID and Robust Estimation

    Science.gov (United States)

    Ishigaki, Tsukasa; Yamamoto, Yoshinobu; Nakamura, Yoshiyuki; Akamatsu, Motoyuki

    Patients that have an health service by doctor have to wait long time at many hospitals. The long waiting time is the worst factor of patient's dissatisfaction for hospital service according to questionnaire for patients. The present paper describes an estimation method of the waiting time for each patient without an electronic medical chart system. The method applies a portable RFID system to data acquisition and robust estimation of probability distribution of the health service and test time by doctor for high-accurate waiting time estimation. We carried out an health service of data acquisition at a real hospital and verified the efficiency of the proposed method. The proposed system widely can be used as data acquisition system in various fields such as marketing service, entertainment or human behavior measurement.

  19. Individual and Regional Factors of Access to the Renal Transplant Waiting List in France in a Cohort of Dialyzed Patients

    National Research Council Canada - National Science Library

    Bayat, S; Macher, M. A; Couchoud, C; Bayer, F; Lassalle, M; Villar, E; Caillé, Y; Mercier, S; Joyeux, V; Noel, C; Kessler, M; Jacquelinet, C

    2015-01-01

    This study demonstrates that in addition to individual factors such as age and comorbidities, the accumulation of patients on the waiting list, likely related to regional variations in organ shortage...

  20. Improved functional outcome after hip fracture is associated with duration of rehabilitation, but not with waiting time for rehabilitation

    DEFF Research Database (Denmark)

    Pedersen, Tonny Jaeger; Bogh, Louise Nicole Bie; Lauritsen, Jens Martin

    2017-01-01

    INTRODUCTION: The aim of this study was to explore the relationship between “waiting time to onset of municipal rehabilitation”, “length of municipal rehabilitation” and the attained level of function four months after the hip fracture. METHODS: Among a consecutive series of 156 patients, the 116...... patients who were recommended a municipal rehabilitation sequence after discharge were included. The exposures were waiting time in days and duration in hours of the municipal rehabilitation. The outcome was lower-extremity functional level as measured with the Short Physical Performance Battery. Effects...... were assessed with non-parametric gamma coefficients. RESULTS: The median waiting time to initiation of rehabilitation was ten days. A weak and insignificant correlation was observed between waiting time and outcome at four months, and a statistically significant correlation was recorded between...