WorldWideScience

Sample records for waiting time

  1. Reducing client waiting time.

    Science.gov (United States)

    1992-01-01

    This first issues of Family Planning (FP) Manager focuses on how to analyze client waiting time and reduce long waits easily and inexpensively. Client flow analysis can be used by managers and staff to identify organizational factors affecting waiting time. Symptoms of long waiting times are overcrowded waiting rooms, clients not returning for services, staff complaints about rushing and waiting, and hurried counseling sessions. Client satisfaction is very important in order to retain FP users. Simple procedures such as routing return visits differently can make a difference in program effectiveness. Assessment of the number of first visits, the number of revisits, and types of methods and services that the clinic provides is a first step. Client flow analysis involves assigning a number to each client on registration, attaching the client flow form to the medical chart, entering the FP method and type of visit, asking staff to note the time at each station, and summarizing data in a master chart. The staff should be involved in plotting data for each client to show waiting versus staff contact time through the use of color coding for each type of staff contact. Bottlenecks become very visible when charted. The amount of time spent at each station can be measured, and gaps in client's contact with staff can be identified. An accurate measure of total waiting time can be obtained. A quick assessment can be made by recording arrival and departure times for each client in one morning or afternoon of a peak day. The procedure is to count the number of clients waiting at 15-minute intervals. The process should be repeated every 3-6 months to observe changes. If waiting times appear long, a more thorough assessment is needed on both a peak and a typical day. An example is given of a completed chart and graph of results with sample data. Managers need to set goals for client flow, streamline client routes, and utilize waiting time wisely by providing educational talks

  2. Organ Type and Waiting Time

    Science.gov (United States)

    ... Kidney/Pancreas Liver Intestine Organ Type and Waiting Time Most candidates, except those with living donors, wait ... organ needed How does organ type affect waiting times? Heart Allocation Physicians assign a status code to ...

  3. 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....

  4. Waiting time guarantee - an update

    DEFF Research Database (Denmark)

    Socha, Karolina; Bech, Mickael

    2008-01-01

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

  5. Advertising Emergency Department Wait Times

    Science.gov (United States)

    Weiner, Scott G.

    2013-01-01

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

  6. Advertising emergency department wait times.

    Science.gov (United States)

    Weiner, Scott G

    2013-03-01

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

  7. Mathematical Models of Waiting Time.

    Science.gov (United States)

    Gordon, Sheldon P.; Gordon, Florence S.

    1990-01-01

    Considered are several mathematical models that can be used to study different waiting situations. Problems involving waiting at a red light, bank, restaurant, and supermarket are discussed. A computer program which may be used with these problems is provided. (CW)

  8. 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...

  9. Can We Predict Patient Wait Time?

    Science.gov (United States)

    Pianykh, Oleg S; Rosenthal, Daniel I

    2015-10-01

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

  10. 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 f

  11. 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…

  12. Waiting time distributions in financial markets

    Science.gov (United States)

    Sabatelli, L.; Keating, S.; Dudley, J.; Richmond, P.

    2002-05-01

    We study waiting time distributions for data representing two completely different financial markets that have dramatically different characteristics. The first are data for the Irish market during the 19th century over the period 1850 to 1854. A total of 10 stocks out of a database of 60 are examined. The second database is for Japanese yen currency fluctuations during the latter part of the 20th century (1989-1992). The Irish stock activity was recorded on a daily basis and activity was characterised by waiting times that varied from one day to a few months. The Japanese yen data was recorded every minute over 24 hour periods and the waiting times varied from a minute to a an hour or so. For both data sets, the waiting time distributions exhibit power law tails. The results for Irish daily data can be easily interpreted using the model of a continuous time random walk first proposed by Montroll and applied recently to some financial data by Mainardi, Scalas and colleagues. Yen data show a quite different behaviour. For large waiting times, the Irish data exhibit a cut off; the Yen data exhibit two humps that could arise as result of major trading centres in the World.

  13. 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.

  14. Deadlocks and waiting times in traffic jam

    OpenAIRE

    Mukherji, Sutapa; Bhattacharjee, Somendra M.

    1997-01-01

    In a city of right moving and upmoving cars with hardcore constraint, traffic jam occurs in the form of bands. We show how the bands are destroyed by a small number of strictly left moving cars yielding a deadlock phase with a rough edge of left cars. We also show that the probability of waiting time at a signal for a particular tagged car has a power law dependence on time, indicating the absence of any characteristic time scale for an emergent traffic jam. The exponent is same for both the ...

  15. First passage times: Busy periods and waiting times

    Institute of Scientific and Technical Information of China (English)

    徐光煇; 袁学明

    1995-01-01

    General expressions of first passage times for denumerable Markov processes are discussed and computation problems for busy periods and waiting times for queues corresponding to Markov processes are studied. In particular, the simplified algorithms for busy periods and waiting times for queues corresponding to G//M/1 type and M/G/1 type Markov processes are derived and some numerical examples are presented.

  16. 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...

  17. 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...

  18. Regional differences in waiting time to pregnancy

    DEFF Research Database (Denmark)

    Juul, Svend; Karmaus, W; Olsen, Jørn

    1999-01-01

    of the pregnancies were planned (64%) and approximately 14% were the result of contraceptive failures. The study shows that smoking, body mass index, age and parity did not explain the differences in fecundity found between the centres. Regional differences in fecundity exist and the causes may be genetic or due......The objective of this study was examine geographical variation in couple fecundity in Europe. The study was based upon all recently pregnant (or still pregnant) women within well-defined geographical areas in Europe (Denmark, Germany, Italy, Sweden and France) at a given time period in 1992....... Altogether, 4035 women responded to a highly structured questionnaire. Highest fecundity was found in Southern Italy and Northern Sweden; lowest fecundity was seen in data from the East German centre. Approximately 16% of the study population had a waiting time of more than 12 months to become pregnant. Most...

  19. Mean waiting time approximation for a real time polling system

    Institute of Scientific and Technical Information of China (English)

    Cao Chunsheng; Yin Rupo; Zhang Weidong; Cai Yunze

    2007-01-01

    This paper considers a novel polling system with two classes of message which can experience an upper bounded time before being served . The station serves these two classes with mixed service discipline , one class with exhaustive service discipline, and the other with gated service discipline. Using iterative method, we have developed an approximation method to obtain the mean waiting time for each message class . The performance of approximation has been compared with the simulation results . The expression for the upper bound of waiting time is given too .

  20. 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...

  1. Waiting time distribution for continuous stochastic systems.

    Science.gov (United States)

    Gernert, Robert; Emary, Clive; Klapp, Sabine H L

    2014-12-01

    The waiting time distribution (WTD) is a common tool for analyzing discrete stochastic processes in classical and quantum systems. However, there are many physical examples where the dynamics is continuous and only approximately discrete, or where it is favourable to discuss the dynamics on a discretized and a continuous level in parallel. An example is the hindered motion of particles through potential landscapes with barriers. In the present paper we propose a consistent generalization of the WTD from the discrete case to situations where the particles perform continuous barrier crossing characterized by a finite duration. To this end, we introduce a recipe to calculate the WTD from the Fokker-Planck (Smoluchowski) equation. In contrast to the closely related first passage time distribution (FPTD), which is frequently used to describe continuous processes, the WTD contains information about the direction of motion. As an application, we consider the paradigmatic example of an overdamped particle diffusing through a washboard potential. To verify the approach and to elucidate its numerical implications, we compare the WTD defined via the Smoluchowski equation with data from direct simulation of the underlying Langevin equation and find full consistency provided that the jumps in the Langevin approach are defined properly. Moreover, for sufficiently large energy barriers, the WTD defined via the Smoluchowski equation becomes consistent with that resulting from the analytical solution of a (two-state) master equation model for the short-time dynamics developed previously by us [Phys. Rev. E 86, 061135 (2012)]. Thus, our approach "interpolates" between these two types of stochastic motion. We illustrate our approach for both symmetric systems and systems under constant force.

  2. 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.

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

    DEFF Research Database (Denmark)

    Christiansen, Terkel; Bech, Mickael

    2013-01-01

    choice of hospital for somatic and psychiatric patients, short maximum waiting time guarantee for life-threatening diseases coupled with care packages for cancer and heart diseases and extra-activity targeted hospital grants. There are good reasons to believe that these policies have reduced waiting...

  4. The Origin of the Solar Flare Waiting-Time Distribution

    CERN Document Server

    Wheatland, M S

    2000-01-01

    It was recently pointed out that the distribution of times between solar flares (the flare waiting-time distribution) follows a power law, for long waiting times. Based on 25 years of soft X-ray flares observed by Geostationary Operational Environmental Satellite (GOES) instruments it is shown that 1. the waiting-time distribution of flares is consistent with a time-dependent Poisson process, and 2. the fraction of time the Sun spends with different flaring rates approximately follows an exponential distribution. The second result is a new phenomenological law for flares. It is shown analytically how the observed power-law behavior of the waiting times originates in the exponential distribution of flaring rates. These results are argued to be consistent with a non-stationary avalanche model for flares.

  5. 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...

  6. Anomalous waiting times in high-frequency financial data

    CERN Document Server

    Scalas, E; Luckock, H; Mainardi, F; Mantelli, M; Raberto, M; Scalas, Enrico; Gorenflo, Rudolf; Luckock, Hugh; Mainardi, Francesco; Mantelli, Maurizio; Raberto, Marco

    2004-01-01

    In high-frequency financial data not only returns, but also waiting times between consecutive trades are random variables. Therefore, it is possible to apply continuous-time random walks (CTRWs) as phenomenological models of the high-frequency price dynamics. An empirical analysis performed on the 30 DJIA stocks shows that the waiting-time survival probability for high-frequency data is non-exponential. This fact imposes constraints on agent-based models of financial markets.

  7. 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...

  8. Real waiting times for surgery. Proposal for an improved system for their management

    Directory of Open Access Journals (Sweden)

    Ignacio Abásolo

    2014-05-01

    Conclusion: Total waiting times are between two and five times higher than those officially published. The relationship between the waiting times at each stage of the medical procedure may be used to decrease variability and maximum waiting times.

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

    Science.gov (United States)

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

    2017-07-29

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

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

    Science.gov (United States)

    2016-12-01

    their Performance Based Logistics ( PBL ) Support Guidebook, but adds a time element by defining the term as “the volume of requisitions satisfied within...41(1), 19–23. Defense Contract Management Agency. (2002). Performance based logistics ( PBL ) support guidebook. Retrieved from: https://acc.dau.mil...adl/en-US/54825/file/ 18745/ PBL -GUIDE.doc Department of Defense. (2000). Customer wait time and time definite delivery (DODI 4140.61). Washington, DC

  11. 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.

  12. Which patients wait longer to be seen and when? A waiting time study in the emergency department.

    Science.gov (United States)

    Elkum, N; Fahim, M; Shoukri, M; Al-Madouj, A

    2009-01-01

    We investigated the waiting time for patients before seeing a physician in the emergency department of a tertiary care hospital in Riyadh, Saudi Arabia. Bi- and multivariate analyses of routine data for 2187 patients determined the association between selected patient characteristics and waiting time. The median waiting time between triage and being seen by a physician was 35.0 min (range 1.0-325.0 min). Age, day of arrival, time of arrival and triage category were significantly associated with waiting time. Older patients and those arriving on Sundays and Wednesdays waited longer. Variability in waiting times could be addressed by more standardized triage policies, but may also be influenced by other clinical or non-clinical factors that required further investigation.

  13. The coronal mass ejection waiting-time distribution

    CERN Document Server

    Wheatland, M S

    2003-01-01

    The distribution of times $\\Delta t$ between coronal mass ejections (CMEs) in the Large Angle and Spectrometric Coronagraph (LASCO) CME catalog for the years 1996-2001 is examined. The distribution exhibits a power-law tail $\\propto (\\Delta t)^{\\gamma}$ with an index $\\gamma\\approx -2.36\\pm 0.11$ for large waiting times ($\\Delta t>10 {\\rm hours}$). The power-law index of the waiting-time distribution varies with the solar cycle: for the years 1996-1998 (a period of low activity), the power-law index is $\\gamma\\approx-1.86\\pm 0.14$, and for the years 1999-2001 (a period of higher activity), the index is $\\gamma\\approx-2.98\\pm 0.20$. The observed CME waiting-time distribution, and its variation with the cycle, may be understood in terms of CMEs occurring as a time-dependent Poisson process. The CME waiting-time distribution is compared with that for greater than C1 class solar flares in the Geostationary Operational Environmental Satellite (GOES) catalog for the same years. The flare and CME waiting-time distri...

  14. 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.

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

    Directory of Open Access Journals (Sweden)

    Elizabeth Buhe

    2011-05-01

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

  16. Waiting Time Dynamics in Two-Dimensional Infrared Spectroscopy

    NARCIS (Netherlands)

    Jansen, Thomas L. C.; Knoester, Jasper

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

  17. [Waiting time for treatment shall be calculated correctly].

    Science.gov (United States)

    Pedersen, Jørgen Ejler

    2011-05-23

    Every system is perfectly designed to achieve the results it gets and in the Danish health care system there is a significant waiting time for the patients. If we want this result to change, we have to change something in the system, but before we do that, we need to understand the system. With queuing theory as a frame of reference, the anatomy and physiology of waiting time is illuminated in order to bring additional knowledge into the design of systems in health care.

  18. 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...

  19. Waiting time for radiotherapy in women with cervical cancer

    Directory of Open Access Journals (Sweden)

    Maria Isabel do Nascimento

    2015-01-01

    Full Text Available ABSTRACT OBJECTIVE To describe the waiting time for radiotherapy for patients with cervical cancer. METHODS This descriptive study was conducted with 342 cervical cancer cases that were referred to primary radiotherapy, in the Baixada Fluminense region, RJ, Southeastern Brazil, from October 1995 to August 2010. The waiting time was calculated using the recommended 60-day deadline as a parameter to obtaining the first cancer treatment and considering the date at which the diagnosis was confirmed, the date of first oncological consultation and date when the radiotherapy began. Median and proportional comparisons were made using the Kruskal Wallis and Chi-square tests. RESULTS Most of the women (72.2% began their radiotherapy within 60 days from the diagnostic confirmation date. The median of this total waiting time was 41 days. This median worsened over the time period, going from 11 days (1995-1996 to 64 days (2009-2010. The median interval between the diagnostic confirmation and the first oncological consultation was 33 days, and between the first oncological consultation and the first radiotherapy session was four days. The median waiting time differed significantly (p = 0.003 according to different stages of the tumor, reaching 56 days, 35 days and 30 days for women whose cancers were classified up to IIA; from IIB to IIIB, and IVA-IVB, respectively. CONCLUSIONS Despite most of the women having had access to radiotherapy within the recommended 60 days, the implementation of procedures to define the stage of the tumor and to reestablish clinical conditions took a large part of this time, showing that at least one of these intervals needs to be improved. Even though the waiting times were ideal for all patients, the most advanced cases were quickly treated, which suggests that access to radiotherapy by women with cervical cancer has been reached with equity.

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

    African Journals Online (AJOL)

    Waiting time is a tangible aspect of practice that patients .... their consent to participate in the study were selected (inclusion ... or the other, 36.5% (35/96) had up to tertiary education while ..... Department of Statistics Malaysia; ... Health Policy.

  1. 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.

  2. Quality improvement cycles that reduced waiting times at Tshwane ...

    African Journals Online (AJOL)

    TDH is a level-one hospital, delivering services in the centre of Pretoria since February 2006. ... finding better ways to provide better care and service.11 The QI cycle is a recognised tool for analysing and improving the efficiency and quality ..... in reducing waiting times and improving patient satisfaction.14 The need for ...

  3. Reallocation of beds to reduce waiting time for cardiac surgery

    NARCIS (Netherlands)

    Akkerman, Renzo; Knip, Marrig

    2002-01-01

    Waiting time for cardiac surgery is a significant problem in the current medical world. The fact that patients length of stay varies considerably makes effective hospital operation a hard job. In this paper, the patients length of stay is analyzed. Three scenarios for hospital management are

  4. 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.

  5. Non-Poissonian Distribution of Tsunami Waiting Times

    Science.gov (United States)

    Geist, E. L.; Parsons, T.

    2007-12-01

    Analysis of the global tsunami catalog indicates that tsunami waiting times deviate from an exponential distribution one would expect from a Poisson process. Empirical density distributions of tsunami waiting times were determined using both global tsunami origin times and tsunami arrival times at a particular site with a sufficient catalog: Hilo, Hawai'i. Most sources for the tsunamis in the catalog are earthquakes; other sources include landslides and volcanogenic processes. Both datasets indicate an over-abundance of short waiting times in comparison to an exponential distribution. Two types of probability models are investigated to explain this observation. Model (1) is a universal scaling law that describes long-term clustering of sources with a gamma distribution. The shape parameter (γ) for the global tsunami distribution is similar to that of the global earthquake catalog γ=0.63-0.67 [Corral, 2004]. For the Hilo catalog, γ is slightly greater (0.75-0.82) and closer to an exponential distribution. This is explained by the fact that tsunamis from smaller triggered earthquakes or landslides are less likely to be recorded at a far-field station such as Hilo in comparison to the global catalog, which includes a greater proportion of local tsunamis. Model (2) is based on two distributions derived from Omori's law for the temporal decay of triggered sources (aftershocks). The first is the ETAS distribution derived by Saichev and Sornette [2007], which is shown to fit the distribution of observed tsunami waiting times. The second is a simpler two-parameter distribution that is the exponential distribution augmented by a linear decay in aftershocks multiplied by a time constant Ta. Examination of the sources associated with short tsunami waiting times indicate that triggered events include both earthquake and landslide tsunamis that begin in the vicinity of the primary source. Triggered seismogenic tsunamis do not necessarily originate from the same fault zone

  6. Interventions to reduce waiting times for elective procedures.

    Science.gov (United States)

    Ballini, Luciana; Negro, Antonella; Maltoni, Susanna; Vignatelli, Luca; Flodgren, Gerd; Simera, Iveta; Holmes, Jane; Grilli, Roberto

    2015-02-23

    Long waiting times for elective healthcare procedures may cause distress among patients, may have adverse health consequences and may be perceived as inappropriate delivery and planning of health care. To assess the effectiveness of interventions aimed at reducing waiting times for elective care, both diagnostic and therapeutic. We searched the following electronic databases: Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1946-), EMBASE (1947-), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), ABI Inform, the Canadian Research Index, the Science, Social Sciences and Humanities Citation Indexes, a series of databases via Proquest: Dissertations & Theses (including UK & Ireland), EconLit, PAIS (Public Affairs International), Political Science Collection, Nursing Collection, Sociological Abstracts, Social Services Abstracts and Worldwide Political Science Abstracts. We sought related reviews by searching the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effectiveness (DARE). We searched trial registries, as well as grey literature sites and reference lists of relevant articles. We considered randomised controlled trials (RCTs), controlled before-after studies (CBAs) and interrupted time series (ITS) designs that met EPOC minimum criteria and evaluated the effectiveness of any intervention aimed at reducing waiting times for any type of elective procedure. We considered studies reporting one or more of the following outcomes: number or proportion of participants whose waiting times were above or below a specific time threshold, or participants' mean or median waiting times. Comparators could include any type of active intervention or standard practice. Two review authors independently extracted data from, and assessed risk of bias of, each included study, using a standardised form and the EPOC 'Risk

  7. 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.

  8. Effects of waiting on the satisfaction with the service: Beyond objective time measures

    NARCIS (Netherlands)

    Pruyn, Adriaan T.H.; Smidts, Ale

    1998-01-01

    A major concern for service managers is to counteract negative effects of waiting. In this study, the effects of objective waiting time and waiting environment on satisfaction with the service were investigated. Two elements of the waiting environment were distinguished: the attractiveness of the

  9. 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.

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

    Science.gov (United States)

    Cahoy, Dexter O.; Polito, Federico

    2013-03-01

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

  11. Introducing waiting times for health care in a labor supply model for sickness absence

    Directory of Open Access Journals (Sweden)

    Daniela Andrén

    2014-08-01

    Full Text Available This paper studies the association between waiting times for different health care services and the duration of sick leave, using a Swedish register database supplemented with information from questionnaires for 3,653 employees. The duration of sick leave is positively associated with waiting two weeks or more for primary care, technical investigations and specialists, compared to waiting one week or less. Except for waiting for a specialist, there is no indication that waiting four weeks or more is associated with longer durations of sick leave than waiting two to three weeks. Long waiting times for surgery is negatively associated with the duration of sick leave, which might be explained by prioritizing where patients with longer waiting times are those with less severe conditions. Including these waiting time variables did not induce substantial changes on the impact of traditional labor supply variables, which suggests that the parameter estimates of traditional variables are relatively robust.

  12. A Directed Continuous Time Random Walk Model with Jump Length Depending on Waiting Time

    Directory of Open Access Journals (Sweden)

    Long Shi

    2014-01-01

    Full Text Available In continuum one-dimensional space, a coupled directed continuous time random walk model is proposed, where the random walker jumps toward one direction and the waiting time between jumps affects the subsequent jump. In the proposed model, the Laplace-Laplace transform of the probability density function P(x,t of finding the walker at position x at time t is completely determined by the Laplace transform of the probability density function φ(t of the waiting time. In terms of the probability density function of the waiting time in the Laplace domain, the limit distribution of the random process and the corresponding evolving equations are derived.

  13. 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

  14. Improved Appliance Coordination Scheme with Waiting Time in Smart Grids

    Directory of Open Access Journals (Sweden)

    Firas A. Al Balas

    2016-04-01

    Full Text Available Smart grids aim to merge the advances in communications and information technologies with traditional power grids. In smart grids, users can generate energy and sell it to the local utility supplier. The users can reduce energy consumption by shifting appliances’ start time to off-peak hours. Many researchers have proposed techniques to reduce the previous issue for home appliances, such as the Appliances Coordination (ACORD scheme and Appliances Coordination with Feed In (ACORD-FI scheme. The goal of this work is to introduce an efficient scheme to reduce the total cost of energy bills by utilizing the ACORD-FI scheme to obtain an effective solution. In this work three scheduling schemes are proposed: the Appliances Coordination by Giving Waiting Time (ACORD-WT, the Appliances Coordination by Giving Priority (ACORD-P, and using photovoltaic (PV with priority and waiting time scheduling algorithms. A simulator written in C++ is used to test the performance of the proposed schemes using. The performance metric used is the total savings in the cost of the energy bill in dollars. The first comparison for the proposed schemes with the ACORD-FI, and the results show that the efficiency of the proposed ACORD-WT is better than the ACORD-FI, regardless of the number of appliances. Moreover, the proposed ACORD-P, is also better than the standard ACORD-FI.

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

    Science.gov (United States)

    Slowiak, Julie M; Huitema, Bradley E

    2015-01-01

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

  16. 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 aff...... timetable by analysing different timetables and/or plans of operation. This article presents methods to examine SWT by simulation for both trains and passengers in entire railway networks....... 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...

  17. Wait and consult times for primary healthcare services in central Mozambique: a time-motion study

    Directory of Open Access Journals (Sweden)

    Bradley H. Wagenaar

    2016-08-01

    Full Text Available Background: We describe wait and consult times across public-sector clinics and identify health facility determinants of wait and consult times. Design: We observed 8,102 patient arrivals and departures from clinical service areas across 12 public-sector clinics in Sofala and Manica Provinces between January and April 2011. Negative binomial generalized estimating equations were used to model associated health facility factors. Results: Mean wait times (in minutes were: 26.1 for reception; 43.5 for outpatient consults; 58.8 for antenatal visits; 16.2 for well-child visits; 8.0 for pharmacy; and 15.6 for laboratory. Mean consultation times (in minutes were: 5.3 for outpatient consults; 9.4 for antenatal visits; and 2.3 for well-child visits. Over 70% (884/1,248 of patients arrived at the clinic to begin queuing for general reception prior to 10:30 am. Facilities with more institutional births had significantly longer wait times for general reception, antenatal visits, and well-child visits. Clinics in rural areas had especially shorter wait times for well-child visits. Outpatient consultations were significantly longer at the smallest health facilities, followed by rural hospitals, tertiary/quaternary facilities, compared with Type 1 rural health centers. Discussion: The average outpatient consult in Central Mozambique lasts 5 min, following over 40 min of waiting, not including time to register at most clinics. Wait times for first antenatal visits are even longer at almost 1 h. Urgent investments in public-sector human resources for health alongside innovative operational research are needed to increase consult times, decrease wait times, and improve health system responsiveness.

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

    DEFF Research Database (Denmark)

    Støvring, Henrik; Pottegård, Anton; Hallas, Jesper

    2016-01-01

    ). When the IAD consisted of a mixture of two Log-Normal distributions, but was analyzed with a single Log-Normal distribution, relative bias did not exceed 9%. Using a Log-Normal FRD, we estimated prescription durations of 117, 91, 137, and 118 days for NSAIDs, warfarin, bendroflumethiazide...... two-component mixture model for the waiting time distribution (WTD). The distribution component for prevalent users estimates the forward recurrence density (FRD), which is related to the distribution of time between subsequent prescription redemptions, the inter-arrival density (IAD), for users......, and the method was applied to empirical data for four model drugs: non-steroidal anti-inflammatory drugs (NSAIDs), warfarin, bendroflumethiazide, and levothyroxine. RESULTS: Simulation studies found negligible bias when the data-generating model for the IAD coincided with the FRD used in the WTD estimation (Log-Normal...

  19. To Minimize the Waiting Time and Waiting Time Cost of Dumpers, Waiting in a Queue for Loader at Stone Crusher Plant Mine by Using the Single and Multi-Channel Queuing Theory.

    Directory of Open Access Journals (Sweden)

    Vaibhav Singh

    2014-09-01

    Full Text Available Waiting line problems arise because there is too much demand on the facilities so that we can say that there is an excess of waiting time or inadequate number of service facilities. At the stone crusher plant mine the dumpers come to load from the loader. The crusher plant has 11 dumpers and these 11 dumpers make 88 trips during 8-hour day. The company has one loader to load all the dumpers, which results in a formation of long waiting line or queue. Due to this queue there is a long waiting time in queue of dumpers and cost associated with waiting time of dumpers. Queuing theory can quite effectively analyze such queuing phenomenon. In this research paper I have applied the queuing theory to the stone crusher plant mine, where the queue of dumpers formed at the loading station. By applying the single channel queuing theory I analyzed the current situation of the stone crusher plant mine and find the problems of the current system. To overcome the above problems I have applied the multi-channel queuing theory to minimize the waiting time in queue of dumpers and very high cost associated with waiting time of dumpers. In the new system not only waiting time in queue of dumpers and very high cost associated with waiting time of dumpers is reduced but also there is an efficient utilization of dumpers and loaders along with provide the profitable situation to the crusher plant.

  20. Waiting time dynamics in two-dimensional infrared spectroscopy.

    Science.gov (United States)

    Jansen, Thomas L C; Knoester, Jasper

    2009-09-15

    We review recent work on the waiting time dynamics of coherent two-dimensional infrared (2DIR) spectroscopy. This dynamics can reveal chemical and physical processes that take place on the femto- and picosecond time scale, which is faster than the time scale that may be probed by, for example, nuclear magnetic resonance spectroscopy. A large number of chemically relevant processes take place on this time scale. Such processes range from forming and breaking hydrogen bonds and proton transfer to solvent exchange and vibrational population transfer. In typical 2DIR spectra, multiple processes contribute to the waiting time dynamics and the spectra are often congested. This makes the spectra challenging to interpret, and the aid of theoretical models and simulations is often needed. To be useful, such models need to account for all dynamical processes in the sample simultaneously. The numerical integration of the Schrodinger equation (NISE) method has proven to allow for a very general treatment of the dynamical processes. It accounts for both the motional narrowing resulting from solvent-induced frequency fluctuations and population transfer between coupled vibrations. At the same time, frequency shifts arising from chemical-exchange reactions and changes of the transition dipoles because of either non-Condon effects or molecular reorientation are included in the treatment. This method therefore allows for the disentanglement of all of these processes. The NISE method has thus far been successfully applied to study chemical-exchange processes. It was demonstrated that 2DIR is not only sensitive to reaction kinetics but also to the more detailed reaction dynamics. NISE has also been applied to the study of population transfer within the amide I band (CO stretch) and between the amide I and amide II bands (CN stretch and NH bend) in polypeptides. From the amide I studies, it was found that the population transfer can be used to enhance cross-peaks that act as

  1. Improving Waiting Time of Tasks Scheduled Under Preemptive Round Robin Using Changeable Time Quantum

    CERN Document Server

    Mostafa, Samih Mohemmed

    2010-01-01

    Minimizing waiting time for tasks waiting in the queue for execution is one of the important scheduling cri-teria which took a wide area in scheduling preemptive tasks. In this paper we present Changeable Time Quan-tum (CTQ) approach combined with the round-robin algorithm, we try to adjust the time quantum according to the burst times of the tasks in the ready queue. There are two important benefits of using (CTQ) approach: minimizing the average waiting time of the tasks, consequently minimizing the average turnaround time, and keeping the number of context switches as low as possible, consequently minimizing the scheduling overhead. In this paper, we consider the scheduling problem for preemptive tasks, where the time costs of these tasks are known a priori. Our experimental results demonstrate that CTQ can provide much lower scheduling overhead and better scheduling criteria.

  2. 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, Pus to plan and implement a larger-scale study of waiting time to pregnancy in Lithuanian population.

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

    Science.gov (United States)

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

    2013-11-01

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

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

    Science.gov (United States)

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

    2013-10-01

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

  5. 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.

  6. General Anesthetic Versus Light Sedation: Effect on Pediatric Endoscopy Wait Times

    Directory of Open Access Journals (Sweden)

    Christine Edwards

    2013-01-01

    Full Text Available BACKGROUND: Wait times are an important measure of health care system effectiveness. There are no studies describing wait times in pediatric gastroenterology for either outpatient visits or endoscopy. Pediatric endoscopy is performed under light sedation or general anesthesia. The latter is hypothesized to be associated with a longer wait time due to practical limits on access to anesthesia in the Canadian health care system.

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

    Directory of Open Access Journals (Sweden)

    Imran Haruna Abdulkareem

    2014-01-01

    Full Text Available 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

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

    Directory of Open Access Journals (Sweden)

    Jurgita Januleviciute Gangstøe

    2016-06-01

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

  9. Wait Time for Treatment in Hospital Emergency Departments: 2009

    Science.gov (United States)

    ... more patients with fewer EDs and with fewer hospital beds. Patients not requiring immediate care have longer wait ... has been made (e.g., because an inpatient bed elsewhere in the hospital is not yet available) ( 4 ). Data source and ...

  10. Genetic progression and the waiting time to cancer.

    Directory of Open Access Journals (Sweden)

    Niko Beerenwinkel

    2007-11-01

    Full Text Available Cancer results from genetic alterations that disturb the normal cooperative behavior of cells. Recent high-throughput genomic studies of cancer cells have shown that the mutational landscape of cancer is complex and that individual cancers may evolve through mutations in as many as 20 different cancer-associated genes. We use data published by Sjöblom et al. (2006 to develop a new mathematical model for the somatic evolution of colorectal cancers. We employ the Wright-Fisher process for exploring the basic parameters of this evolutionary process and derive an analytical approximation for the expected waiting time to the cancer phenotype. Our results highlight the relative importance of selection over both the size of the cell population at risk and the mutation rate. The model predicts that the observed genetic diversity of cancer genomes can arise under a normal mutation rate if the average selective advantage per mutation is on the order of 1%. Increased mutation rates due to genetic instability would allow even smaller selective advantages during tumorigenesis. The complexity of cancer progression can be understood as the result of multiple sequential mutations, each of which has a relatively small but positive effect on net cell growth.

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

    Science.gov (United States)

    Laskowski, Marek; McLeod, Robert D; Friesen, Marcia R; Podaima, Blake W; Alfa, Attahiru S

    2009-07-02

    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.

  12. 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.

  13. Spatial structure increases the waiting time for cancer

    Science.gov (United States)

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

    2011-11-01

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

  14. 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

    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...

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

    Directory of Open Access Journals (Sweden)

    Mei Huan

    2014-01-01

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

  16. 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 is ...

  17. 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.

  18. 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…

  19. 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…

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

    NARCIS (Netherlands)

    Giesen, P.H.J.; Lin, N.G.C.B. van; Mokkink, H.G.A.; Bosch, W.J.H.M. van den; Grol, R.P.T.M.

    2007-01-01

    BACKGROUND: 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

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

    Directory of Open Access Journals (Sweden)

    Chen Long-Fei

    2017-01-01

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

  2. Outpatient waiting time in health services and teaching hospitals: a case study in Iran.

    Science.gov (United States)

    Mohebbifar, Rafat; Hasanpoor, Edris; Mohseni, Mohammad; Sokhanvar, Mobin; Khosravizadeh, Omid; Mousavi Isfahani, Haleh

    2013-11-10

    One of the most important indexes of the health care quality is patient's satisfaction and it takes place only when there is a process based on management. One of these processes in the health care organizations is the appropriate management of the waiting time process. The aim of this study is the systematic analyzing of the outpatient waiting time. This descriptive cross sectional study conducted in 2011 is an applicable study performed in the educational and health care hospitals of one of the medical universities located in the north west of Iran. Since the distributions of outpatients in all the months were equal, sampling stage was used. 160 outpatients were studied and the data was analyzed by using SPSS software. Results of the study showed that the waiting time for the outpatients of ophthalmology clinic with an average of 245 minutes for each patient allocated the maximum time among the other clinics for itself. Orthopedic clinic had the minimal waiting time including an average of 77 minutes per patient. The total average waiting time for each patient in the educational hospitals under this study was about 161 minutes. by applying some models, we can reduce the waiting time especially in the realm of time and space before the admission to the examination room. Utilizing the models including the one before admission, electronic visit systems via internet, a process model, six sigma model, queuing theory model and FIFO model, are the components of the intervention that reduces the outpatient waiting time.

  3. Age Dating Fluvial Sediment Storage Reservoirs to Construct Sediment Waiting Time Distributions

    Science.gov (United States)

    Skalak, K.; Pizzuto, J. E.; Benthem, A.; Karwan, D. L.; Mahan, S.

    2015-12-01

    Suspended sediment transport is an important geomorphic process that can often control the transport of nutrients and contaminants. The time a particle spends in storage remains a critical knowledge gap in understanding particle trajectories through landscapes. We dated floodplain deposits in South River, VA, using fallout radionuclides (Pb-210, Cs-137), optically stimulated luminescence (OSL), and radiocarbon dating to determine sediment ages and construct sediment waiting time distributions. We have a total of 14 age dates in two eroding banks. We combine these age dates with a well-constrained history of mercury concentrations on suspended sediment in the river from an industrial release. Ages from fallout radionuclides document sedimentation from the early 1900s to the present, and agree with the history of mercury contamination. OSL dates span approximately 200 to 17,000 years old. We performed a standard Weibull analysis of nonexceedance to construct a waiting time distribution of floodplain sediment for the South River. The mean waiting time for floodplain sediment is 2930 years, while the median is approximately 710 years. When the floodplain waiting time distribution is combined with the waiting time distribution for in-channel sediment storage (available from previous studies), the mean waiting time shifts to approximately 680 years, suggesting that quantifying sediment waiting times for both channel and floodplain storage is critical in advancing knowledge of particle trajectories through watersheds.

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

    Directory of Open Access Journals (Sweden)

    Laupacis Andreas

    2010-08-01

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

  6. Reconciliation of Waiting Time Statistics of Solar Flares Observed in Hard X-Rays

    CERN Document Server

    Aschwanden, Markus J

    2010-01-01

    We study the waiting time distributions of solar flares observed in hard X-rays with ISEE-3/ICE, HXRBS/SMM, WATCH/GRANAT, BATSE/CGRO, and RHESSI. Although discordant results and interpretations have been published earlier, based on relatively small ranges ($< 2$ decades) of waiting times, we find that all observed distributions, spanning over 6 decades of waiting times ($\\Delta t \\approx 10^{-3}- 10^3$ hrs), can be reconciled with a single distribution function, $N(\\Delta t) \\propto \\lambda_0 (1 + \\lambda_0 \\Delta t)^{-2}$, which has a powerlaw slope of $p \\approx 2.0$ at large waiting times ($\\Delta t \\approx 1-1000$ hrs) and flattens out at short waiting times $\\Delta t \\lapprox \\Delta t_0 = 1/\\lambda_0$. We find a consistent breakpoint at $\\Delta t_0 = 1/\\lambda_0 = 0.80\\pm0.14$ hours from the WATCH, HXRBS, BATSE, and RHESSI data. The distribution of waiting times is invariant for sampling with different flux thresholds, while the mean waiting time scales reciprocically with the number of detected event...

  7. 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

  8. 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.

  9. Minimizing the Message Waiting Time in Single-Hop Multichannel Systems

    OpenAIRE

    Martelli, Francesca; Bonuccelli, Maurizio

    2010-01-01

    In this paper, we examine the problem of packet scheduling in a single-hop multichannel systems, with the goal of minimizing the average message waiting time. Such an objective function represents the delay incurred by the users before receiving the desired data. We show that the problem of finding a schedule with minimum message waiting time, is NP-complete, by means of polynomial time reduction of the time table design problem to our problem. We present also several heuristics which result ...

  10. FACTORS INFLUENCING WAITING TIME IN OUTPATIENT PHARMACY OF LAGOS UNIVERSITY TEACHING HOSPITAL

    Directory of Open Access Journals (Sweden)

    Ndukwe Henry C.

    2011-10-01

    Full Text Available Time, money and expertise are resources that are indispensable to productivity, performance, efficiency, success and growth of any health institution. This research was aimed at identifying and measuring some of the factors influencing patient waiting time in an outpatient pharmacy. The study employed the use of time monitoring card and time study analysis to volunteered participants. A situation analysis conducted revealed an average of 167 minutes of waiting time. The dispensing time averaged 17.65 minutes, and 67.97% of total waiting time by the patient was due to delay components. The major delay components included patient queues for billing of prescription sheets, payment to the cashier and subsequent time wait before drugs are dispensed. The total waiting time for the dispensing process averaged 55.11 minutes. Generally, there were undue delays caused by the dispensing procedure with a 32.03% lag of processing components and operations in the pharmacy. Factors indentified to influence the outpatient waiting time included, queuing and queuing characteristics-type and integrity of queue, adherence to hospital visits and medication for special disease programs, dispensing time, average waiting time (service time plus queuing time, nature of illness or disease presentation, admission status of patient(s, accrued time from other health services provided to the patient prior to services provided by the pharmacist, incentives for providing efficient services, management structures and operational procedures of outpatient hospital pharmacy, implementation of legal rights on waiting time, inadequate treatment or dispensing facilities, technological innovations of automation and computerization , service efficiency and internal operational factors.

  11. Partitioning of Independent Tasks for Minimizing Completion Time and Total Waiting Time

    Institute of Scientific and Technical Information of China (English)

    章中云; 祝明发; 等

    1991-01-01

    Parallel processors provide fast computing environments for various users.But the real efficiencies of parallel processors intensively depend on the partitioning strategies of tasks over the processors.In this paper,the partitioning problems of independent tasks for homogeneous system of parallel processors are quantitatively studied.We adopt two criteria,minimizing the completion time and the total waiting time, to determine the optimal partitioning strategy.

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

    Science.gov (United States)

    Becker, Franklin; Douglass, Stephanie

    2008-01-01

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

  13. Waiting time distribution for electron transport in a molecular junction with electron-vibration interaction

    Science.gov (United States)

    Kosov, Daniel S.

    2017-02-01

    On the elementary level, electronic current consists of individual electron tunnelling events that are separated by random time intervals. The waiting time distribution is a probability to observe the electron transfer in the detector electrode at time t +τ given that an electron was detected in the same electrode at an earlier time t. We study waiting time distribution for quantum transport in a vibrating molecular junction. By treating the electron-vibration interaction exactly and molecule-electrode coupling perturbatively, we obtain the master equation and compute the distribution of waiting times for electron transport. The details of waiting time distributions are used to elucidate microscopic mechanism of electron transport and the role of electron-vibration interactions. We find that as nonequilibrium develops in the molecular junction, the skewness and dispersion of the waiting time distribution experience stepwise drops with the increase of the electric current. These steps are associated with the excitations of vibrational states by tunnelling electrons. In the strong electron-vibration coupling regime, the dispersion decrease dominates over all other changes in the waiting time distribution as the molecular junction departs far away from the equilibrium.

  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...

  15. Reducing Wait Times through Operations Research: Optimizing the Use of Surge Capacity.

    Science.gov (United States)

    Patrick, Jonathan; Puterman, Martin L

    2008-02-01

    Widespread public demand for improved access, political pressure for shorter wait times, a stretched workforce, an aging population and overutilized equipment and facilities challenge healthcare leaders to adopt new management approaches. This paper highlights the significant benefits that can be achieved by applying operations research (OR) methods to healthcare management. It shows how queuing theory provides managers with insights into the causes for excessive wait times and the relationship between wait times and capacity. It provides a case study of the use of several OR methods, including Markov decision processes, linear programming and simulation, to optimize the scheduling of patients with multiple priorities. The study shows that by applying this approach, wait time targets can be attained with the judicious use of surge capacity in the form of overtime. It concludes with some policy insights.

  16. Group Enrollment and Open Gym Format Decreases Cardiac Rehabilitation Wait Times.

    Science.gov (United States)

    Bachmann, Justin M; Klint, Zachary W; Jagoda, Allison M; McNatt, Jeremy K; Abney, Lesa R; Huang, Shi; Liddle, David G; Frontera, Walter R; Freiberg, Matthew S

    2017-09-01

    Wait times for the first cardiac rehabilitation (CR) session are inversely related to CR participation rates. We hypothesized that changing from individually scheduled appointments to a group enrollment and open gym format, in which patients were enrolled during group intake sessions and could arrive for subsequent CR sessions any time during open gym periods, would decrease wait times. A total of 603 patients enrolled in CR at Vanderbilt University Medical Center from July 2012 to December 2014 were included in the study. We evaluated the effect of changing to a group enrollment and open gym format after adjusting for referral diagnosis, insurance status, seasonality, and other factors. We compared outcomes, including exercise capacity and quality of life, between the 2 groups. Patients in the group enrollment and open gym format had significantly lower average wait times than those receiving individual appointments (14.9 vs 19.5 days, P < .001). After multivariable adjustment, the new CR delivery model was associated with a 22% (3.7 days) decrease in average wait times (95% CI, 1.9-5.6, P < .001). Patients completing CR had equally beneficial changes in 6-minute walk distance and Patient Health Questionnaire scores between the 2 groups, although there was no significant difference in participation rates or the number of sessions attended. Implementation of a group enrollment and open gym format was associated with a significant decrease in wait times for first CR sessions. This CR delivery model may be an option for programs seeking to decrease wait times.

  17. Reconciliation of Waiting Time Statistics of Solar Flares Observed in Hard X-rays

    Science.gov (United States)

    Aschwanden, Markus J.; McTiernan, James M.

    2010-07-01

    We study the waiting time distributions of solar flares observed in hard X-rays with ISEE-3/ICE, HXRBS/SMM, WATCH/GRANAT, BATSE/CGRO, and RHESSI. Although discordant results and interpretations have been published earlier, based on relatively small ranges (<2 decades) of waiting times, we find that all observed distributions, spanning over 6 decades of waiting times (Δt ≈ 10-3-103 hr), can be reconciled with a single distribution function, N(Δt) vprop λ0(1 + λ0Δt)-2, which has a power-law slope of p ≈ 2.0 at large waiting times (Δt ≈ 1-1000 hr) and flattens out at short waiting times Δt <~ Δt 0 = 1/λ0. We find a consistent breakpoint at Δt 0 = 1/λ0 = 0.80 ± 0.14 hr from the WATCH, HXRBS, BATSE, and RHESSI data. The distribution of waiting times is invariant for sampling with different flux thresholds, while the mean waiting time scales reciprocically with the number of detected events, Δt 0 vprop 1/n det. This waiting time distribution can be modeled with a nonstationary Poisson process with a flare rate λ = 1/Δt that varies as f(λ) vprop λ-1exp - (λ/λ0). This flare rate distribution requires a highly intermittent flare productivity in short clusters with high rates, separated by relatively long quiescent intervals with very low flare rates.

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

    Science.gov (United States)

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

    2011-10-01

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

  19. 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....

  20. Managing waiting times to predict no-shows and cancelations at a children’s hospital

    Directory of Open Access Journals (Sweden)

    Miguel Rodríguez-García

    2016-12-01

    Full Text Available Purpose: Since long waits in hospitals have been found to be related to high rates of no-shows and cancelations, managing waiting times should be considered as an important tool that hospitals can use to reduce missed appointments. The aim of this study is to analyze patients’ behavior in order to predict no-show and cancelation rates correlated to waiting times. Design/methodology/approach: This study is based on the data from a US children’s hospital, which includes all the appointments registered during one year of observation. We used the call-appointment interval to establish the wait time to get an appointment. Four different types of appointment-keeping behavior and two types of patients were distinguished: arrival, no-show, cancelation with no reschedule, and cancelation with reschedule; and new and established patients. Findings: Results confirmed a strong impact of long waiting times on patients’ appointment-keeping behavior, and the logarithmic regression was found as the best-fit function for the correlation between variables in all cases. The correlation analysis showed that new patients tend to miss appointments more often than established patients when the waiting time increases. It was also found that, depending on the patients’ appointment distribution, it might get more complicated for hospitals to reduce missed appointments as the waiting time is reduced. Originality/value: The methodology applied in our study, which combines the use of regression analysis and patients’ appointment distribution analysis, would help health care managers to understand the initial implications of long waiting times and to address improvement related to patient satisfaction and hospital performance.

  1. 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.

  2. 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.

  3. SOME NEW RESULTS ON WAITING TIME AND BUSY TIME IN M/G/1 QUEUE

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    This paper considers an M/G/1 queue with Poisson rate λ > 0 and servicetime distribution G(t) which is supposed to have finite mean 1/μ. The following questions are first studied: (a) The closed bounds of the probability that waiting time is more than a fixed value; (b)The total busy time of the server, which including the distribution,probability that are more than a fixed value during a given time interval (0, t], and the expected value. Some new and important results are obtained by theories of the classes of life distributions and renewal process.

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

    Science.gov (United States)

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

    2009-04-01

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

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  6. Waiting for Treatment for Chronic Pain – a Survey of Existing Benchmarks: Toward Establishing Evidence-Based Benchmarks for Medically Acceptable Waiting Times

    Directory of Open Access Journals (Sweden)

    Mary E Lynch

    2007-01-01

    Full Text Available As medical costs escalate, health care resources must be prioritized. In this context, there is an increasing need for benchmarks and best practices in wait time management. In December 2005, the Canadian Pain Society struck a Task Force to identify benchmarks for acceptable wait times for treatment of chronic pain. The task force mandate included a systematic review and survey to identify national or international wait time benchmarks for chronic pain, proposed or in use, along with a review of the evidence upon which they are based. An extensive systematic review of the literature and a survey of International Association for the Study of Pain Chapter Presidents and key informants has identified that there are no established benchmarks or guidelines for acceptable wait times for the treatment of chronic pain in use in the world. In countries with generic guidelines or wait time standards that apply to all outpatient clinics, there have been significant challenges faced by pain clinics in meeting the established targets. Important next steps are to ensure appropriate additional research and the establishment of international benchmarks or guidelines for acceptable wait times for the treatment of chronic pain. This will facilitate advocacy for improved access to appropriate care for people suffering from chronic pain around the world.

  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. 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.

  9. Using a Time Timer to increase appropriate waiting behavior in a child with developmental disabilities.

    Science.gov (United States)

    Grey, Ian; Healy, Olive; Leader, Geraldine; Hayes, Deirdre

    2009-01-01

    This study aimed to examine the use of a predictive stimulus (Time Timer) and delayed reinforcement to increase appropriate waiting behavior in a child with developmental disabilities and problem behavior maintained by access to tangible items and activities. The study employed a changing criterion design across settings to gradually increase reinforcement delay from 1s to 10 min. Firstly a baseline phase was conducted to measure the duration of appropriate waiting behavior to access tangible reinforcers/activities. Phase 2 involved the use of a red cue card and the verbal instruction "wait". Phase 3 involved the introduction of the Time Timer with the cue card attached, and the verbal instruction "wait". Finally, Phase 4 utilised the Time Timer without the cue card. This method was an effective strategy for increasing appropriate waiting behavior with this participant in a school setting. The role of adding a concurrent activity during the reinforcement delay, using cues to predict reinforcement, future generalization, maintenance and the teaching of functionally equivalent skills are discussed.

  10. Estimating the waiting time of multi-priority emergency patients with downstream blocking.

    Science.gov (United States)

    Lin, Di; Patrick, Jonathan; Labeau, Fabrice

    2014-03-01

    To characterize the coupling effect between patient flow to access the emergency department (ED) and that to access the inpatient unit (IU), we develop a model with two connected queues: one upstream queue for the patient flow to access the ED and one downstream queue for the patient flow to access the IU. Building on this patient flow model, we employ queueing theory to estimate the average waiting time across patients. Using priority specific wait time targets, we further estimate the necessary number of ED and IU resources. Finally, we investigate how an alternative way of accessing ED (Fast Track) impacts the average waiting time of patients as well as the necessary number of ED/IU resources. This model as well as the analysis on patient flow can help the designer or manager of a hospital make decisions on the allocation of ED/IU resources in a hospital.

  11. 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

    appear to have fewer strokes, lung and digestive tract cancers, and overall mortality than both abstainers and moderate drinkers of beer or spirits. We examined the association between different types of alcoholic beverages and waiting time to pregnancy. METHODS: Self-reported data were used for 29......,844 pregnant women, recruited to the Danish National Birth Cohort in 1997-2000. Main outcome measures were odds ratios for a prolonged waiting time to pregnancy according to consumption of wine, beer and spirits. RESULTS: All levels of wine intake compared with non-wine drinking or with consumption of beer...... 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...

  12. Impact of different discharge patterns on bed occupancy rate and bed waiting time: a simulation approach.

    Science.gov (United States)

    Zhu, Zhecheng

    2011-01-01

    Beds are one of the most important resources in a healthcare system. How to manage beds efficiently is an important indicator of the efficiency of the healthcare system. Bed management is challenging to many healthcare service providers in many aspects. In recent years, population growth and aging society impose extra pressure on bed requirement. There are usually two key performance indicators of a bed management system: bed occupancy rate and bed waiting time. In this paper, different discharge patterns and their impacts on the bed occupancy rate and bed waiting time are studied. A discrete event simulation model is constructed to evaluate the existing discharge pattern in a Singapore regional hospital using actual hospital admission and discharge transaction data. Then different discharge patterns are tested in the same context. Simulation results show that a proper discharge pattern significantly smoothes the fluctuation of bed occupancy rate and reduce the bed waiting time.

  13. Universal law for waiting internal time in seismicity and its implication to earthquake network

    CERN Document Server

    Abe, Sumiyoshi

    2012-01-01

    In their paper (Europhys. Lett., 71 (2005) 1036), Carbone, Sorriso-Valvo, Harabaglia and Guerra showed that "unified scaling law" for conventional waiting times of earthquakes claimed by Bak et al. (Phys. Rev. Lett., 88 (2002) 178501) is actually not universal. Here, instead of the conventional time, the concept of the internal time termed the event time is considered for seismicity. It is shown that, in contrast to the conventional waiting time, the waiting event time obeys a power law. This implies the existence of temporal long-range correlations in terms of the event time with no sharp decay of the crossover type. The discovered power-law waiting event-time distribution turns out to be universal in the sense that it takes the same form for seismicities in California, Japan and Iran. In particular, the parameters contained in the distribution take the common values in all these geographical regions. An implication of this result to the procedure of constructing earthquake networks is discussed.

  14. A model for the distribution of aftershock waiting times

    CERN Document Server

    Shcherbakov, R; Turcotte, D L; Yakovlev, G

    2005-01-01

    In this work the distribution of inter-occurrence times between earthquakes in aftershock sequences is analyzed and a model based on a non-homogeneous Poisson (NHP) process is proposed to quantify the observed scaling. In this model the generalized Omori's law for the decay of aftershocks is used as a time-dependent rate in the NHP process. The analytically derived distribution of inter-occurrence times is applied to several major aftershock sequences in California to confirm the validity of the proposed hypothesis.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-07-01

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

  16. 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.

  17. 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.

  18. Factors Associated with Waiting Time for Breast Cancer Treatment in a Teaching Hospital in Ghana

    Science.gov (United States)

    Dedey, Florence; Wu, Lily; Ayettey, Hannah; Sanuade, Olutobi A.; Akingbola, Titilola S.; Hewlett, Sandra A.; Tayo, Bamidele O.; Cole, Helen V.; de-Graft Aikins, Ama; Ogedegbe, Gbenga; Adanu, Richard

    2016-01-01

    Background: Breast cancer is the leading cause of cancer-related mortality among women in Ghana. Data are limited on the predictors of poor outcomes in breast cancer patients in low-income countries; however, prolonged waiting time has been implicated. Among breast cancer patients who received treatment at Korle Bu Teaching Hospital, this study…

  19. Time on wait lists for coronary bypass surgery in British Columbia, Canada, 1991 – 2000

    Directory of Open Access Journals (Sweden)

    Hayden Robert

    2005-03-01

    Full Text Available Abstract Background In British Columbia, Canada, all necessary medical services are funded publicly. Concerned with growing wait lists in the mid-1990s, the provincial government started providing extra funding for coronary artery bypass grafting (CABG operations annually. Although aimed at improving access, it is not known whether supplementary funding changed the time that patients spent on wait lists for CABG. We sought to determine whether the period of registration on wait lists had an effect on time to isolated CABG and whether the period effect was similar across priority groups. Methods Using records from a population-based registry, we studied the wait-list time before and after supplementary funding became available. We compared the number of weeks from registration to surgery for equal proportions of patients in synthetic cohorts defined by five registration periods in the 1990s. Results Overall, 9,231 patients spent a total of 137,126 person-weeks on the wait lists. The time to surgery increased by the middle of the decade, and decreased toward the end of the decade. Relative to the 1991–92 registration period, the conditional weekly probabilities of undergoing surgery were 30% lower among patients registered on the wait lists in 1995–96, hazard ratio (HR = 0.70 (0.65–0.76, and 23% lower in 1997–98 patients, HR = 0.77 (0.71–0.83, while there were no differences with 1999–2000 patients, HR = 0.94 (0.88–1.02, after adjusting for priority group at registration, comorbidity, age and sex. We found that the effect of registration period was different across priority groups. Conclusion Our results provide evidence that time to CABG shortened after supplementary funding was provided on an annual basis to tertiary care hospitals within a single publicly funded health system. One plausible explanation is that these hospitals had capacity to increase the number of operations. At the same time, the effect was not uniform across

  20. [SPCCTV and SPC Recommendations Related to the Waiting Times for Cardiac Surgery].

    Science.gov (United States)

    Neves, José Pedro; Pereira, Hélder; Sousa-Uva, Miguel; Gavina, Cristina; Leite Moreira, Adelino; Loureiro, Maria José; Silva Cardoso, José

    2014-01-01

    Appointed jointly by the Portuguese Society for Cardiothoracic and Vascular Surgery (SPCCTV) and by the Portuguese Society of Cardiology (SPC), the Working Group related to the Waiting Times for Cardiac Surgery was created with the aim of developing practical recommendations about clinically acceptable waiting times for the three critical phases of the care of adults with a cardiac disease that require surgery or an intervention: cardiology appointments; diagnostic process and invasive therapy. Cardiac surgery has its own characteristics, not comparable to other surgical specialties and, therefore, it is important to reduce its maximum waiting times and, also, increase the efficacy of the systems which are responsible to monitor and trace the patient. The information given in this document was based, mostly, in available clinical information. The methodology used to establish the criteria was based on studies regarding disease's natural history, clinical studies that compared medical treatment with intervention, retrospective and prospective analysis of patients included on a waiting list, and experts or working groups' opinions. After this first step, marked by this publication, the SPCCTV and the SPC PSC should be considered as natural interlocutors about this matter and they are committed to decisively contribute to the definition of operational strategies through the adaption of the clinical evidence with reality and with the available resources.

  1. Impact of adjustment measures on reducing outpatient waiting time in a community hospital: application of a computer simulation

    Institute of Scientific and Technical Information of China (English)

    CHEN Bai-lian; LI En-dong; Kazunobu Yamawuchi; Ken Kato; Shinji Naganawa; MIAO Wei-jun

    2010-01-01

    Background As an important determinant of patient satisfaction, waiting time, has gained increasing attention in the field of health care services. The present study aimed to illustrate the distribution characteristics of waiting time in a community hospital and explore the impact of potential measures to reduce outpatient waiting time based on a computer simulation approach. Methods During a one-month study period in 2006, a cross-sectional study was conducted in a community hospital located in Shanghai, China. Baseline data of outpatient waiting time were calculated according to the records of registration time and payment time. A simulation technique was adopted to investigate the impact of perspective reform methods on reducing waiting time. Results Data from a total of 10 092 patients and 26 816 medical consultations were collected in the study and 19 947 medical consultations were included. The average of the total visit time for outpatients in this hospital was 43.6 minutes in the morning, 19.1 minutes in the afternoon, and 34.3 minutes for the whole day studied period. The simulation results suggested that waiting time for outpatients could be greatly reduced through the introduction of appointment system and flexible demand-orientated doctor scheduling according to the numbers of patients waiting at different time of the workday. Conclusion Adoption of an appointment system and flexible management of doctor scheduling may be effective way to achieve decreased waiting time.

  2. 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.

  3. Waiting time before release increases the motivation to home in homing pigeons (Columba livia).

    Science.gov (United States)

    Dell'Ariccia, Gaia; Costantini, David; Dell'Omo, Giacomo; Lipp, Hans-Peter

    2009-10-01

    When performing homing experiments with individual releases, pigeons have to wait in a transport box for a certain amount of time before being released and hence perceive the departure of companions. Quite often, the last pigeons disappear straightforward from the release site. The question is whether this reflects improved orientation because of prolonged exposure to the release place or whether it reflects increased homing motivation. By releasing pigeons from a familiar site, we investigated the effects of the time spent at the release site on homing performance, recording pigeons' flights with GPS loggers. Our results show that, despite individual peculiarities of flight patterns, the waiting time at release site had a positive effect on homing speed and time, and reduced the time spent circling around the release point. However, the overall path efficiency as derived from GPS tracking was not influenced. These results suggest that a longer waiting time before release improves homing performance and this is related not only to increased navigational abilities but also to increased homing motivation.

  4. Anomalous transport in fluid field with random waiting time depending on the preceding jump length

    Science.gov (United States)

    Zhang, Hong; Li, Guo-Hua

    2016-11-01

    Anomalous (or non-Fickian) transport behaviors of particles have been widely observed in complex porous media. To capture the energy-dependent characteristics of non-Fickian transport of a particle in flow fields, in the present paper a generalized continuous time random walk model whose waiting time probability distribution depends on the preceding jump length is introduced, and the corresponding master equation in Fourier-Laplace space for the distribution of particles is derived. As examples, two generalized advection-dispersion equations for Gaussian distribution and lévy flight with the probability density function of waiting time being quadratic dependent on the preceding jump length are obtained by applying the derived master equation. Project supported by the Foundation for Young Key Teachers of Chengdu University of Technology, China (Grant No. KYGG201414) and the Opening Foundation of Geomathematics Key Laboratory of Sichuan Province, China (Grant No. scsxdz2013009).

  5. The application of queue theory in cloud computing to reduce the waiting time

    Directory of Open Access Journals (Sweden)

    N.N. Bharkad

    2014-10-01

    Full Text Available Cloud computing is a new technology in computer field to provide on line service to the customers. -Cloud computing has got enormous popularity as it offers dynamic, low-cost computing solutions. To get the service of cloud the user has to be in queue until he is served. Each arriving Cloud computing User (CCU requests Cloud computing Service Provider (CCSP to use the resources, if server is available, the arriving user will seize and hold it for a length of time, which leads to queue length and more waiting time. A new arrival leaves the queue with no service. After service completion the server is made immediately available to others. From the user’s point of view he needs to be served immediately and to prevent waiting the CCSP’s can use infinite servers to reduce waiting time & queue length. The arrival pattern is often Poisson in queuing theory. In this article we analyzed the dynamic behavior of the system with infinite servers by finding various effective measures like response time, average time spend in the system, utilization and throughput.

  6. The Impact of Waiting Time on Health Gains from Surgery: Evidence from a National Patient-reported Outcome Dataset.

    Science.gov (United States)

    Nikolova, Silviya; Harrison, Mark; Sutton, Matt

    2016-08-01

    Reducing waiting times has been a major focus of the English National Health Service for many years, but little is known about the impact on health outcomes. The collection of data on patient-reported outcome measures for all patients undergoing four large-volume procedures facilitates analysis of the impact of waiting times on patient outcomes. The availability of patient-reported outcome measures before and after surgery allows us to estimate the impact of waiting times on the effectiveness of treatment, controlling for pre-surgery health and the endogeneity of waiting times caused by prioritisation with respect to pre-intervention health. We find that waiting time has a negative and statistically significant impact on the health gain from hip and knee replacement surgery and no impact on the effectiveness of varicose vein and hernia surgery. The magnitude of this effect at patient level is small, 0.1% of the outcome measure range for each additional week of waiting. However, the value of this effect is substantially larger than existing estimates of the disutility experienced during the waiting period. The health losses associated with an additional week of waiting for annual populations of hip and knee replacement patients are worth £11.1m and £11.5m, respectively. Copyright © 2015 John Wiley & Sons, Ltd.

  7. Scheduling a three-machine no-wait flowshop with separated setup time

    Institute of Scientific and Technical Information of China (English)

    CHANG Jun-lin; SHAO Hui-he

    2006-01-01

    In many practical flowshop production environments, there is no intermediate storage space available to keep partially completed jobs between any two machines. The workflow has to be continuous, implying that the no-wait conditions must be abided, which is typical in steel and plastic production. We discuss the threemachine no-wait flowshop scheduling problem where the setup times are considered as separated from processing times and sequence independent. The scheduling goal is to minimize the total flowtime. An optimal property and two heuristic algorithms for this problem are proposed. Evaluated over a large number of problems, the proposed heuristics are found that they can yield good solutions effectively with low computational complexity, and have more obvious advantage for the large size problem compared with the existing one.

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

    CERN Document Server

    Haskell, Brynmor

    2016-01-01

    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 a cut-off deviations from a power-law distribution for smaller glitches. In this paper we incorporate the results of quantum mechanical simulations in a macroscopic scale superfluid hydrodynamics simulation. We show that the effect of vortex coupling to the neutron and proton fluids in the neutron star naturally leads to deviati...

  9. Scheduling queues in the Ethernet switch, considering the waiting time of frames

    Directory of Open Access Journals (Sweden)

    Kizilov Evgeniy

    2016-01-01

    Full Text Available Authors proposes an algorithm to scheduling queues with temporal selection of frames in the Ethernet switches with QoS support, which is based on the waiting time of frames in the queues of different classes. Evaluation of the effectiveness of this algorithm compared to the classical cyclic algorithms by simulation with hierarchical temporal coloured Petri nets using CPN Tools package was conducte.

  10. Scaling of earthquake waiting times and the Olami-Feder-Christensen model

    CERN Document Server

    Hedges, M; Hedges, Morgan; Takacs, George

    2005-01-01

    Waiting-time statistics are generated from the Olami-Feder-Christensen model and shown to mimic some aspects of real seismicity. Preliminary analysis of the model data implies a recently proposed universal scaling law for the distribution in seismicity may be due to a mixing between aftershocks and uncorrelated event pairs, thus having limited application. Earthquake catalog data is also presented to support the argument.

  11. Waiting time distribution of solar energetic particle events modeled with a non-stationary Poisson process

    CERN Document Server

    Li, Chuan; Wang, Linghua; Su, Wei; Fang, Cheng

    2014-01-01

    We present a study of the waiting time distributions (WTDs) of solar energetic particle (SEP) events observed with the spacecraft $WIND$ and $GOES$. Both the WTDs of solar electron events (SEEs) and solar proton events (SPEs) display a power-law tail $\\sim \\Delta t^{-\\gamma}$. The SEEs display a broken power-law WTD. The power-law index is $\\gamma_{1} =$ 0.99 for the short waiting times ($$100 hours). The break of the WTD of SEEs is probably due to the modulation of the corotating interaction regions (CIRs). The power-law index $\\gamma \\sim$ 1.82 is derived for the WTD of SPEs that is consistent with the WTD of type II radio bursts, indicating a close relationship between the shock wave and the production of energetic protons. The WTDs of SEP events can be modeled with a non-stationary Poisson process which was proposed to understand the waiting time statistics of solar flares (Wheatland 2000; Aschwanden $\\&$ McTiernan 2010). We generalize the method and find that, if the SEP event rate $\\lambda = 1/\\Delt...

  12. Probabilistic model of waiting times between large failures in sheared media.

    Science.gov (United States)

    Brinkman, Braden A W; LeBlanc, Michael P; Uhl, Jonathan T; Ben-Zion, Yehuda; Dahmen, Karin A

    2016-01-01

    Using a probabilistic approximation of a mean-field mechanistic model of sheared systems, we analytically calculate the statistical properties of large failures under slow shear loading. For general shear F(t), the distribution of waiting times between large system-spanning failures is a generalized exponential distribution, ρ_{T}(t)=λ(F(t))P(F(t))exp[-∫_{0}^{t}dτλ(F(τ))P(F(τ))], where λ(F(t)) is the rate of small event occurrences at stress F(t) and P(F(t)) is the probability that a small event triggers a large failure. We study the behavior of this distribution as a function of fault properties, such as heterogeneity or shear rate. Because the probabilistic model accommodates any stress loading F(t), it is particularly useful for modeling experiments designed to understand how different forms of shear loading or stress perturbations impact the waiting-time statistics of large failures. As examples, we study how periodic perturbations or fluctuations on top of a linear shear stress increase impact the waiting-time distribution.

  13. 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.

  14. Analyzing patient's waiting time in emergency & trauma department in public hospital - A case study

    Science.gov (United States)

    Roslan, Shazwa; Tahir, Herniza Md; Nordin, Noraimi Azlin Mohd; Zaharudin, Zati Aqmar

    2014-09-01

    Emergency and Trauma Department (ETD) is an important element for a hospital. It provides medical service, which operates 24 hours a day in most hospitals. However overcrowding is not exclusion for ETD. Overflowing occurs due to affordable services provided by public hospitals, since it is funded by the government. It is reported that a patient attending ETD must be treated within 90 minutes, in accordance to achieve the Key Performance Indicator (KPI). However, due to overcrowd situations, most patients have to wait longer than the KPI standard. In this paper, patient's average waiting time is analyzed. Using Chi-Square Test of Goodness, patient's inter arrival per hour is also investigated. As conclusion, Monday until Wednesday was identified as the days that exceed the KPI standard while Chi-Square Test of Goodness showed that the patient's inter arrival is independent and random.

  15. Transition in the waiting-time distribution of price-change events in a global socioeconomic system

    Science.gov (United States)

    Zhao, Guannan; McDonald, Mark; Fenn, Dan; Williams, Stacy; Johnson, Nicholas; Johnson, Neil F.

    2013-12-01

    The goal of developing a firmer theoretical understanding of inhomogeneous temporal processes-in particular, the waiting times in some collective dynamical system-is attracting significant interest among physicists. Quantifying the deviations between the waiting-time distribution and the distribution generated by a random process may help unravel the feedback mechanisms that drive the underlying dynamics. We analyze the waiting-time distributions of high-frequency foreign exchange data for the best executable bid-ask prices across all major currencies. We find that the lognormal distribution yields a good overall fit for the waiting-time distribution between currency rate changes if both short and long waiting times are included. If we restrict our study to long waiting times, each currency pair’s distribution is consistent with a power-law tail with exponent near to 3.5. However, for short waiting times, the overall distribution resembles one generated by an archetypal complex systems model in which boundedly rational agents compete for limited resources. Our findings suggest that a gradual transition arises in trading behavior between a fast regime in which traders act in a boundedly rational way and a slower one in which traders’ decisions are driven by generic feedback mechanisms across multiple timescales and hence produce similar power-law tails irrespective of currency type.

  16. Parallel-Batch Scheduling and Transportation Coordination with Waiting Time Constraint

    Directory of Open Access Journals (Sweden)

    Hua Gong

    2014-01-01

    Full Text Available This paper addresses a parallel-batch scheduling problem that incorporates transportation of raw materials or semifinished products before processing with waiting time constraint. The orders located at the different suppliers are transported by some vehicles to a manufacturing facility for further processing. One vehicle can load only one order in one shipment. Each order arriving at the facility must be processed in the limited waiting time. The orders are processed in batches on a parallel-batch machine, where a batch contains several orders and the processing time of the batch is the largest processing time of the orders in it. The goal is to find a schedule to minimize the sum of the total flow time and the production cost. We prove that the general problem is NP-hard in the strong sense. We also demonstrate that the problem with equal processing times on the machine is NP-hard. Furthermore, a dynamic programming algorithm in pseudopolynomial time is provided to prove its ordinarily NP-hardness. An optimal algorithm in polynomial time is presented to solve a special case with equal processing times and equal transportation times for each order.

  17. 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

    Full Text Available Abstract Background Prioritization of waiting lists for elective surgery represents a major issue in public systems in view of the fact that patients often suffer from consequences of long waiting times. In addition, administrative and standardized data on waiting lists are generally lacking in Italy, where no detailed national reports are available. This is true although since 2002 the National Government has defined implicit Urgency-Related Groups (URGs associated with Maximum Time Before Treatment (MTBT, similar to the Australian classification. The aim of this paper is to propose a model to manage waiting lists and prioritize admissions to elective surgery. Methods In 2001, the Italian Ministry of Health funded the Surgical Waiting List Info System (SWALIS project, with the aim of experimenting solutions for managing elective surgery waiting lists. The project was split into two phases. In the first project phase, ten surgical units in the largest hospital of the Liguria Region were involved in the design of a pre-admission process model. The model was embedded in a Web based software, adopting Italian URGs with minor modifications. The SWALIS pre-admission process was based on the following steps: 1 urgency assessment into URGs; 2 correspondent assignment of a pre-set MTBT; 3 real time prioritization of every referral on the list, according to urgency and waiting time. In the second project phase a prospective descriptive study was performed, when a single general surgery unit was selected as the deployment and test bed, managing all registrations from March 2004 to March 2007 (1809 ordinary and 597 day cases. From August 2005, once the SWALIS model had been modified, waiting lists were monitored and analyzed, measuring the impact of the model by a set of performance indexes (average waiting time, length of the waiting list and Appropriate Performance Index (API. Results The SWALIS pre-admission model was used for all registrations in the

  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. Marginal estimation for multi-stage models: waiting time distributions and competing risks analyses.

    Science.gov (United States)

    Satten, Glen A; Datta, Somnath

    2002-01-15

    We provide non-parametric estimates of the marginal cumulative distribution of stage occupation times (waiting times) and non-parametric estimates of marginal cumulative incidence function (proportion of persons who leave stage j for stage j' within time t of entering stage j) using right-censored data from a multi-stage model. We allow for stage and path dependent censoring where the censoring hazard for an individual may depend on his or her natural covariate history such as the collection of stages visited before the current stage and their occupation times. Additional external time dependent covariates that may induce dependent censoring can also be incorporated into our estimates, if available. Our approach requires modelling the censoring hazard so that an estimate of the integrated censoring hazard can be used in constructing the estimates of the waiting times distributions. For this purpose, we propose the use of an additive hazard model which results in very flexible (robust) estimates. Examples based on data from burn patients and simulated data with tracking are also provided to demonstrate the performance of our estimators.

  20. Delay decomposition at a single server queue with constant service time and multiple inputs. [Waiting time on computer network

    Science.gov (United States)

    Ziegler, C.; Schilling, D. L.

    1977-01-01

    Two networks consisting of single server queues, each with a constant service time, are considered. The external inputs to each network are assumed to follow some general probability distribution. Several interesting equivalencies that exist between the two networks considered are derived. This leads to the introduction of an important concept in delay decomposition. It is shown that the waiting time experienced by a customer can be decomposed into two basic components called self delay and interference delay.

  1. Use of queue modelling in the analysis of elective patient treatment governed by a maximum waiting time policy

    DEFF Research Database (Denmark)

    Kozlowski, Dawid; Worthington, Dave

    2015-01-01

    Many public healthcare systems struggle with excessive waiting lists for elective patient treatment. Different countries address this problem in different ways, and one interesting method entails a maximum waiting time guarantee. Introduced in Denmark in 2002, it entitles patients to treatment at...... by hospital planners and strategic decision makers....... at a private hospital in Denmark or at a hospital abroad if the public healthcare system is unable to provide treatment within the stated maximum waiting time guarantee. Although clearly very attractive in some respects, many stakeholders have been very concerned about the negative consequences of the policy...... on the utilization of public hospital resources. This paper illustrates the use of a queue modelling approach in the analysis of elective patient treatment governed by the maximum waiting time policy. Drawing upon the combined strengths of analytic and simulation approaches we develop both continuous-time Markov...

  2. ADAPTATION OF JOHNSON SEQUENCING ALGORITHM FOR JOB SCHEDULING TO MINIMISE THE AVERAGE WAITING TIME IN CLOUD COMPUTING ENVIRONMENT

    Directory of Open Access Journals (Sweden)

    SOUVIK PAL

    2016-09-01

    Full Text Available Cloud computing is an emerging paradigm of Internet-centric business computing where Cloud Service Providers (CSPs are providing services to the customer according to their needs. The key perception behind cloud computing is on-demand sharing of resources available in the resource pool provided by CSP, which implies new emerging business model. The resources are provisioned when jobs arrive. The job scheduling and minimization of waiting time are the challenging issue in cloud computing. When a large number of jobs are requested, they have to wait for getting allocated to the servers which in turn may increase the queue length and also waiting time. This paper includes system design for implementation which is concerned with Johnson Scheduling Algorithm that provides the optimal sequence. With that sequence, service times can be obtained. The waiting time and queue length can be reduced using queuing model with multi-server and finite capacity which improves the job scheduling model.

  3. The Impact of Private versus Social Health Insurance on Offered Waiting Times in German Acute Care Hospitals

    OpenAIRE

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

    2009-01-01

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

  4. Waiting times before dental care under general anesthesia in children with special needs in the Children's Hospital of Casablanca

    OpenAIRE

    Badre, Bouchra; Serhier, Zineb; El Arabi, Samira

    2014-01-01

    Introduction Oral diseases may have an impact on quality of children's life. The presence of severe disability requires the use of care under general anesthesia (GA). However, because of the limited number of qualified health personnel, waiting time before intervention can be long. Aim: To evaluate the waiting time before dental care under general anesthesia for children with special needs in Morocco. Methods A retrospective cohort study was carried out in pediatric dentistry unit of the Univ...

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

    DEFF Research Database (Denmark)

    Gorst-Rasmussen, Anders; Hansen, Martin Bøgsted

    confidence intervals and statistical tests, including a simple bootstrap two-sample test for comparing patience distributions. The methods are exemplified in a small simulation study, and a real data example is given involving comparison of patience distributions for two customer classes in a call center.......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...

  6. Application of Queuing Analytic Theory to Decrease Waiting Times in Emergency Department: Does it Make Sense?

    Science.gov (United States)

    Alavi-Moghaddam, Mostafa; Forouzanfar, Reza; Alamdari, Shahram; Shahrami, Ali; Kariman, Hamid; Amini, Afshin; Pourbabaee, Shokooh; Shirvani, Armin

    2012-01-01

    Patients who receive care in an emergency department (ED), are usually unattended while waiting in queues. This study was done to determine, whether the application of queuing theory analysis might shorten the waiting times of patients admitted to emergency wards. This was an operational study to use queuing theory analysis in the ED. In the first phase, a field study was conducted to delineate the performance of the ED and enter the data obtained into simulator software. In the second phase, "ARENA" software was used for modeling, analysis, creating a simulation and improving the movement of patients in the ED. Validity of the model was confirmed through comparison of the results with the real data using the same instrument. The third phase of the study concerned modeling in order to assess the effect of various operational strategies, on the queue waiting time of patients who were receiving care in the ED. In the first phase, it was shown that 47.7% of the 3000 patient records were cases referred for trauma treatment, and the remaining 52.3% were referred for non-trauma services. A total of 56% of the cases were male and 44% female. Maximum input was 4.5 patients per hour and the minimum input was 0.5 per hour. The average length of stay for patients in the trauma section was three hours, while for the non-trauma section it was four hours. In the second phase, modeling was tested with common scenarios. In the third phase, the scenario with the addition of one or more senior emergency resident(s) on each shift resulted in a decreased length of stay from 4 to 3.75 hours. Moreover, the addition of one bed to the Intensive Care Unit (ICU) and/or Critical Care Unit (CCU) in the study hospital, reduced the occupancy rate of the nursing service from 76% to 67%. By adding another clerk to take electrocardiograms (ECG) in the ED, the average time from a request to performing the procedure is reduced from 26 to 18 minutes. Furthermore, the addition of 50% more staff to the

  7. Improving Adult ART Clinic Patient Waiting Time by Implementing an Appointment System at Gondar University Teaching Hospital, Northwest Ethiopia

    Directory of Open Access Journals (Sweden)

    Asmamaw Atnafu

    2015-01-01

    Full Text Available Background. Long waiting time has been among the major factors that affect patient satisfaction and health service delivery. The aim of this study was to determine the median waiting time at the Anti-Retroviral Therapy (ART Clinic before and after introduction of an intervention of the systematic appointment system. Methods. Patient waiting time was measured before and after the introduction of an intervention; target population of the study was all adult HIV patients/clients who have visited the outpatient ART Clinic in the study period. 173 patients were included before and after the intervention. Systematic patient appointment system and health education to patients on appointment system were provided as an intervention. The study period was from October 2011 to the end of January 2012. Data were analyzed using SPSS software version 17.0. Independent sample t-test at 95% confidence interval and 5% significance level was used to determine the significance of median waiting time difference between pre- and postintervention periods. Results and Conclusion. The total median waiting time was reduced from 274.8 minutes (IQR 180.6 minutes and 453.6 minutes before intervention to 165 minutes (IQR 120 minutes and 377.4 minutes after intervention (40% decrease, p=0.02. Overall, the study showed that the introduction of the new appointment system significantly reduces patient waiting time.

  8. 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 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.

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

    Science.gov (United States)

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

    2016-04-01

    This article maps current approaches to public reporting on waiting times, patient experience and aggregate measures of quality and safety in 11 high-income countries (Australia, Canada, England, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and the United States). Using a questionnaire-based survey of key national informants, we found that the data most commonly made available to the public are on waiting times for hospital treatment, being reported for major hospitals in seven countries. Information on patient experience at hospital level is also made available in many countries, but it is not generally available in respect of primary care services. Only one of the 11 countries (England) publishes composite measures of overall quality and safety of care that allow the ranking of providers of hospital care. Similarly, the publication of information on outcomes of individual physicians remains rare. We conclude that public reporting of aggregate measures of quality and safety, as well as of outcomes of individual physicians, remain relatively uncommon. This is likely to be due to both unresolved methodological and ethical problems and concerns that public reporting may lead to unintended consequences. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  10. Waiting time reduction in intravitreal clinics by optimization of appointment scheduling: balancing demand and supply.

    Science.gov (United States)

    Ugarte, Marta

    2015-01-01

    This study was designed guided by the Model for Improvement framework to reduce waiting times and visit duration in the intravitreal therapy clinic, while improving patient and staff experience. In our aim to provide good quality, patient-centred care and constantly improve, we optimised the appointment profile and patient flow. We involved a multidisciplinary team (one consultant, junior doctors, staff nurses, technicians, and receptionist), as well as patients and relatives, to try to understand the main delays in the clinic. Process mapping, a fishbone diagram, run charts, together with feedback from patients and staff, provided an insight on the possible roots of the delays experienced by our patients. The results of the inquiry led us to take actions focused on optimising appointment scheduling. After implementing the new scheduling profile (with a gap in the middle of the session), various cycles of plan-do-study-act and a comparative, qualitative study by interviewing 10 patients demonstrated that the waiting times decreased, and patients and staff experience improved.

  11. Waiting times before dental care under general anesthesia in children with special needs in the Children's Hospital of Casablanca.

    Science.gov (United States)

    Badre, Bouchra; Serhier, Zineb; El Arabi, Samira

    2014-01-01

    Oral diseases may have an impact on quality of children's life. The presence of severe disability requires the use of care under general anesthesia (GA). However, because of the limited number of qualified health personnel, waiting time before intervention can be long. To evaluate the waiting time before dental care under general anesthesia for children with special needs in Morocco. A retrospective cohort study was carried out in pediatric dentistry unit of the University Hospital of Casablanca. Data were collected from records of patients seen for the first time between 2006 and 2011. The waiting time was defined as the time between the date of the first consultation and intervention date. 127 children received dental care under general anesthesia, 57.5% were male and the average age was 9.2 (SD = 3.4). Decay was the most frequent reason for consultation (48%), followed by pain (32%). The average waiting time was 7.6 months (SD = 4.2 months). The average number of acts performed per patient was 13.5. Waiting times were long, it is necessary to take measures to reduce delays and improve access to oral health care for this special population.

  12. The pattern for waiting time in the context of multiple stochastic process

    CERN Document Server

    Jamali, Tayeb; Farahani, S Vasheghani

    2015-01-01

    The aim here is to provide a deeper understanding on the concept of waiting time in application to multiple stochastic processes. This obliges us to work with the vector stochastic process which enables considering at least two stochastic process at simultaneous time instances. In the present study the plan is to master vector stochastic processes by developing the level crossing method. The reason that the previous level-crossing methods lack generality is based on their individual element studies, where the coupling between the components of the vector stochastic process had been simply neglected. In the present work by introducing the generalized level crossing method, consideration of coupling between the components has become possible. This enables analyzing and hence extracting information out of coupled processes usually faced when working in tensor environments. The results obtained by this technique state that in addition to the point distribution of the vector stochastic process, the coupling plays ...

  13. Optimizing computed tomography simulation wait times in a busy radiation medicine program.

    Science.gov (United States)

    Roussos, Jerry; Zahedi, Payam; Spence, Tara; Swanson, Lue-Ann; Li-Cheung, Fionna; Cops, Fred; Darcy, Patrick; Chhin, Veng; Moyo, Elen; Warde, Padraig; Foxcroft, Sophie; Liu, Fei-Fei

    An audit was conducted of patient schedules for computed tomography simulation (CT-Sim) scans within the Radiation Medicine Program at the Princess Margaret Cancer Centre to investigate opportunities for improved efficiencies, enhancing process, reducing rescanning rates, and decreasing wait times. A 3-phased approach was undertaken to evaluate the current practice in the CT-Sim facility with a view toward implementing improvements. The first phase involved a review and assessment of the validity of current guidelines and protocols associated with 16 different disease sites. The second phase incorporated the use of a patient record and verification program MOSAIQ to capture the duration of each appointment. The last phase allocated additional time for patient-centered care and staff engagement. The audit revealed that efficiency could be achieved through staff training, updating protocols, and improving process coordination. With the exception of sarcoma, pediatric, and palliative patients who require unique management approaches, the duration for each CT-Sim appointment was successfully shortened for all disease sites by 22% to 33%, corresponding to a reduction of 10 to 15 minutes per appointment. Rescanning rates for patients requiring self-administered preparations before CT-Sim procedures were also significantly reduced by enhancing processes to increase patient compliance. Implementation of procedural changes resulted in an overall net gain of 3060 minutes, equivalent to 102 additional 30-minute CT-Sim appointment slots available for each month. This retrospective evaluation, review, and optimization of CT-Sim guidelines and practices identified opportunities to shorten appointment timeslots, and reduce rescanning rates for CT-Sim procedures, thereby significantly shortening wait times and improving access to service for our patients. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    2012-07-01

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

  15. Models for Flare Statistics and the Waiting-time Distribution of Solar Flare Hard X-ray Bursts

    Science.gov (United States)

    Wheatland, M. S.; Edney, S. D.

    1999-12-01

    In a previous study (Wheatland, Sturrock, McTiernan 1998), a waiting-time distribution was constructed for solar flare hard X-ray bursts observed by the ICE/ISEE-3 spacecraft. A comparison of the observed distribution with that of a time-dependent Poisson process indicated an overabundance of short waiting times (10~s -- 10~min), implying that the hard X-ray bursts are not independent events. Models for flare statistics assume or predict that flares are independent events -- in particular the avalanche model makes this specific prediction. The results of the previous study may be reconciled with the avalanche picture if individual flares produce several distinct bursts of hard X-ray emission. A detailed comparison of the avalanche model and the ICE/ISEE-3 waiting-time distribution is presented here.

  16. Arrival time pattern and waiting time distribution of patients in the emergency outpatient department of a tertiary level health care institution of North India

    Directory of Open Access Journals (Sweden)

    Yogesh Tiwari

    2014-01-01

    Full Text Available Background: Emergency Department (ED of tertiary health care institute in India is mostly overcrowded, over utilized and inappropriately staffed. The challenges of overcrowded EDs and ill-managed patient flow and admission processes result in excessively long waits for patients. Aim: The objective of the present study was to analyze the patient flow system by assessing the arrival and waiting time distribution of patients in an Emergency out Patient Department (EOPD. Materials and Methods: This short cross-sectional descriptive study was conducted in the EOPD of a Tertiary level health care Institution in North India in the month of May, 2011. The data was obtained from 591 patients, who were present in the EOPD during the month of May, 2011. The waiting time, inter arrival time between two consecutive patients were calculated in addition to the daily census data (discharge rate, admission rate and transfer out rates etc. of the emergency. Results: Arrival time pattern of patients in the EOPD was highly stochastic with the peak arrival hours to be "9.00-12.00 h" in which around 26.3% patients arrived in the EOPD. The primary waiting areas of patients included patients "under observation" (29.6%; "waiting for routine diagnostic tests" (16.4% and "waiting for discharge" (14.6%. Around 71% patients were waiting due to reasons within emergency complex. Conclusion: The patient flow of the ED could only be addressed by multifaceted, multidisciplinary and hospital wide approach.

  17. Analyzing the waiting time pattern for non-critical patients in the emergency department using six sigma approach

    Science.gov (United States)

    Majid, Noriza; Mohd Suradi, Nur Riza; Ahmad Sabri, Safura

    2013-04-01

    This study was conducted to examine the waiting time of non-critical patients in the Emergency Department (ED) of Universiti Kebangsaan Malaysia Medical Centre (UKMMC) using the approach of six sigma (6σ). The define phase is completed by obtaining customers' critical to quality in UKMMC using survey. In measure phase, data on patients to the ED of UKMMC in May 2009 were gathered. Subsequently, analysis phase is performed using cause-and-effect diagram to identify root causes of the problems. Finally, improvements are proposed based on the identified problems. Results show that waiting time is critical to quality for health services in the ED.

  18. 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.

  19. Splitting Travel Time Based on AFC Data: Estimating Walking, Waiting, Transfer, and In-Vehicle Travel Times in Metro System

    Directory of Open Access Journals (Sweden)

    Yong-Sheng Zhang

    2015-01-01

    Full Text Available The walking, waiting, transfer, and delayed in-vehicle travel times mainly contribute to route’s travel time reliability in the metro system. The automatic fare collection (AFC system provides huge amounts of smart card records which can be used to estimate all these times distributions. A new estimation model based on Bayesian inference formulation is proposed in this paper by integrating the probability measurement of the OD pair with only one effective route, in which all kinds of times follow the truncated normal distributions. Then, Markov Chain Monte Carlo method is designed to estimate all parameters endogenously. Finally, based on AFC data in Guangzhou Metro, the estimations show that all parameters can be estimated endogenously and identifiably. Meanwhile, the truncated property of the travel time is significant and the threshold tested by the surveyed data is reliable. Furthermore, the superiority of the proposed model over the existing model in estimation and forecasting accuracy is also demonstrated.

  20. Prediction problem for target events based on the inter-event waiting time

    Science.gov (United States)

    Shapoval, A.

    2010-11-01

    In this paper we address the problem of forecasting the target events of a time series given the distribution ξ of time gaps between target events. Strong earthquakes and stock market crashes are the two types of such events that we are focusing on. In the series of earthquakes, as McCann et al. show [W.R. Mc Cann, S.P. Nishenko, L.R. Sykes, J. Krause, Seismic gaps and plate tectonics: seismic potential for major boundaries, Pure and Applied Geophysics 117 (1979) 1082-1147], there are well-defined gaps (called seismic gaps) between strong earthquakes. On the other hand, usually there are no regular gaps in the series of stock market crashes [M. Raberto, E. Scalas, F. Mainardi, Waiting-times and returns in high-frequency financial data: an empirical study, Physica A 314 (2002) 749-755]. For the case of seismic gaps, we analytically derive an upper bound of prediction efficiency given the coefficient of variation of the distribution ξ. For the case of stock market crashes, we develop an algorithm that predicts the next crash within a certain time interval after the previous one. We show that this algorithm outperforms random prediction. The efficiency of our algorithm sets up a lower bound of efficiency for effective prediction of stock market crashes.

  1. Comparison of Emergency Department Wait Times in Adults with Sickle Cell Disease Versus Other Painful Etiologies.

    Science.gov (United States)

    Pulte, Dianne; Lovett, Paris B; Axelrod, David; Crawford, Albert; McAna, John; Powell, Rhea

    2016-09-01

    Sickle cell disease is characterized by intermittent painful crises often requiring treatment in the emergency department (ED). Past examinations of time-to-provider (TTP) in the ED for patients with sickle cell disease demonstrated that these patients may have longer TTP than other patients. Here, we examine TTP for patients presenting for emergency care at a single institution, comparing patients with sickle cell disease to both the general population and to those with other painful conditions, with examination of both institutional and patient factors that might affect wait times. Our data demonstrated that at our institution patients with sickle cell disease have a slightly longer average TTP compared to the general ED population (+16 min.) and to patients with other painful conditions (+4 min.) However, when confounding factors were considered, there was no longer a significant difference between TTP of patients with sickle cell disease and the general population nor between patients with sickle cell disease and those with other painful conditions. Multivariate analyses demonstrated that gender, race, age, high utilizer status, fast track use, time of presentation, acuity and insurance type, were all independently associated with TTP, with acuity, time of presentation and use of fast track having the greatest influence. We concluded that the longer TTP observed in patients with sickle cell disease can at least partially be explained by institutional factors such as the use of fast track protocols. Further work to reduce TTP for sickle cell disease and other patients is needed to optimize care.

  2. Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal

    Directory of Open Access Journals (Sweden)

    Logandran Naidoo

    2016-03-01

    Full Text Available Background: Prolonged waiting time is a source of patient dissatisfaction with health care and is negatively associated with patient satisfaction. Prolonged waiting times in many district hospitals result in many dissatisfied patients, overworked and frustrated staff, and poor quality of care because of the perceived increased workload.Aim: The aim of the study was to determine the impact of Lean principles techniques, and tools on the operational efficiency in the outpatient department (OPD of a rural district hospital.Setting: The study was conducted at the Catherine Booth Hospital (CBH – a rural district hospital in KwaZulu-Natal, South Africa.Methods: This was an action research study with pre-, intermediate-, and post-implementation assessments. Cycle and waiting times were measured by direct observation on two occasions before, approximately two-weekly during, and on two occasions after Lean implementation. A standardised data collection tool was completed by the researcher at each of the six key service nodes in the OPD to capture the waiting times and cycle times.Results: All six service nodes showed a reduction in cycle times and waiting times between the baseline assessment and post-Lean implementation measurement. Significant reduction was achieved in cycle times (27%; p < 0.05 and waiting times (from 11.93 to 10 min; p = 0.03 at the Investigations node. Although the target reduction was not achieved for the Consulting Room node, there was a significant reduction in waiting times from 80.95 to 74.43 min, (p < 0.001. The average efficiency increased from 16.35% (baseline to 20.13% (post-intervention.Conclusion: The application of Lean principles, tools and techniques provides hospital managers with an evidence-based management approach to resolving problems and improving quality indicators.

  3. Analysis of Time of Day Fare Discounts on Urban Mass Transit Travel Behavior, Crowding, and Waiting Time

    Directory of Open Access Journals (Sweden)

    Xiao Guo

    2014-01-01

    Full Text Available Every morning, commuters select the regularly dispatched urban mass transit for traveling from a residential area to a workplace. This paper aims to find an optimal discount fare and time intervals on morning peak hour. As a direct and flexible traffic economic instrument, fares can influence commuters’ behavior. Therefore, fare discount has been proposed to regulate traffic flow in different time. Two models have been analyzed to describe it with schedule delay because of the travel demand size. The first objective function is constructed on pressure equalization when the travel demand is small. The other objective function is to minimize total waiting time when the travel demand is large. In the end, numerical examples based on an artificial network are performed to characterize fare discount models.

  4. The waiting time of the ship on port entrance at required water level

    Directory of Open Access Journals (Sweden)

    Wiesław GALOR

    2008-01-01

    Full Text Available The safety of a ship which manoeuvres within a port area depends to a large extent on the underkeel clearance (UKC. Ports have been built to handle ships of specific maximum parameters. In many cases, however, the existing ports face the need to accept ships larger than those they were designed for. The construction of newharbours is limited by both natural conditions and exceedingly high estimated costs. The main restriction for handling larger ships is the depth of port basins, directly affecting the safety of the manoeuvring ship. The minimum underkeel clearance is most often specified by port regulations as a constant value. However, depending on the prevailingconditions, mainly water level, this required UKC value can be reduced. Thus, ships of larger draft will be allowed to enter. This article / paper present a method of UKC optimization with two restrictions: maximum permitted navigational risk and the time ofwaiting for sufficient water level. An example has been given in reference to ship’s waiting time probability for the port of Świnoujście.

  5. Using a Time Timer[TM] to Increase Appropriate Waiting Behavior in a Child with Developmental Disabilities

    Science.gov (United States)

    Grey, Ian; Healy, Olive; Leader, Geraldine; Hayes, Deirdre

    2009-01-01

    This study aimed to examine the use of a predictive stimulus (Time Timer[TM]) and delayed reinforcement to increase appropriate waiting behavior in a child with developmental disabilities and problem behavior maintained by access to tangible items and activities. The study employed a changing criterion design across settings to gradually increase…

  6. A simple derivation of the waiting time distributions in a non-preemptive M/M/c queue with priorities

    NARCIS (Netherlands)

    L.A. van Vianen (Lars); A.F. Gabor (Adriana); J.C.W. van Ommeren (Jan-Kees)

    2014-01-01

    textabstractIn this article we give a new derivation for the waiting time distributions in an M/M/c queue with multiple priorities and a common service rate by using elementary lattice paths counting. An advantage of the approach is that it does not require inversion of the Laplace-Stieltjes transfo

  7. Children’s Mental Health Visits to the Emergency Department: Factors Affecting Wait Times and Length of Stay

    Directory of Open Access Journals (Sweden)

    Amanda S. Newton

    2014-01-01

    Full Text Available Objective. This study explores the association of patient and emergency department (ED mental health visit characteristics with wait time and length of stay (LOS. Methods. We examined data from 580 ED mental health visits made to two urban EDs by children aged ≤18 years from April 1, 2004, to March 31, 2006. Logistic regressions identified characteristics associated with wait time and LOS using hazard ratios (HR with 95% confidence intervals (CIs. Results. Sex (male: HR=1.48, 95% CI=1.20–1.84, ED type (pediatric ED: HR=5.91, 95% CI=4.16–8.39, and triage level (Canadian Triage and Acuity Scale (CTAS 2: HR=3.62, 95% CI=2.24–5.85 were statistically significant predictors of wait time. ED type (pediatric ED: HR=1.71, 95% CI=1.18–2.46, triage level (CTAS 5: HR=2.00, 95% CI=1.15–3.48, number of consultations (HR=0.46, 95% CI=0.31–0.69, and number of laboratory investigations (HR=0.75, 95% CI=0.66–0.85 predicted LOS. Conclusions. Based on our results, quality improvement initiatives to reduce ED waits and LOS for pediatric mental health visits may consider monitoring triage processes and the availability, access, and/or time to receipt of specialty consultations.

  8. Increased wait-list time predicts dropout from outpatient enhanced cognitive behaviour therapy (CBT-E) for eating disorders.

    Science.gov (United States)

    Carter, Olivia; Pannekoek, Louise; Fursland, Anthea; Allen, Karina L; Lampard, Amy M; Byrne, Susan M

    2012-08-01

    Between 30 and 70% of patients with eating disorders drop out from outpatient treatment. However, research has been unable to identify factors that consistently predict dropout from eating disorder treatment. Most studies have exclusively investigated the role that individual patient characteristics play in dropout and have ignored more process-based factors such as expectations about treatment, the therapeutic alliance, or time spent on a treatment waiting list. This study aimed to investigate the roles of both individual patient characteristics and process-based factors in dropout from outpatient treatment for eating disorders. The study involved data collected from consecutive eating disorder referrals to the only public specialist eating disorder service for youth and adults in Perth, Western Australia. The standard treatment provided at this service is Enhanced Cognitive Behaviour Therapy on an individual basis. The study involved 189 patients referred to the service between 2005 and 2010. Forty five percent of this sample dropped out of treatment. Results showed that, in this sample, two individual factors, lowest reported weight and the tendency to avoid affect, and one process-based factor, time spent on the wait list for treatment, were significant predictors of dropout. These findings are valuable because a process-based factor, such as wait-list time, may be easier to address and modify than a patient's weight history or the trait of mood intolerance. Increased resources for eating disorder services may reduce waiting list times which would help to reduce dropout and maximize treatment outcomes.

  9. A multi-stage compartmental model for HIV-infected individuals: I--waiting time approach.

    Science.gov (United States)

    Billard, L; Dayananda, P W A

    2014-03-01

    Traditionally, epidemic processes have focused on establishing systems of differential-difference equations governing the number of individuals at each stage of the epidemic. Except for simple situations such as when transition rates are linear, these equations are notoriously intractable mathematically. In this work, the process is described as a compartmental model. The model also allows for individuals to go directly from any prior compartment directly to a final stage corresponding to death. This allows for the possibility that individuals can die earlier due to some non-disease related cause. Then, the model is based on waiting times in each compartment. Survival probabilities of moving from a given compartment to another compartment are established. While our approach can be used for general epidemic processes, our framework is for the HIV/AIDS process. It is then possible to establish the impact of the HIV/AIDS epidemic process on, e.g., insurance premiums and payouts and health-care costs. The effect of changing model parameter values on these entities is investigated.

  10. Effect of Lean Processes on Surgical Wait Times and Efficiency in a Tertiary Care Veterans Affairs Medical Center.

    Science.gov (United States)

    Valsangkar, Nakul P; Eppstein, Andrew C; Lawson, Rick A; Taylor, Amber N

    2017-01-01

    There are an increasing number of veterans in the United States, and the current delay and wait times prevent Veterans Affairs institutions from fully meeting the needs of current and former service members. Concrete strategies to improve throughput at these facilities have been sparse. To identify whether lean processes can be used to improve wait times for surgical procedures in Veterans Affairs hospitals. Databases in the Veterans Integrated Service Network 11 Data Warehouse, Veterans Health Administration Support Service Center, and Veterans Information Systems and Technology Architecture/Dynamic Host Configuration Protocol were queried to assess changes in wait times for elective general surgical procedures and clinical volume before, during, and after implementation of lean processes over 3 fiscal years (FYs) at a tertiary care Veterans Affairs medical center. All patients evaluated by the general surgery department through outpatient clinics, clinical video teleconferencing, and e-consultations from October 2011 through September 2014 were included. Patients evaluated through the emergency department or as inpatient consults were excluded. The surgery service and systems redesign service held a value stream analysis in FY 2013, culminating in multiple rapid process improvement workshops. Multidisciplinary teams identified systemic inefficiencies and strategies to improve interdepartmental and patient communication to reduce canceled consultations and cases, diagnostic rework, and no-shows. High-priority triage with enhanced operating room flexibility was instituted to reduce scheduling wait times. General surgery department pilot projects were then implemented mid-FY 2013. Planned outcome measures included wait time, clinic and telehealth volume, number of no-shows, and operative volume. Paired t tests were used to identify differences in outcome measures after the institution of reforms. Following rapid process improvement workshop project rollouts, mean

  11. Markov chain modeling of precipitation time series: Modeling waiting times between tipping bucket rain gauge tips

    DEFF Research Database (Denmark)

    Sørup, Hjalte Jomo Danielsen; Madsen, Henrik; Arnbjerg-Nielsen, Karsten

    2011-01-01

    A very fine temporal and volumetric resolution precipitation time series is modeled using Markov models. Both 1st and 2nd order Markov models as well as seasonal and diurnal models are investigated and evaluated using likelihood based techniques. The 2nd order Markov model is found to be insignif...

  12. Estimating medication stopping fraction and real-time prevalence of drug use in pharmaco-epidemiologic databases. An application of the reverse waiting time distribution

    DEFF Research Database (Denmark)

    Støvring, Henrik; Pottegård, Anton; Hallas, Jesper

    2017-01-01

    Purpose: To introduce the reverse waiting time distribution (WTD) and show how it can be used to estimate stopping fractions and real-time prevalence of treatment in pharmacoepidemiological studies. Methods: The reverse WTD is the distribution of time from the last dispensed prescription of each ...

  13. Waiting Time for Coronal Preparation and the Influence of Different Cements on Tensile Strength of Metal Posts

    Directory of Open Access Journals (Sweden)

    Ilione Kruschewsky Costa Sousa Oliveira

    2012-01-01

    Full Text Available This study aimed to assess the effect of post-cementation waiting time for core preparation of cemented cast posts and cores had on retention in the root canal, using two different luting materials. Sixty extracted human canines were sectioned 16 mm from the root apex. After cast nickel-chromium metal posts and cores were fabricated and luted with zinc phosphate (ZP cement or resin cement (RC, the specimens were divided into 3 groups (n = 10 according to the waiting time for core preparation: no preparation (control, 15 minutes, or 1 week after the core cementation. At the appropriate time, the specimens were subjected to a tensile load test (0.5 mm/min until failure. Two-way ANOVA (time versus cement and the Tukey tests (P < 0.05 showed significantly higher (P < 0.05 tensile strength values for the ZP cement groups than for the RC groups. Core preparation and post-cementation waiting time for core recontouring did not influence the retention strength. ZP was the best material for intraradicular metal post cementation.

  14. Prototype of a Questionnaire and Quiz System for Supporting Increase of Health Awareness During Wait Time in Dispensing Pharmacy

    Science.gov (United States)

    Toda, Takeshi; Chen, Poa-Min; Ozaki, Shinya; Ideguchi, Naoko; Miyaki, Tomoko; Nanbu, Keiko; Ikeda, Keiko

    For quit-smoking clinic and its campaign, there was a need for pharmacists to investigate pediatric patient's parent consciousness to tobacco harm utilizing wait time in a pediatric dispensing pharmacy. In this research, we developed the questionnaire and quiz total system using the tablet for user interface, in which people can easily answer the questionnaire/quiz and quickly see the total results on the spot in order to enhance their consciousness to the tobacco harm. The system also provides their tobacco dependence level based on the questionnaire results and some advice for their health and dietary habits due to the tobacco dependence level. From a field trial with one hundred four examinees in the pediatric dispensing pharmacy, the user interface was useful compared to conventional questionnaire form. The system could enhance their consciousness to tobacco harm and make their beneficial use of waiting time in dispensing pharmacy. Some interesting suggestions for improvement and new services were also obtained.

  15. 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

  16. Impact of clinical urgency, physician supply and procedural capacity on regional variations in wait times for coronary angiography

    Directory of Open Access Journals (Sweden)

    Natarajan Madhu K

    2010-01-01

    Full Text Available Abstract Background Despite universal health care, there continues to be regional access disparities to coronary angiography in Canada. Our objective was to evaluate the extent to which demand-side factors such as clinical urgency/need, and supply-side factors, as reflected by differences in physician and procedural supply account for these inequalities. Methods Our cohort consisted of 74,254 consecutive patients referred for coronary angiography in Ontario, Canada between April 1st 2005 and March 31st 2006, divided into three urgency strata based on a clinical urgency scale. Cox-proportional hazard models were developed, adjusting for age, gender, socioeconomic status (SES, region, and urgency score, with greater hazard ratios (HR indicating shorter wait times. To evaluate mediators of any residual wait-time differences, we examined the influence of the regional supply of cath lab facilities, invasive cardiologists and general practitioners (GP. Results We found that the urgency score was a significant predictor of wait time in all three strata (urgent patients: HR 1.61 for each unit increase in patient urgency (95% Confidence interval (CI 1.55-1.67; semi-urgent patients: HR 1.55 (95% CI 1.44-1.68; elective patients: HR 1.13 (95% CI 1.08-1.18. After accounting for clinical need/urgency, regional wait time differences persisted; these were most consistently associated with variation in cath lab supply. The impact of invasive cardiologist supply was restricted to urgent patients while that of GP supply was confined to semi-urgent and elective patients. Conclusion We found that there remained significant regional disparities in access to coronary angiography after accounting for clinical need. These disparities are partially explained by variations in supply of both procedural capacity and physician services, most notably in elective and semi-urgent patients.

  17. The impact of travel distance, travel time and waiting time on health-related quality of life of diabetes patients: An investigation in six European countries.

    Science.gov (United States)

    Konerding, Uwe; Bowen, Tom; Elkhuizen, Sylvia G; Faubel, Raquel; Forte, Paul; Karampli, Eleftheria; Mahdavi, Mahdi; Malmström, Tomi; Pavi, Elpida; Torkki, Paulus

    2017-04-01

    The effects of travel distance and travel time to the primary diabetes care provider and waiting time in the practice on health-related quality of life (HRQoL) of patients with type 2 diabetes are investigated. Survey data of 1313 persons with type 2 diabetes from six regions in England (274), Finland (163), Germany (254), Greece (165), the Netherlands (354), and Spain (103) were analyzed. Various multiple linear regression analyses with four different EQ-5D-3L indices (English, German, Dutch and Spanish index) as target variables, with travel distance, travel time, and waiting time in the practice as focal predictors and with control for study region, patient's gender, patient's age, patient's education, time since diagnosis, thoroughness of provider-patient communication were computed. Interactions of regions with the remaining five control variables and the three focal predictors were also tested. There are no interactions of regions with control variables or focal predictors. The indices decrease with increasing travel time to the provider and increasing waiting time in the provider's practice. HRQoL of patients with type 2 diabetes might be improved by decreasing travel time to the provider and waiting time in the provider's practice. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Does Extending the Waiting Time of Low-Rectal Cancer Surgery after Neoadjuvant Chemoradiation Increase the Perioperative Complications?

    Science.gov (United States)

    Timudom, Kittinut; Phothong, Natthawut; Akaraviputh, Thawatchai; Chinswangwatanakul, Vitoon; Pongpaibul, Ananya; Petsuksiri, Janjira; Ithimakin, Suthinee

    2016-01-01

    Background. Traditionally, rectal cancer surgery is recommended 6 to 8 weeks after completing neoadjuvant chemoradiation. Extending the waiting time may increase the tumor response rate. However, the perioperative complication rate may increase. The purpose of this study was to determine the association between extending the waiting time of surgery after neoadjuvant chemoradiation and perioperative outcomes. Methods. Sixty patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiation followed by radical resection at Siriraj hospital between June 2012 and January 2015 were retrospectively analyzed. Demographic data and perioperative outcomes were compared between the two groups. Results. The two groups were comparable in term of demographic parameters. The mean time interval from neoadjuvant chemoradiation to surgery was 6.4 weeks in Group A and 11.7 weeks in Group B. The perioperative outcomes were not significantly different between Groups A and B. Pathologic examination showed a significantly higher rate of circumferential margin positivity in Group A than in Group B (30% versus 9.3%, resp.; P = 0.04). Conclusions. Extending the waiting to >8 weeks from neoadjuvant chemoradiation to surgery did not increase perioperative complications, whereas the rate of circumferential margin positivity decreased.

  19. Detailed Performance and Waiting-Time Predictability Analysis of Scheduling Options in On-Demand Video Streaming

    Directory of Open Access Journals (Sweden)

    Alsmirat MohammadA

    2010-01-01

    Full Text Available The number of on-demand video streams that can be supported concurrently is highly constrained by the stringent requirements of real-time playback and high transfer rates. To address this problem, stream merging techniques utilize the multicast facility to increase resource sharing. The achieved resource sharing depends greatly on how the waiting requests are scheduled for service. We investigate the effectiveness of the recently proposed cost-based scheduling in detail and analyze opportunities for further tunings and enhancements. In particular, we analyze alternative ways to compute the delivery cost. In addition, we propose a new scheduling policy, called Predictive Cost-Based Scheduling (PCS, which applies a prediction algorithm to predict future scheduling decisions and then uses the prediction results to potentially alter its current scheduling decisions. Moreover, we propose an enhancement technique, called Adaptive Regular Stream Triggering (ART, which significantly enhances stream merging behavior by selectively delaying the initiation of full-length video streams. We analyze the effectiveness of the proposed strategies in terms of their performance effectiveness and impacts on waiting-time predictability through extensive simulation. The results show that significant performance benefits as well as better waiting-time predictability can be attained.

  20. Donor Heart Utilization following Cardiopulmonary Arrest and Resuscitation: Influence of Donor Characteristics and Wait Times in Transplant Regions

    Directory of Open Access Journals (Sweden)

    Mohammed Quader

    2014-01-01

    Full Text Available Background. Procurement of hearts from cardiopulmonary arrest and resuscitated (CPR donors for transplantation is suboptimal. We studied the influences of donor factors and regional wait times on CPR donor heart utilization. Methods. From UNOS database (1998 to 2012, we identified 44,744 heart donors, of which 4,964 (11% received CPR. Based on procurement of heart for transplantation, CPR donors were divided into hearts procured (HP and hearts not procured (HNP groups. Logistic regression analysis was used to identify predictors of heart procurement. Results. Of the 4,964 CPR donors, 1,427 (28.8% were in the HP group. Donor characteristics that favored heart procurement include younger age (25.5 ± 15 yrs versus 39 ± 18 yrs, P≤0.0001, male gender (34% versus 23%, P≤0.0001, shorter CPR duration (30 min, P≤0.0001, and head trauma (60% versus 15%. Among the 11 UNOS regions, the highest procurement was in Region 1 (37% and the lowest in Region 3 (24%. Regional transplant volumes and median waiting times did not influence heart procurement rates. Conclusions. Only 28.8% of CPR donor hearts were procured for transplantation. Factors favoring heart procurement include younger age, male gender, short CPR duration, and traumatic head injury. Heart procurement varied by region but not by transplant volumes or wait times.

  1. THE INFLUENCE OF WAITING TIME SATISFACTION ON CUSTOMER LOYALTY TOWARDS MULTI-STAGE SERVICES IN A FULL-SERVICE RESTAURANT: EVIDENCE FROM INDIA

    OpenAIRE

    Mittal, A.

    2016-01-01

    Research shows waiting time in services is an important source of service evaluation by the customer. In fact, time is one component of the total 'cost' that the customer bears and cost is a core component of the perceived cost-benefit equation that the customer uses to evaluate her or his sustained patronage of a particular service. In most services, customers consider waiting as a waste of time. However, from the customer perspective, in the case of a full-service restaurant, waiting is exp...

  2. The influence of waiting time satisfaction on customer loyalty towards multi-stage services in a full-service restaurant: evidence from India

    OpenAIRE

    Mittal, A.

    2016-01-01

    Research shows waiting time in services is an important source of service evaluation by the customer. In fact, time is one component of the total 'cost' that the customer bears and cost is a core component of the perceived cost-benefit equation that the customer uses to evaluate her or his sustained patronage of a particular service. In most services, customers consider waiting as a waste of time. However, from the customer perspective, in the case of a full-service restaurant, waiting is exp...

  3. On the gap between an empirical distribution and an exponential distribution of waiting times for price changes in a financial market

    CERN Document Server

    Sazuka, N

    2006-01-01

    We analyze waiting times for price changes in a foreign currency exchange rate. Recent empirical studies of high frequency financial data support that trades in financial markets do not follow a Poisson process and the waiting times between trades are not exponentially distributed. Here we show that our data is well approximated by a Weibull distribution rather than an exponential distribution in a non-asymptotic regime. Moreover, we quantitatively evaluate how much an empirical data is far from an exponential distribution using a Weibull fit. Finally, we discuss a phase transition between a Weibull-law and a power-law in the asymptotic long waiting time regime.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    Background: There is wide variation in the psychosocial response to false-positive mammography. We aimed to assess whether women having to wait longer to exclude cancer had increased psychosocial consequences that persisted after cancer was ruled out. Findings: We selected women with false......-positive mammography (n = 272), screened for breast cancer in Copenhagen and Funen (Denmark) over a 1-year period. We measured psychosocial consequences immediately before women attended their recall visit and 1, 6, 18 and 36 months after women received their final diagnosis. After women were told that cancer had been...

  5. A "package solution" fast track program can reduce the diagnostic waiting time in head and neck cancer

    DEFF Research Database (Denmark)

    Sørensen, Jesper Roed; Johansen, Jørgen; Gano, Lars;

    2014-01-01

    In 2007, a fast track program for patients with suspicion of head and neck cancer (HNC) was introduced in Denmark to reduce unnecessary waiting time. The program was based on so called "package solutions" including pre-booked slots for outpatient evaluation, imaging, and diagnostic surgical...... the introduction, and the third interval represents the current situation. The median time from referral to first consultation was reduced from eight calendar days in group 1 to only one day in groups 2 and 3 (p ...

  6. No More Waits and Delays: Streamlining Workflow to Decrease Patient Time of Stay for Image-guided Musculoskeletal Procedures.

    Science.gov (United States)

    Cheung, Yvonne Y; Goodman, Eric M; Osunkoya, Tomiwa O

    2016-01-01

    Long wait times limit our ability to provide the right care at the right time and are commonly products of inefficient workflow. In 2013, the demand for musculoskeletal (MSK) procedures increased beyond our department's ability to provide efficient and timely service. We initiated a quality improvement (QI) project to increase efficiency and decrease patient time of stay. Our project team included three MSK radiologists, one senior resident, one technologist, one administrative assistant/scheduler, and the lead technologist. We adopted and followed the Lean Six Sigma DMAIC (define, measure, analyze, improve, and control) approach. The team used tools such as voice of the customer (VOC), along with affinity and SIPOC (supplier, input, process, output, customer) diagrams, to understand the current process, identify our customers, and develop a project charter in the define stage. During the measure stage, the team collected data, created a detailed process map, and identified wastes with the value stream mapping technique. Within the analyze phase, a fishbone diagram helped the team to identify critical root causes for long wait times. Scatter plots revealed relationships among time variables. Team brainstorming sessions generated improvement ideas, and selected ideas were piloted via plan, do, study, act (PDSA) cycles. The control phase continued to enable the team to monitor progress using box plots and scheduled reviews. Our project successfully decreased patient time of stay. The highly structured and logical Lean Six Sigma approach was easy to follow and provided a clear course of action with positive results. (©)RSNA, 2016.

  7. Reduction of client waiting time using task shifting in an antiretroviral clinic at Specialist Hospital Bauchi, Nigeria

    Directory of Open Access Journals (Sweden)

    Nisser A. Umar

    2011-02-01

    Full Text Available Aiming to assess the impact of the intervention in reducing the patients’ waiting time in the clinic, two surveys were conducted before and after task shifting intervention in an anti-retroviral (ARV clinic at the Specialist Hospital, Bauchi, Nigeria in November 2008 and April 2009, respectively. Before the task shifting, six nurses from the clinic were trained on integrated management of adolescent and adult illness, as well as on the principle and guidelines for the anti-retroviral therapy, after which their schedule in the clinic was broadened to include seeing HIV patients presenting for routine refill and follow-up visits. In this study, fifty-six and sixty patients, respectively out of 186 and 202 who attended the clinic on the days of the pre- and post-intervention surveys, were randomly sampled. Data on patients’ sex, age and marital status, whether patient a first timer or follow up visitor and the time spent in the clinic on that day as well as the number and composition of staff and equipment in the clinic was collected. The difference in waiting time spent between the first group before task shifting and second group after task shifting was statistically analyzed and significance tested using unpaired t- test. There was a reduction in the average waiting time for patients attending the clinic from 6.48 h before task shifting to 4.35 h after task shifting. The difference of mean was -2.13 h, with 95% CI: -2.44:-1.82 hours and the test of significance by unpaired t-test P<0.0001.

  8. 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

    2017-08-01

    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 rapid test group the time was 14 days (p rapid test group (p rapid 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.

  9. Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department.

    Science.gov (United States)

    Ng, David; Vail, Gord; Thomas, Sophia; Schmidt, Nicki

    2010-01-01

    In recognition of patient wait times, and deteriorating patient and staff satisfaction, we set out to improve these measures in our emergency department (ED) without adding any new funding or beds. In 2005 all staff in the ED at Hôtel-Dieu Grace Hospital began a transformation, employing Toyota Lean manufacturing principles to improve ED wait times and quality of care. Lean techniques such as value-stream mapping, just-in-time delivery techniques, workplace organization, reduction of systemic wastes, use of the worker as the source of quality improvement and ongoing refinement of our process steps formed the basis of our project. Our ED has achieved major improvements in departmental flow without adding any additional ED or inpatient beds. The mean registration to physician time has decreased from 111 minutes to 78 minutes. The number of patients who left without being seen has decreased from 7.1% to 4.3%. The length of stay (LOS) for discharged patients has decreased from a mean of 3.6 to 2.8 hours, with the largest decrease seen in our patients triaged at levels 4 or 5 using the Canadian Emergency Department Triage and Acuity Scale. We noted an improvement in ED patient satisfaction scores following the implementation of Lean principles. Lean manufacturing principles can improve the flow of patients through the ED, resulting in greater patient satisfaction along with reduced time spent by the patient in the ED.

  10. Managing patients' wait time in specialist out-patient clinic using real-time data from existing queue management and ADT systems.

    Science.gov (United States)

    Ju, John Chen; Gan, Soon Ann; Tan Siew Wee, Justine; Huang Yuchi, Peter; Mei Mei, Chan; Wong Mei Mei, Sharon; Fong, Kam Weng

    2013-01-01

    In major cancer centers, heavy patients load and multiple registration stations could cause significant wait time, and can be result in patient complains. Real-time patient journey data and visual display are useful tools in hospital patient queue management. This paper demonstrates how we capture patient queue data without deploying any tracing devices; and how to convert data into useful patient journey information to understand where interventions are likely to be most effective. During our system development, remarkable effort has been spent on resolving data discrepancy and balancing between accuracy and system performances. A web-based dashboard to display real-time information and a framework for data analysis were also developed to facilitate our clinics' operation. Result shows our system could eliminate more than 95% of data capturing errors and has improved patient wait time data accuracy since it was deployed.

  11. THE INFLUENCE OF WAITING TIME SATISFACTION ON CUSTOMER LOYALTY TOWARDS MULTI-STAGE SERVICES IN A FULL-SERVICE RESTAURANT: EVIDENCE FROM INDIA

    Directory of Open Access Journals (Sweden)

    A. Mittal

    2016-06-01

    Full Text Available Research shows waiting time in services is an important source of service evaluation by the customer. In fact, time is one component of the total 'cost' that the customer bears and cost is a core component of the perceived cost-benefit equation that the customer uses to evaluate her or his sustained patronage of a particular service. In most services, customers consider waiting as a waste of time. However, from the customer perspective, in the case of a full-service restaurant, waiting is expected and sometimes desirable also. Prior research, mainly in the west, suggests that when customers think that a wait for service is too long, they become less satisfied with overall service quality. Based on a research setting in a full-scale restaurant in India, this paper seeks answers to two research questions: First, what are the determinants of overall waiting-time satisfaction and second, what is the influence of waiting-time satisfaction on customer loyalty.

  12. On the Brightness and Waiting-time Distributions of a Type III Radio Storm observed by STEREO/WAVES

    CERN Document Server

    Eastwood, J P; Hudson, H S; Krucker, S; Bale, S D; Maksimovic, M; Goetz, K; Bougeret, J -L

    2009-01-01

    Type III solar radio storms, observed at frequencies below approximately 16 MHz by space borne radio experiments, correspond to the quasi-continuous, bursty emission of electron beams onto open field lines above active regions. The mechanisms by which a storm can persist in some cases for more than a solar rotation whilst exhibiting considerable radio activity are poorly understood. To address this issue, the statistical properties of a type III storm observed by the STEREO/WAVES radio experiment are presented, examining both the brightness distribution and (for the first time) the waiting-time distribution. Single power law behavior is observed in the number distribution as a function of brightness; the power law index is approximately 2.1 and is largely independent of frequency. The waiting-time distribution is found to be consistent with a piecewise-constant Poisson process. This indicates that during the storm individual type III bursts occur independently and suggests that the storm dynamics are consiste...

  13. Using lean manufacturing principles to evaluate wait times for HIV-positive patients in an urban clinic in Kenya.

    Science.gov (United States)

    Monroe-Wise, Aliza; Reisner, Elizabeth; Sherr, Kenneth; Ojakaa, David; Mbau, Lilian; Kisia, Paul; Muhula, Samuel; Farquhar, Carey

    2017-01-01

    As human immunodeficiency virus (HIV) treatment programs expand in Africa, delivery systems must be strengthened to support patient retention. Clinic characteristics may affect retention, but a relationship between clinic flow and attrition is not established. This project characterized HIV patient experience and flow in an urban Kenyan clinic to understand how these may affect retention. We used Toyota's lean manufacturing principles to guide data collection and analysis. Clinic flow was evaluated using value stream mapping and time and motion techniques. Clinic register data were analyzed. Two focus group discussions were held to characterize HIV patient experience. Results were shared with clinic staff. Wait times in the clinic were highly variable. We identified four main barriers to patient flow: inconsistent patient arrivals, inconsistent staffing, filing system defects, and serving patients out of order. Focus group participants explained how clinic operations affected their ability to engage in care. Clinic staff were eager to discuss the problems identified and identified numerous low-cost potential solutions. Lean manufacturing methodologies can guide efficiency interventions in low-resource healthcare settings. Using lean techniques, we identified bottlenecks to clinic flow and low-cost solutions to improve wait times. Improving flow may result in increased patient satisfaction and retention.

  14. Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency's ambulatory care unit through simulation.

    Science.gov (United States)

    Santibáñez, Pablo; Chow, Vincent S; French, John; Puterman, Martin L; Tyldesley, Scott

    2009-12-01

    We consider an ambulatory care unit (ACU) in a large cancer centre, where operational and resource utilization challenges led to overcrowding, excessive delays, and concerns regarding safety of critical patient care duties. We use simulation to analyze the simultaneous impact of operations, scheduling, and resource allocation on patient wait time, clinic overtime, and resource utilization. The impact of these factors has been studied before, but usually in isolation. Further, our model considers multiple clinics operating concurrently, and includes the extra burden of training residents and medical students during patient consults. Through scenario analyses we found that the best outcomes were obtained when not one but multiple changes were implemented simultaneously. We developed configurations that achieve a reduction of up to 70% in patient wait times and 25% in physical space requirements, with the same appointment volume. The key findings of the study are the importance of on time clinic start, the need for improved patient scheduling; and the potential improvements from allocating examination rooms flexibly and dynamically among individual clinics within each of the oncology programs. These findings are currently being evaluated for implementation by senior management.

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

    Science.gov (United States)

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

    2014-12-01

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

  16. 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 BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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

  17. Fractional Fokker-Planck equation with tempered α-stable waiting times: langevin picture and computer simulation.

    Science.gov (United States)

    Gajda, Janusz; Magdziarz, Marcin

    2010-07-01

    In this paper we introduce a Langevin-type model of subdiffusion with tempered α-stable waiting times. We consider the case of space-dependent external force fields. The model displays subdiffusive behavior for small times and it converges to standard Gaussian diffusion for large time scales. We derive general properties of tempered anomalous diffusion from the theory of tempered α-stable processes, in particular we find the form of the fractional Fokker-Planck equation corresponding to the tempered subdiffusion. We also construct an algorithm of simulation of sample paths of the introduced process. We apply the algorithm to approximate solutions of the fractional Fokker-Planck equation and to study statistical properties of the tempered subdiffusion via Monte Carlo methods.

  18. The influence of deterministic and stochastic waiting time for triggering mortality and colonization events on the coexistence of cooperators and defectors in an evolutionary game model

    Directory of Open Access Journals (Sweden)

    YouHua Chen

    2014-06-01

    Full Text Available In the present report, the coexistence of Prisoners' Dilemma game players (cooperators and defectors were explored in an individual-based framework with the consideration of the impacts of deterministic and stochastic waiting time (WT for triggering mortality and/or colonization events. For the type of deterministic waiting time, the time step for triggering a mortality and/or colonization event is fixed. For the type of stochastic waiting time, whether a mortality and/or colonization event should be triggered for each time step of a simulation is randomly determined by a given acceptance probability (the event takes place when a variate drawn from a uniform distribution [0,1] is smaller than the acceptance probability. The two strategies of modeling waiting time are considered simultaneously and applied to both quantities (mortality: WTm, colonization: WTc. As such, when WT (WTm and/or WTc is an integral >=1, it indicated a deterministically triggering strategy. In contrast, when 1>WT>0, it indicated a stochastically triggering strategy and the WT value itself is used as the acceptance probability. The parameter space between the waiting time for mortality (WTm-[0.1,40] and colonization (WTc-[0.1,40] was traversed to explore the coexistence and non-coexistence regions. The role of defense award was evaluated. My results showed that, one non-coexistence region is identified consistently, located at the area where 1>=WTm>=0.3 and 40>=WTc>=0.1. As a consequence, it was found that the coexistence of cooperators and defectors in the community is largely dependent on the waiting time of mortality events, regardless of the defense or cooperation rewards. When the mortality events happen in terms of stochastic waiting time (1>=WTm>=0.3, extinction of either cooperators or defectors or both could be very likely, leading to the emergence of non-coexistence scenarios. However, when the mortality events occur in forms of relatively long deterministic

  19. Analysis and prediction of effects of the Manchester Triage System on patient waiting times in an emergency department by means of agent-based simulation

    Directory of Open Access Journals (Sweden)

    Schaaf, Michael

    2014-02-01

    Full Text Available [english] A simulation of complex clinical processes is a challenging task and suitable methods need to be found which can capture the influence of relevant factors and their relationships. The Manchester triage system (MTS is widely used in German emergency departments (ED, however the impact on patient waiting times remain difficult to predict. The purpose of this work is the assessment of MTS particularly with regard to the waiting times of different degrees of severity. The methodology of agent based simulation was found suitable for the ED domain and the agent based simulation tool SeSAm was chosen due to its intuitive user interface and easy adaption of the simulation models. Altogether four agent classes could be implemented based on the information derived from a process model. The model permits a dynamic simulation of the ED processes and a reliable assessment of patient waiting times. In addition, the implementation of a triage nurse allowed the simulation of the triage process and a direct comparison to the current state without a standardized triage procedure. Essential influencing factors (e.g. number of patients, manning level were implemented and their effects on the ED processes and patient waiting times assessed. The simulation runs delivered correct results based on the underlying process model and the collected statistical data. The process flow and the waiting times of an ED could be mapped exactly. In all simulation runs the waiting times of high triage levels (MTS-levels 1 and 2 could be reduced. Especially patients of MTS-level 2 in the waiting area of the ED benefit significantly from the implementation of a standardized triage procedure and the associated permanent monitoring.

  20. Evaluating wait times from screening to breast cancer diagnosis among women undergoing organised assessment vs usual care.

    Science.gov (United States)

    Chiarelli, Anna M; Muradali, Derek; Blackmore, Kristina M; Smith, Courtney R; Mirea, Lucia; Majpruz, Vicky; O'Malley, Frances P; Quan, May Lynn; Holloway, Claire Mb

    2017-05-09

    Timely coordinated diagnostic assessment following an abnormal screening mammogram reduces patient anxiety and may optimise breast cancer prognosis. Since 1998, the Ontario Breast Screening Program (OBSP) has offered organised assessment through Breast Assessment Centres (BACs). For OBSP women seen at a BAC, an abnormal mammogram is followed by coordinated referrals through the use of navigators for further imaging, biopsy, and surgical consultation as indicated. For OBSP women seen through usual care (UC), further diagnostic imaging is arranged directly from the screening centre and/or through their physician; results must be communicated to the physician who is then responsible for arranging any necessary biopsy and/or surgical consultation. This study aims to evaluate factors associated with diagnostic wait times for women undergoing assessment through BAC and UC. Of the 2 147 257 women aged 50-69 years screened in the OBSP between 1 January 2002 and 31 December 2009, 155 866 (7.3%) had an abnormal mammogram. A retrospective design identified two concurrent cohorts of women diagnosed with screen-detected breast cancer at a BAC (n=4217; 47%) and UC (n=4827; 53%). Multivariable logistic regression analyses examined associations between wait times and assessment and prognostic characteristics by pathway. A two-sided 5% significance level was used. Screened women with breast cancer were two times more likely to be diagnosed within 7 weeks when assessed through a BAC vs UC (OR=1.91, 95% CI=1.73-2.10). In addition, compared with UC, women assessed through a BAC were significantly more likely to have their first assessment procedure within 3 weeks of their abnormal mammogram (OR=1.25, 95% CI=1.12-1.39), ⩽3 assessment procedures (OR=1.54, 95% CI=1.41-1.69), ⩽2 assessment visits (OR=1.86, 95% CI=1.70-2.05), and ⩾2 procedures per visit (OR=1.41, 95% CI=1.28-1.55). Women diagnosed through a BAC were also more likely than those in UC to have imaging (OR=1.99, 95

  1. Waiting experience in railway environments

    NARCIS (Netherlands)

    Hagen, van Mark; Galetzka, Mirjam; Pruyn, Ad Th.

    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. Pa

  2. Improvement in Obstructive Sleep Apnea Diagnosis and Management Wait Times: A Retrospective Analysis of a Home Management Pathway for Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Samuel Alan Stewart

    2015-01-01

    Full Text Available Obstructive sleep apnea is a common condition within the Canadian population. The current gold standard for diagnosis and management of patients is in-laboratory (in-lab polysomnography; however, the limited availability of testing options for patients has led to long wait times and increased disease burden within the population. The Sleep Research Laboratory in Saskatoon (Saskatchewan implemented a home management program to run in parallel with the in-lab system several years ago in an effort to increase their capacity and reduce wait times. The present study was a retrospective analysis of all patients referred to the program between 2009 and 2012. The home management system has improved wait times by diagnosing and managing up to one-half of the referred patient population, reducing the wait for in-lab treatment from a median of 152 days in 2009 to 92 days in 2012 (P<0.0001. Moving forward, home management can provide a viable alternative to in-lab testing for patients who meet strict entry criteria, reducing the in-lab workload and, ultimately, reducing wait times.

  3. Average Wait Time Until Hearing Held Report (By Month), September 2016 (53rd week)

    Data.gov (United States)

    Social Security Administration — A presentation of the average time (in months) from the hearing request date until a hearing is held for claims pending in the Office of Disability Adjudication and...

  4. Real-Time Wait-Free Queues using Micro-Transactions

    DEFF Research Database (Denmark)

    Meawad, Fadi; Iyer, Karthik; Schoeberl, Martin

    2011-01-01

    This paper evaluates the applicability of transactional mem- ory to the implementation of dierent non-blocking data structures in the context of the Real-time Specication for Java. In particular, we argue that hardware support for micro-transaction allows us to implement eciently data structures ...

  5. 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

    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...... was 30 days (15-41). Tumor volume increase was significantly correlated to time and histological differentiation. Twelve (20%) developed new lymph-node metastasis and 10 (16%) progressed in TNM-classification. Evaluated by RECIST criteria 18 (30%) patients had progressive disease. INTERPRETATION...

  6. Waiting time to radiotherapy as a prognostic factor for glioblastoma patients in a scenario of medical disparities

    Energy Technology Data Exchange (ETDEWEB)

    Loureiro, Luiz Victor Maia; Callegaro-Filho, Donato; Koch, Ludmila de Oliveira; Weltman, Eduardo; Victor, Elivane da Silva; Malheiros, Suzana Maria Fleury, E-mail: lvmaia@gmail.com [Hospital Israelita Albert Einstein, Sao Paulo, SP (Brazil); Santos, Adrialdo Jose; Borges, Lia Raquel Rodrigues; Segreto, Roberto Araujo [Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP (Brazil). Escola paulista de Medicina; Pontes, Luciola de Barros [Hospital do Coracao, Sao Paulo, SP (Brazil). Dept. de Oncologia

    2015-02-15

    Objective: to evaluate the effect of waiting time (WT) to radiotherapy (RT) on overall survival (OS) of glioblastoma (GBM) patients as a reliable prognostic variable in Brazil, a scenario of medical disparities. Method: retrospective study of 115 GBM patients from two different health-care institutions (one public and one private) in Brazil who underwent post-operative RT. Results: Median WT to RT was 6 weeks (range,1.3-17.6). The median OS for WT ≤ 6 weeks was 13.5 months (95%CI , 9.1-17.9) and for WT . 6 weeks was 14.2 months (95%CI, 11.2-17.2) (HR 1.165, 95%CI 0.770-1.762; p = 0.470). In the multivariate analysis, the variables associated with survival were KPS (p , 0.001), extent of resection (p = 0.009) and the adjuvant treatment (p = 0.001). The KPS interacted with WT to RT (HR 0.128, 95%CI 0.034-0.476; p = 0.002), showing that the benefit of KPS on OS depends on the WT to RT. Conclusion: no prognostic impact of WT to RT could be detected on the OS. Although there are no data to ensure that delays to RT are tolerable, we may reassure patients that the time-length to initiate treatment does not seem to influence the control of the disease, particularly in face of other prognostic factors. (author)

  7. Waiting time to radiotherapy as a prognostic factor for glioblastoma patients in a scenario of medical disparities

    Directory of Open Access Journals (Sweden)

    Luiz Victor Maia Loureiro

    2015-02-01

    Full Text Available Objective To evaluate the effect of waiting time (WT to radiotherapy (RT on overall survival (OS of glioblastoma (GBM patients as a reliable prognostic variable in Brazil, a scenario of medical disparities. Method Retrospective study of 115 GBM patients from two different health-care institutions (one public and one private in Brazil who underwent post-operative RT. Results Median WT to RT was 6 weeks (range, 1.3-17.6. The median OS for WT ≤ 6 weeks was 13.5 months (95%CI , 9.1-17.9 and for WT > 6 weeks was 14.2 months (95%CI, 11.2-17.2 (HR 1.165, 95%CI 0.770-1.762; p = 0.470. In the multivariate analysis, the variables associated with survival were KPS (p < 0.001, extent of resection (p = 0.009 and the adjuvant treatment (p = 0.001. The KPS interacted with WT to RT (HR 0.128, 95%CI 0.034-0.476; p = 0.002, showing that the benefit of KPS on OS depends on the WT to RT. Conclusion No prognostic impact of WT to RT could be detected on the OS. Although there are no data to ensure that delays to RT are tolerable, we may reassure patients that the time-length to initiate treatment does not seem to influence the control of the disease, particularly in face of other prognostic factors.

  8. The Effect of the Transition to Home Monitoring for the Diagnosis of OSAS on Test Availability, Waiting Time, Patients’ Satisfaction, and Outcome in a Large Health Provider System

    Directory of Open Access Journals (Sweden)

    Ahmad Safadi

    2014-01-01

    Full Text Available During 2009, the Haifa district of Clalit Health Services (CHS has switched from in-lab polysomnography (PSG to home studies for the diagnosis of obstructive sleep apnea (OSA. We assessed the effects of this change on accessibility, waiting time, satisfaction, costs, and CPAP purchase by the patients. Data regarding sleep studies, CPAP purchase, and waiting times were collected retrospectively from the computerized database of CHS. Patients’ satisfaction was assessed utilizing a telephone questionnaire introduced to a randomized small sample of 70 patients. Comparisons were made between 2007 and 2008 (in-lab PSGs and 2010 and 2011 (when most studies were ambulatory. Of about 650000 insured individuals in the Haifa district of CHS, 1471 sleep studies were performed during 2007-2008 compared to 2794 tests during 2010-2011. The average waiting time was 9.9 weeks in 2007-2008 compared to 1.1 weeks in 2010-2011 (P<0.05. 597 CPAPs were purchased in 2007-2008 compared to 831 in 2010-2011. The overall patients’ satisfaction was similar, but discomfort tended to be higher in the in-laboratory group (4.1 vs 2.7 in a scale of 0–10; P=0.11. Switching to ambulatory diagnosis improved the test accessibility and reduced the waiting times. Patients’ satisfaction remained similarly high. The total direct cost of OSA management was reduced.

  9. Weighing waiting

    Directory of Open Access Journals (Sweden)

    Samuel M. Duncan

    2007-12-01

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

  10. Waiting time - an offence?

    DEFF Research Database (Denmark)

    Ludvigsen, Mette Spliid

    2004-01-01

    The purpose of the original study: Patient-culture - a qualitative study among hospitalised patients, which is inspired by the work of Album and Isaksen, is to discover, and describe patients' experiences of informal relations and interpret the meaning of having fellow-patients during hospitalisa......The purpose of the original study: Patient-culture - a qualitative study among hospitalised patients, which is inspired by the work of Album and Isaksen, is to discover, and describe patients' experiences of informal relations and interpret the meaning of having fellow-patients during...... fieldwork is set up consisting of participant observation and interviews.   Based on the qualitative analysis completed to date on a data set consisting of field notes from participant observations and informal interviews I explore patients' social interactions in their day-to-day lives on two adult...... surgical units at a teaching hospital. The presentation focuses on the nature of patients' social interactions; how these social interactions influence their way of understanding their own situation; differences between patients' formal and informal social interactions; and the factors that may influence...

  11. Willingness to wait and altered encoding of time-discounted reward in the orbitofrontal cortex with normal aging.

    Science.gov (United States)

    Roesch, Matthew R; Bryden, Daniel W; Cerri, Domenic H; Haney, Zachary R; Schoenbaum, Geoffrey

    2012-04-18

    Normal aging has been associated with cognitive changes, including shifts in responding for time-discounted rewards. The orbitofrontal cortex, an area previously associated with aging-related cognitive changes, is critical for normal discounting. Previously we have shown in a choice task that rats prefer immediate over delayed reward and that neural representations of delayed reward in orbitofrontal cortex were attenuated, whereas immediate reward elicited strong responses. Changes in choice performance were correlated with changes in firing rate in orbitofrontal neurons, suggesting that these reward representations were critical to the rats' ability to wait for reward. Here we asked whether age-dependent changes in discounting behavior were related to changes in the representation of delayed reward in the orbitofrontal cortex. Young (3-6 months) and aged (22-26 months) rats were trained on the same discounting paradigm used previously. We found that aged rats showed less sensitivity to increasing delay preceding reward delivery, shifting behavior away from the delayed reward more slowly than younger rats. This sensitivity was specific to delay, since choice performance did not differ between the two groups when delay was held constant and reward size varied. Aged rats exhibited a corresponding increase in the prevalence of neurons that fired more strongly for delayed reward. Again this change was specific to delay; there was no change in encoding of different-sized rewards. These results suggest that natural aging results in altered representations of reward in orbitofrontal cortex. These changes may relate to the increased ability to delay gratification and reduced impulsivity associated with aging.

  12. 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

  13. ¿Ha llegado la hora de la gestión de las listas de espera? Has the time arrived for the management of waiting lists?

    Directory of Open Access Journals (Sweden)

    E. Bernal

    2002-10-01

    Full Text Available Las personas que ocupan una lista de espera sufren a menudo un riesgo adicional derivado del tiempo que pasa hasta que obtienen tratamiento; sin embargo, en otras ocasiones, las personas en lista no tienen necesidad del tratamiento por el que esperan. Ambos argumentos, contrastables con evidencias empíricas, serían suficientes para afirmar que debe llegar la gestión a las listas de espera dejando a un lado políticas más o menos oportunistas. Por políticas oportunistas se entiende mantener la mala información sobre listas o su "maquillaje", utilizar programas de autoconcertación sin más horizonte que llegar a final de año sin lista de más de seis meses, etcétera. El panorama no es del todo oscuro. Algunas iniciativas de gestión (incluso de Política con mayúscula se van abriendo paso y pueden entrar en la agenda de los próximos años. Así, cabe destacar la aplicación de tiempos de atención garantizada o la priorización de las listas en función de criterios explícitos. En todo caso, conviene recordar que, con la excepción de las colas producidas en las salas de espera de los centros de salud y aquéllas que se producen en las puertas de urgencias, el resto de colas del sistema están mediadas por la decisión de un médico. Así que una estrategia ineludible para gestionar las listas de espera consiste en atenuar los problemas derivados de la incertidumbre (o ignorancia con respecto al diagnóstico o al pronóstico de los pacientes.Individuals on the waiting list frequently suffer an additional risk caused by the mean time until they receive treatment; however, other individuals do not need the treatment for which they are waiting. Both arguments, which can be contrasted with empirical evidence, would be sufficient to affirm that waiting list management should be implemented, leaving aside policies that are more of less opportunistic. Opportunistic policies are understood as those providing misinformation on waiting lists or

  14. 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.

  15. Breast cancer: diagnosis-to-treatment waiting times for elderly women at a reference hospital of São Paulo, Brazil.

    Science.gov (United States)

    Souza, Camila Brandão; Fustinoni, Suzete Maria; Amorim, Maria Helena Costa; Zandonade, Eliana; Matos, Jéssica Carvalho; Schirmer, Janine

    2015-12-01

    This study compares waiting time from diagnosis of breast cancer to start of treatment with patients' social-demographic and clinical profiles in women aged 60 or more at the PérolaByington Hospital, São Paulo, over the years 2001-2006.It is a descriptive study based on secondary data in a sample of 1,299 cases. Social-demographic, clinical and temporal variables were collected. Patients were divided into two groups: those with period between diagnosis and start of treatment less than 60 days, and greater than 60 days. The average time between diagnosis and start of treatment was 74.7 days (SD = 212.6), and the median time was 45 days. This waiting time was lower for subjects without diagnosis and without prior treatment (p = 0.001), and also for those with tumors at Stage 0, in situ or Stage I(p = 0.001). Time was significant for the outcomes of relapse (p = 0.004) and metastasis (p = 0.038). Having established diagnosis and treatment also resulted in lower time to start of the required care. Improvement to the structuring and functioning of the health service is an essential need, for dealing with the cases of the disease in an efficient manner, an important challenge for Brazil's Unified Health System.

  16. Whittling Down the Wait Time: Exploring Models to Minimize the Delay from Initial Concern to Diagnosis and Treatment of Autism Spectrum Disorder.

    Science.gov (United States)

    Gordon-Lipkin, Eliza; Foster, Jessica; Peacock, Georgina

    2016-10-01

    The process from initial concerns to diagnosis of autism spectrum disorder (ASD) can be a long and complicated process. The traditional model for evaluation and diagnosis of ASD often consists of long wait-lists and evaluations that result in a 2-year difference between the earliest signs of ASD and mean age of diagnosis. Multiple factors contribute to this diagnostic bottleneck, including time-consuming evaluations, cost of care, lack of providers, and lack of comfort of primary care providers to diagnose autism. This article explores innovative clinical models that have been implemented to address this as well as future directions and opportunities.

  17. Waiting for surgery from the patient perspective

    Directory of Open Access Journals (Sweden)

    Tracey Carr

    2009-10-01

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

  18. The effects of an accelerated triage and treatment protocol on left without being seen rates and wait times of urgent patients at a military emergency department.

    Science.gov (United States)

    Levsky, Marc E; Young, Scott E; Masullo, Lawrence N; Miller, Michael A; Herold, Thomas J S

    2008-10-01

    To combat increasing wait times and left without being seen (LWOBS) rates, our emergency department (ED) implemented an accelerated triage and treatment (TNT) protocol. A TNT team was allocated treatment rooms to begin management of urgent patients if a bed in the main ED was not available. A retrospective database study was performed using three separate 6-month periods: two control periods before the intervention (P1, P2) and one period after the intervention (P3). The primary outcome measures were LWOBS rate, time to evaluation, and total ED time for urgent patients. The time to be seen for EC3 patients improved from P1 to P3 by an average of 12.6 minutes (18.5%, p protocol was associated with a significant reduction in EC3 patient LWOBS rates and time to evaluation.

  19. 等待是一种折磨?等待时间知觉及其导致的非理性决策行为%Is Waiting A Kind of Torture? Perceived Waiting Time and the Resulting Irrational Decision Making

    Institute of Scientific and Technical Information of China (English)

    李爱梅; 赵丹; 熊冠星; 谭飞; 王笑天; 凌文辁

    2014-01-01

    Perceived waiting time is defined as how individuals perceive and feel about the duration they have to wait and how it affects their approach behavior. This paper systematically reviews the effective factors that could have an impact on perceived waiting time, which includes objective factors and subjective factors. The objective factors include the fillers, certainty, service phase and the physical environment during waiting time; the subjective factors contain negative emotions, self-control and personality. Moreover, It results in irrational decision making behaviors, such as time sunk cost effect, delay/speed-up framing effect, peak-end effect, preference reversal, et al. Future research direction includes: (1) Compare the differences of perceived waiting time under the conduction of time priming and money priming; (2) Study the rules of perceived waiting time in the view of time mental accounting;(3) Explore the mechanism of perceived waiting time based on the time perception theory models..%等待时间知觉是指人们在等待过程中对等待时长的主观感受和心理体验,它对人们的决策行为产生影响。影响等待时间知觉的客观因素包括等待过程的填充物、等待时间的确定性、接受服务的阶段和等待的物理环境等;主观因素有负性情绪、自我控制和人格因素等。等待时间知觉导致的非理性决策行为包括时间沉没成本效应、“延迟-提前”框架效应、峰-终效应、偏好反转等。未来研究可从三个方面开展:(1)时间启动和金钱启动下等待时间知觉的差异;(2)基于时间心理账户视角研究等待时间知觉规律;(3)借鉴时间知觉理论探讨等待时间知觉影响决策行为的心理机制。

  20. Exploring implications of Medicaid participation and wait times for colorectal screening on early detection efforts in Connecticut--a secret-shopper survey.

    Science.gov (United States)

    Patel, Vatsal B; Nahar, Richa; Murray, Betty; Salner, Andrew L

    2013-04-01

    Routine colorectal screening, decreases in incidence, and advances in treatment have lowered colorectal cancer mortality rates over the past three decades. Nevertheless, it remains the second most common cause of cancer death amongst men and women combined in U.S. Most cases of colon cancer are diagnosed at a late stage leading to poor survival outcomes for patients. After extensive research of publically available data, it would appear that the state of Connecticut does not have available state-wide data on patient wait times for routine colonoscopy screening. Furthermore, there are no publicly available, or Connecticut-specific, reports on Medicaid participation rates for colorectal screening amongst gastroenterologists (GI) in Connecticut. In 2012, the American Cancer Society report on Colorectal Cancer Screening Rates confirmed barriers to health-care access and disparities in health outcomes and survival rates for colon cancer patients based on race, ethnicity, and low socioeconomic status. Given this information, one could conjecture that low Medicaid participation rates among GIs could potentially have a more severe impact on health-care access and outcomes for underserved populations. At present, funding and human resources are being employed across the state of Connecticut to address bottlenecks in colorectal cancer screening. More specifically, patient navigation and outreach programs are emerging and expanding to address the gaps in services for hard-to-reach populations and the medically underserved. Low Medicaid participation rates and increased wait times for colonoscopy screening may impair the efficacy of colorectal cancer patient navigation and outreach efforts and potentially funding for future interventions. In this study, we report the results of our secret-shopper telephone survey comprising of 93 group and independent gastroenterologist (GI) practices in different counties of Connecticut. Reviewing online resources and yellow pages

  1. 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

  2. The Relationship between Wait Time after Triage and Show Rate for Intake in a Nonurgent Student Population

    Science.gov (United States)

    DiMino, John; Blau, Gary

    2012-01-01

    Ideally, students requesting services should be seen quickly at their university counseling center to increase the likelihood of a successful treatment outcome. However, in these times of ever-increasing demand for university counseling services and the challenges of securing resources to keep up with that demand, the reality of prompt…

  3. On waiting, work-time and imagined futures : theorizing temporal precariousness among Chinese chefs in Sweden’s restaurant industry

    OpenAIRE

    Axelsson, Linn; Malmberg, Bo; Zhang, Qian

    2015-01-01

    This paper explores the precarious working conditions in the Chinese restaurant industry in Sweden – a country considered to have one of Europe’s most liberal labour immigration policies. Drawing upon a theoretical framework inspired by scholarship on precarious work and time geography, the paper argues that precarious work performed by migrant labour can be usefully understood through three interrelated temporal processes that, when they work together, produce and maintain precarious work-li...

  4. Evaluation of a New Equation for Calculating the Maximum Wait Time for Pilots That Have Used an Impairing Medication

    Science.gov (United States)

    2013-08-01

    2 x Dose (2) CAMI (3) Medication Max Hrs Hrs Half-lives Interv Hrs Half-lives Eq Hrs Half-lives Codeine 4.0 24 6.0 8.0 2.0 15 3.6 Morphine 7.0 24...return-to-duty time, even for individuals on the extreme metabolic margins of the general population. The variation in t½ (calculated by the CAMI

  5. 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

    Full Text Available Abstract Background Waiting time and costs from referral to day case outpatient surgery are at an unacceptably high level. The waiting time in Norway averages 240 days for common surgical conditions. Furthermore, in North Norway the population is scattered throughout a large geographic area, making the cost of travel to a specialist examination before surgery considerable. Electronic standardised referrals and booking of day case outpatient surgery by GPs are possible through the National Health Network, which links all health care providers in an electronic network. New ways of using this network might reduce the waiting time and cost of outpatient day case surgery. Materials and Methods In a randomised controlled trial, selected patients (inguinal hernia, gallstone disease and pilonidal sinus referred to the university hospital are either randomised to direct electronic referral and booking for outpatient surgery (one stop, or to the traditional patient pathway where all patients are seen at the outpatient clinic several weeks ahead of surgery. Consultants in gastrointestinal surgery designed standardised referral forms and guidelines. New software has been designed making it possible to implement referral forms, guidelines and patient information in the GP's electronic health record. For "one-stop" referral, GPs must provide mandatory information about the specific condition. Referrals were linked to a booking system, enabling the GPs to book the hospital, day and time for outpatient surgery. The primary endpoints are waiting time and costs. The sample size calculation was based on waiting time. A reduction in waiting time of 60 days (effect size, 25%, is significant, resulting in a sample size of 120 patients in total. Discussion Poor communication between primary and secondary care often results in inefficiencies and unsatisfactory outcomes. We hypothesised that standardised referrals would improve the quality of information, making it

  6. The Wait Calculation: The Broader Consequences of the Minimum Time from Now to Interstellar Destinations and its Significance to the Space Economy

    Science.gov (United States)

    Kennedy, A.

    This paper summarises the wait calculation [1] of interstellar voyagers which finds the minimum time to destination given exponential growth in the rate of travel available to a civilisation. The minimum time obliges stellar system colonisers to consider departure times a significant risk factor in their voyages since a departure then to a destination will beat a departure made at any other time before or after. Generalised conclusions will be drawn about the significant impact that departures to interstellar destinations before, at, or after the minimum time will have on the economic potential of missions and on the inevitability of competition between them. There will be no international law operating in interstellar space and an ability to escape predatory actions en route, or at the destination, can only be done by precise calculations of departure times. Social and economic forces affecting the factors in the growth equation are discussed with reference to the probability of accelerating growth reaching the technological Singularity and strengthening the growth incentive trap. Islamic banking practices are discussed as a credible alternative to compounding interest bearing paper for funding the space economy in the long term and for supporting stakeholder investment in such long term mission development. The paper considers the essential free productivity of the Earth's biosphere and the capital accumulations made possible by land productivity are essential components to a viable long term space economy and that research into re-creating the costless productivity of the biosphere at a destination will determine both the mission's ultimate success and provide means of returns for stakeholders during the long build up. Conclusions of these arguments suggest that the Icarus project should ignore a robotic interstellar mission concept and develop a manned colonising mission from now.

  7. The Effect of 5S-Continuous Quality Improvement-Total Quality Management Approach on Staff Motivation, Patients' Waiting Time and Patient Satisfaction with Services at Hospitals in Uganda.

    Science.gov (United States)

    Take, Naoki; Byakika, Sarah; Tasei, Hiroshi; Yoshikawa, Toru

    2015-03-31

    This study aimed at analyzing the effect of 5S practice on staff motivation, patients' waiting time and patient satisfaction with health services at hospitals in Uganda. Double-difference estimates were measured for 13 Regional Referral Hospitals and eight General Hospitals implementing 5S practice separately. The study for Regional Referral Hospitals revealed 5S practice had the effect on staff motivation in terms of commitment to work in the current hospital and waiting time in the dispensary in 10 hospitals implementing 5S, but significant difference was not identified on patient satisfaction. The study for General Hospitals indicated the effect of 5S practice on patient satisfaction as well as waiting time, but staff motivation in two hospitals did not improve. 5S practice enables the hospitals to improve the quality of services in terms of staff motivation, waiting time and patient satisfaction and it takes as least four years in Uganda. The fourth year since the commencement of 5S can be a threshold to move forward to the next step, Continuous Quality Improvement.

  8. The study of waiting time to first pregnancy in the south of Iran: A parametric frailty model approach

    Science.gov (United States)

    Zare, Najaf; Nouri, Bijan; Moradi, Fariba; Parvareh, Maryam

    2017-01-01

    Background: Time to first pregnancy (TTFP) has never been studied in an Iranian setting. Lifestyle, occupational and environmental factors have been suggested to affect the female reproduction. Objective: This study was conducted to measure TTFP in the south of Iran and survey the effects of several similar factors on TTFP by frailty models. Materials and Methods: The data on TTFP were available for 882 women who were randomly selected from the rural population (the south of Iran). Only the first and the planned pregnancies of every woman were included. The data were collected retrospectively by using self-administered questionnaires. Frailty and shared frailty models were used to determine which factors had the highest impact on TTFP. Results: The median TTFP was 6.4 months and several factors were surveyed. However, only the age of marriage, height, maternal education and regularity of menstruation prior to conception were selected in the multivariable models. Conclusion: Among the several factors which were included in the study, the result of frailty model showed that the height, age of marriage and regular menstruation seemed more notable predictors of TTFP. PMID:28280795

  9. The study of waiting time to first pregnancy in the south of Iran: A parametric frailty model approach.

    Science.gov (United States)

    Zare, Najaf; Nouri, Bijan; Moradi, Fariba; Parvareh, Maryam

    2017-01-01

    Time to first pregnancy (TTFP) has never been studied in an Iranian setting. Lifestyle, occupational and environmental factors have been suggested to affect the female reproduction. This study was conducted to measure TTFP in the south of Iran and survey the effects of several similar factors on TTFP by frailty models. The data on TTFP were available for 882 women who were randomly selected from the rural population (the south of Iran). Only the first and the planned pregnancies of every woman were included. The data were collected retrospectively by using self-administered questionnaires. Frailty and shared frailty models were used to determine which factors had the highest impact on TTFP. The median TTFP was 6.4 months and several factors were surveyed. However, only the age of marriage, height, maternal education and regularity of menstruation prior to conception were selected in the multivariable models. Among the several factors which were included in the study, the result of frailty model showed that the height, age of marriage and regular menstruation seemed more notable predictors of TTFP.

  10. Development of a minimization instrument for allocation of a hospital-level performance improvement intervention to reduce waiting times in Ontario emergency departments

    Directory of Open Access Journals (Sweden)

    Anderson Geoff

    2009-06-01

    Full Text Available Abstract Background Rigorous evaluation of an intervention requires that its allocation be unbiased with respect to confounders; this is especially difficult in complex, system-wide healthcare interventions. We developed a short survey instrument to identify factors for a minimization algorithm for the allocation of a hospital-level intervention to reduce emergency department (ED waiting times in Ontario, Canada. Methods Potential confounders influencing the intervention's success were identified by literature review, and grouped by healthcare setting specific change stages. An international multi-disciplinary (clinical, administrative, decision maker, management panel evaluated these factors in a two-stage modified-delphi and nominal group process based on four domains: change readiness, evidence base, face validity, and clarity of definition. Results An original set of 33 factors were identified from the literature. The panel reduced the list to 12 in the first round survey. In the second survey, experts scored each factor according to the four domains; summary scores and consensus discussion resulted in the final selection and measurement of four hospital-level factors to be used in the minimization algorithm: improved patient flow as a hospital's leadership priority; physicians' receptiveness to organizational change; efficiency of bed management; and physician incentives supporting the change goal. Conclusion We developed a simple tool designed to gather data from senior hospital administrators on factors likely to affect the success of a hospital patient flow improvement intervention. A minimization algorithm will ensure balanced allocation of the intervention with respect to these factors in study hospitals.

  11. Evaluation of patients' attitudes to their care during oral and maxillofacial surgical outpatient consultations: the importance of waiting times and quality of interaction between patient and doctor.

    Science.gov (United States)

    Dimovska, E O F; Sharma, S; Trebble, T M

    2016-06-01

    Knowing what patients think about their care is fundamental to the provision of an effective, quality service, and it can help to direct change and reduce costs. Much of the work in oral and maxillofacial departments concerns the treatment of outpatients, but as little is known about what they think about their care, we aimed to find out which aspects were associated with satisfaction. Consecutive patients (n=244) who attended the oral and maxillofacial outpatient department at Southampton University Hospital NHS Foundation Trust over a 7-day period were given a questionnaire to complete before and after their consultation. It included questions with Likert scale responses on environmental, procedural, and interactive aspects of the visit, and a 16-point scale to rank their priorities. A total of 187 patients (77%) completed the questionnaires. No association was found between expected (p=0.93) or actual (p=0.41) waiting times, and 90% of patients were satisfied with their visit. Seeing the doctor, having confidence in the treatment plan, being listened to, and the ability of the doctor to recognise their personal needs, were ranked as important. Environmental and procedural aspects were considered the least important. These findings may be of value in the development of services to improve patient-centred care.

  12. Correlation analysis for energy losses, waiting times and durations of type I edge-localized modes in the Joint European Torus

    Science.gov (United States)

    Shabbir, A.; Verdoolaege, G.; Hornung, G.; Kardaun, O. J. W. F.; Zohm, H.; Contributors, JET

    2017-03-01

    Several important ELM control techniques are in large part motivated by the empirically observed inverse relationship between average ELM energy loss and ELM frequency in a plasma. However, to ensure a reliable effect on the energy released by the ELMs, it is important that this relation is verified for individual ELM events. Therefore, in this work the relation between ELM energy loss ≤ft({{W}\\text{ELM}}\\right) and waiting time ≤ft(Δ {{t}\\text{ELM}}\\right) is investigated for individual ELMs in a set of ITER-like wall plasmas in JET. A comparison is made with the results from a set of carbon-wall and nitrogen-seeded ITER-like wall JET plasmas. It is found that the correlation between W ELM and Δ {{t}\\text{ELM}} for individual ELMs varies from strongly positive to zero. Furthermore, the effect of the extended collapse phase often accompanying ELMs from unseeded JET ILW plasmas and referred to as the slow transport event (STE) is studied on the distribution of ELM durations, and on the correlation between W ELM and Δ {{t}\\text{ELM}} . A high correlation between W ELM and Δ {{t}\\text{ELM}} , comparable to CW plasmas is only found in nitrogen-seeded ILW plasmas. Finally, a regression analysis is performed using plasma engineering parameters as predictors for determining the region of the plasma operational space with a high correlation between W ELM and Δ {{t}\\text{ELM}} .

  13. Application of Six Sigma management on shortening the waiting time of patients accepting CT check%应用六西格玛管理法缩短CT检查等候时间

    Institute of Scientific and Technical Information of China (English)

    杨君; 曲路; 钟惠玲; 吴清香; 丁小容

    2013-01-01

    目的 探讨应用六西格玛管理法缩短CT检查等候时间,以提高患者对医疗护理服务的满意度.方法 根据六西格玛5步法(即定义、测量、分析、改进、控制)对CT检查流程进行改进管理,包括成立六西格玛管理小组,测量CT检查等候时间,分析影响CT检查等候时间的因素,改进影响CT检查等候时间的措施,制订控制措施.结果 患者CT检查等候时间缩短(P<0.01),患者及医生满意度提高(P<0.01或P<0.05).结论 应用六西格玛管理方法能有效提高CT检查的工作质量与效率.%Objective To explore the application of the six sigma management in shorting the waiting time of patients accepting CT check, and to improve patients'satisfaction of medical care service. Methods According to the five - step methods of Six Sigma( define, measure, analyz, improve, and control) ,the following measures were undertaken. The methods included establishing Six Sigma management team, measuring the waiting time of CT check, analyzing the influencing factors of the waiting time during CT check, improving measures of influencing CT check waiting time and making control measures. Results The waiting time of patients accepting CT check was shorten ( P < 0. 01 ) , the patient's and doctor's satisfaction were significantly increased ( P< 0. 01 or P < 0. 05 ). Conclusion The application of Six Sigma management can effectively enhance the working quality and efficiency.

  14. Wait for It

    Institute of Scientific and Technical Information of China (English)

    李义华

    1998-01-01

    朋友,你想购买电脑吗?本文的观点是:Wait for It!或曰:且慢! 东南亚的金融危机使其货币大幅度贬值。钱不值钱了,去购买电脑,从本质言,当然是一件“伤心”之举。因为:…bought with devalued coin,is significantly more expensive. 然而,货币之贬值并非劝君缓购电脑的根本原因所在: But it’s not just currency fluctuations that should influence your buying decision.There are also some other reasons—mostly centring on a computer’s most costlycomponent:the processor chip. processor chip者,俗称计算机的心脏——“芯片”也。现在已在使用Pentium 2chips,它与Pentium 166 megahertz processor chips的区别如何呢?本文介绍如下: …but with standard Pentium 166 megahertz processor chips from U.S.manufacturer Intel still costing,$380 a throw,and the latest Pentium 2 chips,whichrun at least double the speed of old-style Pentiums,costing three times that. 基于以上情况,the latest Pentium 2 chips是否会因货币的贬值而降价呢?老百姓的这个善良愿望和简单的推理是有违市场经济规律的: Consumer spending is generally more exposed to poor economic conditions,so thefa

  15. 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…

  16. Straight-to-test colonoscopy for 2-week-wait referrals improves time to diagnosis of colorectal cancer and is feasible in a high-volume unit.

    Science.gov (United States)

    Banerjea, A; Voll, J; Chowdhury, A; Siddika, A; Thomson, S; Briggs, R; Humes, D J

    2017-09-01

    We have introduced 'straight-to-test' (STT) colonoscopy as part of our 2-week-wait (2WW) pathway to address increasing numbers of urgent referrals for colorectal cancer (CRC) within the National Health Service. In this study we evaluated the ability of this initiative to shorten the time to diagnosis of CRC. We amended our 2WW referral form to include performance status and comorbidities. General practitioners were asked to provide data on estimated glomerular filtration rate and full blood count/ferritin. Our 2WW referrals were screened by a colorectal consultant and a nurse specialist. Those deemed unsuitable for STT were offered outpatient assessment (OPA). Of 553 2WW referrals screened, 352 were considered suitable, 65 of whom failed a telephone assessment or were uncontactable, and accordingly 287 were offered the STT pathway. The STT group was significantly younger than the OPA group (median 65.9 years vs 78.7 years; P STT colonoscopy significantly reduced the time to first test (13 days vs 22 days; P STT pathway were managed with 'best supportive care only' compared with patients attending OPA (one of 15 vs six of 22, respectively). STT colonoscopy obviated the need for clinic attendance before testing in 287 patients, representing a potential net cost benefit of at least £48 500 in 4 months. STT colonoscopy was safe and effective for selecting out a group of symptomatic patients who could proceed straight to endoscopic examination and receive a diagnosis more rapidly. Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland.

  17. Neural activity of orbitofrontal cortex contributes to control of waiting.

    Science.gov (United States)

    Xiao, Xiong; Deng, Hanfei; Wei, Lei; Huang, Yanwang; Wang, Zuoren

    2016-09-01

    The willingness to wait for delayed reward and information is of fundamental importance for deliberative behaviors. The orbitofrontal cortex (OFC) is thought to be a core component of the neural circuitry underlying the capacity to control waiting. However, the neural correlates of active waiting and the causal role of the OFC in the control of waiting still remain largely unknown. Here, we trained rats to perform a waiting task (waiting for a pseudorandom time to obtain the water reward), and recorded neuronal ensembles in the OFC throughout the task. We observed that subset OFC neurons exhibited ramping activities throughout the waiting process. Receiver operating characteristic analysis showed that neural activities during the waiting period even predicted the trial outcomes (patient vs. impatient) on a trial-by-trial basis. Furthermore, optogenetic activation of the OFC during the waiting period improved the waiting performance, but did not influence rats' movement to obtain the reward. Taken together, these findings reveal that the neural activity in the OFC contributes to the control of waiting.

  18. Canadians with Health Problems: Their Use of Specialized Services and Their Waiting Experiences

    OpenAIRE

    2008-01-01

    Improving access to healthcare has been a consistent priority for Canadians. In particular, reducing patient waiting times for health services has been a prominent policy issue. Across the country, governments are using a range of strategies to reduce patient waiting times for care, with a particular focus on reducing waits for specialized services. Although information is emerging on waits for selected procedures, there is limited information on whether the utilization of services or waiting...

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

    Directory of Open Access Journals (Sweden)

    Alejandro Letelier

    2014-07-01

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

  20. 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.

  1. Iran - waiting and watching

    Energy Technology Data Exchange (ETDEWEB)

    Malhotra, T. C.

    2007-07-01

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

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

    Science.gov (United States)

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

    2017-05-05

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

  3. Impact of Paving Waiting Time on Performance of Epoxy Asphalt Mixture%摊铺等待时间对环氧沥青混合料性能的影响

    Institute of Scientific and Technical Information of China (English)

    黄明; 黄卫东

    2012-01-01

    A large number of laboratory tests were carried out, which took high temperature, fatigue and moisture resistance as main test items. The research not only evaluated the impact of waiting time for paving on the performance of epoxy asphalt from three aspects, but also integrated these items and put forward suggestions on the value of waiting time for paving by the grey relationship analysis methods. The results indicate that if the waiting time for paving is less than 30 min, the performance of epoxy asphalt will remain unchanged; however, when the grey connection performance declines to 80%, it will take the longest waiting time for paving, which can be as long as 80 min. This method can be applied to the researches and developments of epoxy asphalt as well as the evaluation of engineering practice.%通过大量室内试验,以高温、疲劳和抗水损害性能作为主要检测项目,分别从3个方面评价环氧沥青混合料摊铺等待时间对其性能的影响,并通过灰关联分析法给出了环氧沥青混合料的最佳摊铺等待时间推荐值.结果表明:当摊铺等待时间小于30 min时,环氧沥青混合料性能无变化;当灰关联综合性能下降至80%时,其摊铺等待时间最长,可达80 min.这种方法可用于环氧沥青的研发和工程实践的评判.

  4. [Waiting list for nursing home admission gives limited insight of the problems. Study in handling of the waiting list and the consequences for the patients].

    Science.gov (United States)

    Meiland, Franka

    2002-04-01

    The waiting list for nursing home admission is expected to remain unacceptably long. A study of the use and of possibly problematic consequences of the waiting list was described in a thesis. Despite long mean waiting periods and many problems (depressive symptoms, experiences of burden) already at the start of the waiting period, the majority of the informal caregivers were satisfied with the waiting times. This may be explained by a reticence to nursing home admission and by enlistment to the waiting list "out of precaution". Both a long and a short waiting period could be experienced as too long. Waiting list figures give insufficient insight in the "real" demand for nursing home care and in problematic waiting periods.

  5. Waiting for care in Canada: findings from the health services access survey.

    Science.gov (United States)

    Sanmartin, Claudia; Pierre, Fritz; Tremblay, Stéphane

    2006-11-01

    Waiting for care has been and continues to be a major issue for the healthcare sector in Canada. While considerable gains have been made regarding valid and reliable information on waiting times, gaps remain. Statistics Canada continues to provide information regarding patients' experiences in accessing care at the national and provincial levels, including how long individuals waited for specialized services, through the Health Services Access Survey. The survey offers several advantages, including waiting time information that is comparable across time and space, enhanced patient information and information regarding patients' experiences in waiting for care. The results for 2005 indicate that median waiting time for all specialized services was between 3 and 4 weeks and remained relatively stable between 2003 and 2005. Waiting times for specialist visits did not vary by income. In addition to being asked how long they waited, individuals were asked about their experiences in waiting for care. While the majority of individuals waiting for care indicated that their waiting time was acceptable, there continues to be a proportion of Canadians who feel they are waiting an unacceptably long time for care. Between 11% and 18% of individuals waiting for care indicated that their life was affected by waiting.

  6. Simulated waiting list prioritization for equitable allocation of donor lungs

    NARCIS (Netherlands)

    Ouwens, JP; Groen, H; TenVergert, EM; Koeter, GH; van der Bij, W

    Background: In lung transplantation (LTx), allocation of donor lungs is usually based on blood group, height and waiting time. Long waiting times favor patients with a slowly progressive end-stage lung disease and make the current allocation system the subject of discussion. In an attempt to

  7. Design and application of optimized algorithm of examination sequence to minimize total waiting time of patients%缩短患者候检时间的检查序列优化算法的设计和应用

    Institute of Scientific and Technical Information of China (English)

    戴星; 张少明; 周礼明; 杜勤; 吴正一

    2013-01-01

    目的 探讨有效缩短患者候检时间累加和的优化算法,充分挖掘医院现有资源的服务能力.方法 以门诊患者候检时间累加和为目标函数,建立门诊检查的混合开放车间作业模型.计算各检查部门设备的服务检查负荷,确定瓶颈部门;提出了基于瓶颈部门的半在线优化算法,并在上海交通大学医学院附属第九人民医院的20批门诊患者的候诊过程中进行数据验证.结果 通过基于瓶颈的半在线检查项目序列优化算法,20批门诊患者的候诊时间累加和减少了10.5%.结论 与患者随机生成检查序列相比,优化算法可以明显缩短患者的候检时间累加和,提高医院现有资源的服务能力.%Objective To propose the optimized algorithm to effectively reduce the total waiting time of patients as so to make full use of the hospital resources for medical service.Methods With total waiting time of outpatients as objective function,hybrid open flow shop model of outpatient examinations was established.The examination load of equipment of each examination department was calculated,and the bottleneck department was determined.The semi-online algorithm based on the bottleneck department was proposed to minimize the total waiting time of outpatients,and was performed on the data collected from 20 groups of outpatients in the Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine.Results Through the semi-online algorithm based on the bottleneck department,the total waiting time of 20 groups of outpatients decreased by 10.5%.Conclusion Compared with the sequence generated randomly by the outpatients,the proposed algorithm can effectively reduce the total waiting time and improve the efficiency of hospital resources for medical service.

  8. Waiting Lines and Customer Satisfaction

    OpenAIRE

    Sridhar, M. S.

    2001-01-01

    The paper points out certain quantitative methods largely ignored by library service providers, highlights the importance of customer participation in service delivery process, examines the concepts service quality and customer satisfaction, emphasizes the need for appropriately handling waiting lines in service organisations, presents briefly the theory of waiting lines (queuing theory), psychology of customers in waiting lines with illustrations from library situations, discusses ways and m...

  9. 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.

  10. Protocol to Exploit Waiting Resources for UASNs.

    Science.gov (United States)

    Hung, Li-Ling; Luo, Yung-Jeng

    2016-03-08

    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.

  11. Simulating test and energy-saving analysis of elevator running based on waiting-time%考虑等待时间的电梯运行模拟测试与节能分析

    Institute of Scientific and Technical Information of China (English)

    卿晓霞; 王波; 段军

    2012-01-01

    Up till now, the main target of elevator scheduling algorithms at home and abroad is minimization of passenger waiting time, which results in fewer passenger numbers and higher energy consumption during elevator operation in non-rush hour traffic. In order to balance the service efficiency and energy-saving of elevator, a new elevator scheduling rule for energy-saving based on elevator waiting-time is proposed. In order to quantitatively analyze the energy-saving effects of the new elevator scheduling rule based on the waiting-time, the new software is developed. The software can simulate elevator operation, calculate energy consumption and analyze energy-saving effected by generating randomly passenger flows, and then the amount of energy consumption, the elevator start and stop frequency and running distances are compared in different combined conditions of the height of building, the numbers of elevator, the elevator rated capacity, the concentration ratio of passenger in 5 min while different waiting-times are used and not used. The results of simulating tests show that the average energy-saving effects of 7.1%~9.4% can be gotten by using different waiting-time, and that introducing the elevator scheduling rule based on the waiting-time into the traditional elevator scheduling algorithms is a low-cost effective method of elevator energy-saving.%国内外电梯调度算法都以追求乘客候梯时间的最小化为主要目标,导致电梯在非高峰交通时段载客率较低,运行能耗较大.为兼顾电梯服务效率和节能,提出了一种基于等待时间的电梯运行节能调度规则.为定量分析新规则的节能效果,利用所开发的电梯模拟运行、能耗计算与节能分析软件,通过随机产生客流,计算办公建筑电梯在不同组合条件(建筑物高度、电梯台数、电梯额定载客率、5 min乘客集中率)下,加入不同等待时间后的电梯启停次数、运行里程及电能消耗,并与相同组合

  12. [Longer waiting time and higher mortality in older people with traumatic brain injuries. Mapping of emergency prehospital management and hospital management in Västerbotten].

    Science.gov (United States)

    Holzmann, Martin; Bylund, Per O; Degerfält, Lisa; Carlsson, Axel C; Wändell, Per; Ruge, Toralph

    2015-10-06

    The main purpose was to study the prehospital and early intrahospital treatment of patients with traumatic brain injury (TBI) in the county of Västerbotten 2011-2012. In total, 162 patients were included. The main finding was that a large proportion of TBI patients were older men who fell in the same or from a different level. Older patients had higher mortality and had to wait longer for diagnostic imaging compared to younger patients. Furthermore, most patients were initially relatively unaffected by the injury and around 1/5 of the patients were transported to hospital by private transport. Finally, we observed that most patients were admitted to hospital and computer tomography scan of the head was performed within 4 hours.

  13. Strategy as active waiting.

    Science.gov (United States)

    Sull, Donald N

    2005-09-01

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

  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. Application of Six Sigma in Shortening the Waiting Time of Lung Cancer Chemotherapy%应用六西格玛缩短肺癌化疗等待时间

    Institute of Scientific and Technical Information of China (English)

    林峰; 朱玲凤; 陈海啸; 王喜丰; 吴小脉; 张蔚卿

    2015-01-01

    目的探讨应用六西格玛管理法缩短呼吸科肺癌化疗用药等待时间,让化疗结束的患者在当天就可以办理出院,不仅合理增加了床位的利用率,而且可以收治急诊留观的危重患者,减轻了医院意外事件发生的风险,同时提高了患者的满意度,更是真正体现医院一切以患者的健康和利益为中心的指导思想。方法根据六西格玛5步法(即定义、测量、分析、改进、控制)对呼吸科肺癌化疗用药等待流程进行改进管理,包括成立六西格玛管理小组,测量肺癌化疗用药等待时间,分析影响肺癌化疗用药等待时间因素,改进影响肺癌化疗用药等待的措施,制订控制措施。结果呼吸科肺癌化疗用药等待时间缩短(P<0.01)。结论应用六西格玛管理方法能有效缩短呼吸科肺癌化疗患者的用药等待时间,提高了工作质量与效率,合理增加了床位的使用率,真正做到了以人为本。%Objective Six sigma management could shorten the waiting time of lung cancer chemotherapy so that patients could be discharged right after their last chemotherapy. It not only increased the utilization of beds, but also admitted critically ill patients from emergency observation wards, which reduced the risk of accidents in hospital and improved patients' satisfaction. It fully reflects the guiding thought that all measures should patient-centered.Method According to 5-steps method of six sigma (define, measure, analyze, improve, control), improved the waiting process management of lung cancer chemotherapy in respiratory department, including the establishment of six sigma management team, measuring the waiting time of lung cancer chemotherapy and analyzing its influencing factors before took improvement measures.Results The waiting time of lung cancer chemotherapy in respiratory department was shortened (P <0.01).Conclusion Six Sigma method can effectively reduce the waiting time

  16. Opportunities for Network Coding: To Wait or Not to Wait

    CERN Document Server

    Hsu, Yu-Pin; Ramasamy, Solairaja; Gautam, Natarajan; Sprintson, Alex; Shakkottai, Srinivas

    2011-01-01

    It has been well established that reverse-carpooling based network coding can significantly improve the efficiency of multi-hop wireless networks. However, in a stochastic environment when there are no opportunities to code because of packets without coding pairs, should these packets wait for a future opportunity or should they be transmitted without coding? To help answer that question we formulate a stochastic dynamic program with the objective of minimizing the long-run average cost per unit time incurred due to transmissions and delays. In particular, we develop optimal control actions that would balance between costs of transmission against those of delays. In that process we seek to address a crucial question: what should be observed as the state of the system We analytically show that just the queue lengths is enough if it can be modeled as a Markov process. Subsequently we show that a stationary policy based on queue lengths is optimal and describe a procedure to find such a policy. We further substa...

  17. [How many patient transfer rooms are necessary for my OR suite? : Effect of the number of OR transfer rooms on waiting times and patient throughput in the OR - analysis by simulation].

    Science.gov (United States)

    Messer, C; Zander, A; Arnolds, I V; Nickel, S; Schuster, M

    2015-12-01

    In most hospitals the operating rooms (OR) are separated from the rest of the hospital by transfer rooms where patients have to pass through for reasons of hygiene. In the OR transfer room patients are placed on the OR table before surgery and returned to the hospital bed after surgery. It could happen that the number of patients who need to pass through a transfer room at a certain point in time exceed the number of available transfer rooms. As a result the transfer rooms become a bottleneck where patients have to wait and which, in turn, may lead to delays in the OR suite. In this study the ability of a discrete event simulation to analyze the effect of the duration of surgery and the number of ORs on the number of OR transfer rooms needed was investigated. This study was based on a discrete event simulation model developed with the simulation software AnyLogic®. The model studied the effects of the number of OR transfer rooms on the processes in an OR suite of a community hospital by varying the number of ORs from one to eight and using different surgical portfolios. Probability distributions for the process duration of induction, surgery and recovery and transfer room processes were calculated on the basis of real data from the community hospital studied. Furthermore, using a generic simulation model the effect of the average duration of surgery on the number of OR transfer rooms needed was examined. The discrete event simulation model enabled the analysis of both quantitative as well as qualitative changes in the OR process and setting. Key performance indicators of the simulation model were patient throughput per day, the probability of waiting and duration of waiting time in front of OR transfer rooms. In the case of a community hospital with 1 transfer room the average proportion of patients waiting before entering the OR was 17.9 % ± 9.7 % with 3 ORs, 37.6 % ± 9.7 % with 5 ORs and 62.9 % ± 9.1 % with 8 ORs. The average waiting

  18. Monitor to investigate trust for making patients wait too long.

    Science.gov (United States)

    2014-10-01

    HEALTH REGULATOR Monitor has launched an investigation into Yorkshire Teaching Hospital NHS Foundation Trust after finding that some patients had been waiting too long to be assessed for emergency care. The regulator believes that repeated failures to ensure patients were seen soon enough may indicate wider problems at the trust, which has failed to meet the quarterly national emergency department waiting time target five times in nearly two years.

  19. Operations methods waiting line applications

    CERN Document Server

    Shaw, Ken

    2012-01-01

    The intent of this book is to help business practitioners and students expand their knowledge of how waiting line analysis can be used to address situations beyond the simple examples they were presented in basic operations courses. Throughout the book, practical examples are given and worked out to aid in understanding the material presented. Some emphasis is given to the caveats in applying waiting line theory and the importance of being aware of the assumptions used in developing that theory. The first chapters begin with a review of those simple examples and the terminology used for wai

  20. Bed capacity and surgical waiting lists: a simulation analysis

    Directory of Open Access Journals (Sweden)

    Manel Antelo

    2015-12-01

    Full Text Available Waiting time for elective surgery is a key problem in the current medical world. This paper aims to reproduce, by a Monte Carlo simulation model, the relationship between hospital capacity, inpatient activity, and surgery waiting list size in teaching hospitals. Inpatient activity is simulated by fitting a Normal distribution to real inpatient activity data, and the effect of the number of beds on inpatient activity is modelled with a linear regression model. Analysis is performed with data of the University Multi-Hospital Complex of Santiago de Compostela (Santiago de Compostela, Spain, by considering two scenarios regarding the elastiticity of demand with bed increase. If demand does not grow with an increase on bed capacity, small changes lead to drastic reductions in the waiting lists. However, if demand grows as bed capacity does, adding additional capacity merely makes waiting lists worse.

  1. 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…

  2. Brazil well worth the wait

    Energy Technology Data Exchange (ETDEWEB)

    Duey, R.

    1999-11-01

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

  3. Hurry up and wait

    OpenAIRE

    Stephen Kinsella

    2005-01-01

    It is precisely in those fast moving markets that some interim intervention may be needed because of the risk that by the time the case is finally resolved there may have been irreparable harm to the market. Stephen Kinsella (Sidley Austin)

  4. 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.

  5. 基于现场实验的背景音乐对顾客等待时间的影响研究——以华侨大学主题实验餐厅为例%An Experimental Study on the Impact of Background Music on Customers' Waiting Time --A Case Study of the Huaqiao University Theme Experimental Restaurant

    Institute of Scientific and Technical Information of China (English)

    邢宁宁; 汪京强

    2012-01-01

    Many studies show that background music is an environmental factor that can be controlled and can affect customers' waiting time in the restaurant, which is significant for solving the problem of customers' waiting in service industry. This essay adopts a management experiment method to validate the influence of background music on customers' waiting time, drawing the conclusion: (1) the background music is able to impact customers' waiting time, (2) the slow-tempo background music can prolong customers' waiting time threshold, and (3) the fastempo background music can shorten customers' waiting time threshold.%很多学者研究表明,背景音乐是餐厅可控的、能够影响顾客等待时间的环境因素,对于解决服务行业顾客等待时间问题有一定的管理意义。文章采用管理实验方法验证背景音乐对顾客等待时间的影响,得出结论:(1)背景音乐确实能够影响顾客的等待时间;(2)慢节奏的背景音乐能够延长顾客等待时间阈;(5)快节奏的背景音乐会缩短顾客的等待时间阈。

  6. 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......-culture - a qualitative study among hospitalised patients, is that informal relationships among patients during hospitalisation have more influence on wellbeing, understanding of own illnesses and recovery than we until now have recognised. The purpose is to describe patients' experiences of informal relationships...

  7. Waiting for Unruh

    Science.gov (United States)

    Fewster, Christopher J.; Juárez-Aubry, Benito A.; Louko, Jorma

    2016-08-01

    How long does a uniformly accelerated observer need to interact with a quantum field in order to record thermality in the Unruh temperature? We address this question for a pointlike Unruh-DeWitt detector, coupled linearly to a real Klein-Gordon field of mass m≥slant 0 and treated within first order perturbation theory, in the limit of large detector energy gap {E}{gap}. We first show that when the interaction duration {{Δ }}T is fixed, thermality in the sense of detailed balance cannot hold as {E}{gap}\\to ∞ , and this property generalises from the Unruh effect to any Kubo-Martin-Schwinger state satisfying certain technical conditions. We then specialise to a massless field in four spacetime dimensions and show that detailed balance does hold when {{Δ }}T grows as a power-law in {E}{gap} as {E}{gap}\\to ∞ , provided the switch-on and switch-off intervals are stretched proportionally to {{Δ }}T and the switching function has sufficiently strong Fourier decay. By contrast, if {{Δ }}T grows by stretching a plateau in which the interaction remains at constant strength but keeping the duration of the switch-on and switch-off intervals fixed, detailed balance at {E}{gap}\\to ∞ requires {{Δ }}T to grow faster than any polynomial in {E}{gap}, under mild technical conditions. The results also hold for a static detector in a Minkowski heat bath. The results limit the utility of the large {E}{gap} regime as a probe of thermality in time-dependent versions of the Hawking and Unruh effects, such as an observer falling into a radiating black hole. They may also have implications on the design of prospective experimental tests of the Unruh effect.

  8. Identificación de las variables de influencia en los tiempos de espera en atención especializada Identification of variables influencing waiting times for specialized care

    Directory of Open Access Journals (Sweden)

    J.G. Cano

    2003-10-01

    Full Text Available Objetivo: Identificar, mediante análisis de regresión múltiple, las variables de influencia en el tiempo de acceso a atención especializada (listas de espera, y analizar las zonas de salud con tiempo de acceso elevado, en función de las mencionadas variables. Diseño: Estudio descriptivo transversal, retrospectivo, del tiempo de acceso a atención especializada, durante los años 1997 y 1998. Emplazamiento: Área 20 de la Conselleria de Sanitat de la Comunidad Valenciana; 12 zonas de salud; 204.424 habitantes. Intervenciones: Se recogen variables de demanda (tipo de municipio, envejecimiento e índices de dependencia poblacional, porcentaje de pensionistas, de oferta (edad, sexo, formación y situación laboral del médico, tamaño del cupo y de consumo (porcentaje de derivación a especializada por mil habitantes, tiempo medio de acceso a especializada (en días naturales por zona y año, frecuentación y presión asistencial. Se construye un modelo de regresión múltiple por eliminación (hacia atrás, tomando como variable dependiente el tiempo medio de espera (TE y como independiente el resto. La ecuación resultante permitió calcular el TE esperado por zona de salud y la desviación de su TE real sobre el esperado. Se consideró zona con TE elevado cuando su desviación superaba la media más una desviación estándar de dicha distribución. Resultados: El tiempo de espera medio para acceder a especializada fue de 37 días en 1997 y 34 días en 1998. Existe una correlación significativa (p Objective: To identify the variables influencing waiting time for specialized care (waiting lists through multiple regression analysis and to analyze the health districts with long waiting times according to these variables. Design: Descriptive, cross sectional and retrospective study of waiting times for access to specialized care between 1997 and 1998. Setting: Area 20 of the Health Department of the Autonomous Community of Valencia (Spain

  9. Repetition in Waiting for Godot

    Institute of Scientific and Technical Information of China (English)

    李想; 魏妍

    2015-01-01

    Waiting for Godot is one of the most famous plays written by Samuel Barclay Beckett, and also is the founding work of“Theatre of the Absurd”. In the drama, repetitive phenomena shed light on the whole construction considerably. All the charac-ters were helpless and unthinking. Their dialogues were simple, nonsense and repetitive. Two scenes were cyclical. Repetition was used subtly in order to express the theme of the play, showing mental crisis after depravation of WWII.

  10. 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 be

  11. 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

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

    NARCIS (Netherlands)

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

    2015-01-01

    We consider a variant of Hotelling’s location model that was proposed by Kohlberg (1983): when choosing a firm, consumers take travel time and also (expected) waiting time, which again depends on the number of consumers choosing that firm, into consideration. If we assume that firms are symmetric, t

  13. Gas business waits for better times

    Energy Technology Data Exchange (ETDEWEB)

    Parent, L.V.

    1992-02-01

    Gas prices are in a state of collapse. Low wellhead prices are at levels that push producers to the edge of bankruptcy, but they have not resulted in noticeably higher consumption, nor are they likely to in the near term. This paper reports that exploration technology gains have saved drilling from total wipeout. Without these gains, and without certain tax credits, reserve additions would have fallen to alarmingly low levels, and gas well drilling would have come to a shuddering standstill. Pipeliners have high hopes that they will be able to make it in the open-access environment of the pending Mega-NOPR (notices of proposed regulations). The Federal Energy Regulatory Commission (FERC) rulemakers are working around the clock on a final, all- encompassing rule to cover all aspects of FERC-regulated transportation. This giant rulemaking, when it emerges, will prescribe the rules and regulations that are to form the benchmark from this point on. In the meantime, state officials also are busy trying to shore up the gas industry with new regulations that are expected to offer price support to producers.

  14. Waiting-time targets. Early learners.

    Science.gov (United States)

    Moore, Alison

    2007-04-05

    Thirteen 'early achiever' sites have volunteered to deliver the new 18-week target ahead of schedule. The sites have highlighted recurring issues for trusts aiming for 18 weeks: orthopaedics, audiology, endoscopy and some smaller specialties have all proved challenging. The target should be seen as a vital step towards a 'no unnecessary delay' system of working and thinking.

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

    Science.gov (United States)

    Dudko, Yevgeni; Kruger, Estie; Tennant, Marc

    2017-01-01

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

  16. Protocol to Exploit Waiting Resources for UASNs †

    Science.gov (United States)

    Hung, Li-Ling; Luo, Yung-Jeng

    2016-01-01

    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. PMID:27005624

  17. 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 ...

  18. SOLVABLE CASES OF THE NO-WAIT FLOWSHOP SCHEDULING PROBLEM

    NARCIS (Netherlands)

    VANDERVEEN, JAA; VANDAL, R

    1991-01-01

    The no-wait flow-shop scheduling problem (NWFSSP) with a makespan objective function is considered. As is well known, this problem is NP-hard for three or more machines. Therefore, it is interesting to consider special cases, i.e. special structured processing time matrices, that allow polynomial

  19. 不同时间点心脏移植等待者的焦虑和抑郁状态分析%Anxiety and depression status among patients waiting for heart transplantation surgery at different time points

    Institute of Scientific and Technical Information of China (English)

    叶尘宇; 庄亚敏; 张颖; 季建林; 陈昊

    2015-01-01

    preoperatively admitted to the Cardiac Surgery Department.The scales were assessed repeatedly at the 1st day,3rd day,7th day,10th day and so on until the operation took place.Result The mean scores of HAMD and HAMA of 93 patients in the waiting list were separately 13.11 ±3.81 and 14.20±4.57.Among them 18(19.4%) were classified as moderately depressed,31(33.3%) had moderately anxious symptoms,and 14(14.1%) had severe anxious symptoms.Thirty-six patients were preoperatively admitted to hospital.Their mean scores of HAMD and HAMA were separately 13.19-± 3.82 and 16.17 ± 4.35.Among them 7(19.4%) were classified as moderate depression at the time of admission,16 (44.4%) had moderately anxious symptoms and 9 (25.0%) had severe anxious symptoms.The scores of HAMD had significant difference (t =3.383,P =0.002) before and after admission.Paired t test was separately conducted to analyze the first assessment and the 3rd-day assessment of HAMA and HAMD total scores after admission of all the inpatients.The results showed the scores were statistically different (for HAMA,t =2.786,P =0.009; for HAMD,t =14.024,P =0.000).Repeated ANOVA was used to analyze the recipients who had three assessments.The results had statistical difference (for HAMA,F =4.568,P=0.020; for HAMD,F=5.626,P =0.034) and the difference of HAMD score at different time points had a linear trend (F =8.273,P =0.013).Conclusion After hospital admission,the depression symptoms will be significantly alleviated.When waiting for the transplant in the hospital,the anxiety symptoms alleviate slightly in three days and then aggravate significantly.The depression symptoms alleviate slightly continuously.

  20. The Religious Meaning in "Waiting for Godot"

    Science.gov (United States)

    Wang, Jing

    2011-01-01

    "Waiting for Godot" is one of the classic works of theater of the absurd. The play seems absurd but with a deep religious meaning. This text tries to explore the theme in four parts of God and man, breaking the agreement, repentance and imprecation and waiting for salvation.

  1. Waiting list management practices for home-care occupational therapy in the province of Quebec, Canada.

    Science.gov (United States)

    Raymond, Marie-Hélène; Demers, Louise; Feldman, Debbie E

    2016-03-01

    Referral prioritisation is commonly used in home-based occupational therapy to minimise the negative impacts of waiting, but this practice is not standardised. This may lead to inequities in access to care, especially for clients considered as low priority, who tend to bear the brunt of lengthy waiting lists. This cross-sectional study aimed to describe waiting list management practices targeting low-priority clients in home-based occupational therapy in the province of Quebec, Canada, and to investigate the association between these practices and the length of the waiting list. A structured telephone interview was conducted in 2012-2013 with the person who manages the occupational therapy waiting list in 55 home care programmes across Quebec. Questions pertained to strategies aimed at servicing low-priority clients, the date of the oldest referral and the number of clients waiting. Results were analysed using descriptive statistics and non-parametric tests. The median wait time for the oldest referral was 18 months (range: 2-108 months). A variety of strategies were used to service low-priority clients. Programmes that used no strategies to service low-priority clients (n = 16) had longer wait times (P occupational therapy programmes. However, in programmes where none of these strategies are used, low-priority clients may be denied access to services indefinitely.

  2. [Access to the waiting list and renal transplantation].

    Science.gov (United States)

    Hourmant, M; de Cornelissen, F; Brunet, P; Pavaday, K; Assogba, F; Couchoud, C; Jacquelinet, C

    2013-09-01

    This chapter provides a set of indicators related to Renal Transplantation access in France. It describes patient outcomes and reports on cumulative incidence rates of wait-listing and renal transplantation according to main patient of characteristics and regions. The REIN registry integrates kidney transplant and dialysis data. It provides a comprehensive view on waiting list and renal transplantation access to the patients, nephrologists, and national or regional health authorities. Access to the waiting list is evaluated on a cohort of 51,845 new patients who started dialysis between 2002 and 2011 in 25 regions. The probability of first wait-listing was of 3.7% at the start of dialysis (pre-emptive registrations), 15% at 12, 22% at 36 and 24% to 60 months. The probability of being registered was strongly related to age, diabetes and region. Patient older than 60 had a very poor access to the waiting list, whatever their diabetes status was. Probability of first wait-listing was much lower (36.5% at 60 months) in type 2 diabetic-40 to 59 years old patients. Among 13,653 patients less than 60 years old, the probability of being registered was 11% at the start of dialysis, 43% to 12 months, 62% to 36 months and 66% to 60 months (median dialysis duration: 16 months). Seventeen regions with up to 5 years follow-up show an increase of 8 to 15% in pre-emptive registrations between 2007 and 2001, without change at 1 year. Access to kidney transplant is evaluated on a cohort of 53,301 new patients who started a renal replacement therapy (dialysis or pre-emptive renal transplant) between 2002 and 2011 in 25 regions. The probability of first kidney transplant was of 7% at 12, 17% at 36 and 21% at 60 months. 8,633 patients (16,2%) had received a first renal transplant within 14.7 month median time; 1,455 (2.7%) had received a pre-emptive graft [male: 58%, median age: 48.7y]. Among the 14,770 new patients less than 60 years old, the probability of being transplanted was of

  3. Canadians with health problems: their use of specialized services and their waiting experiences.

    Science.gov (United States)

    Ho, Thi; Morris, Kathleen

    2008-08-01

    Improving access to healthcare has been a consistent priority for Canadians. In particular, reducing patient waiting times for health services has been a prominent policy issue. Across the country, governments are using a range of strategies to reduce patient waiting times for care, with a particular focus on reducing waits for specialized services. Although information is emerging on waits for selected procedures, there is limited information on whether the utilization of services or waiting experiences of Canadians with health problems are different from those of the general population. Data from the Health Services Access Survey (2001-2005) were used to compare waiting experiences for specialized services between adults with health problems and healthier adults. The specialized services included specialist visits for a new illness or condition, non-emergency surgery and diagnostic tests. National-level estimates revealed that adults with health problems were more likely to self-report that they required specialized services. However, the median waiting times for these services were comparable to those of healthier adults.

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

    OpenAIRE

    Arroll, Bruce; Alrutz, Stowe; Moyes, Simon

    2014-01-01

    Objective To explore the basis for patient complaints about the oldness of most magazines in practice waiting rooms. Design Cohort study. Setting Waiting room of a general practice in Auckland, New Zealand. Participants 87 magazines stacked into three mixed piles and placed in the waiting room: this included non-gossipy magazines (Time magazine, the Economist, Australian Women’s Weekly, National Geographic, BBC History) and gossipy ones (not identified for fear of litigation). Gossipy was def...

  5. To wait or to pay for medical treatment? Restraining ex-post moral hazard in health insurance.

    Science.gov (United States)

    Felder, Stefan

    2008-12-01

    We explore the hierarchy of two instruments, waiting time and coinsurance for medical treatment, for optimally solving the tradeoff between the economic gains from risk sharing and the losses from moral hazard. We show that the optimal waiting time is zero, given that the coinsurance rate is optimally set.

  6. Waiting experience at train stations

    NARCIS (Netherlands)

    van Hagen, M.

    2011-01-01

    In the railway sector there is a great deal of interest in objective time but hardly any in passengers’ subjective experience of time. The focus of this publication is thus not on (shortening) objective time but on how time itself is experienced and how this can be improved. Aware that a journey

  7. [Waiting lists guarantee in health care. Some theoretical reflections].

    Science.gov (United States)

    Piene, H; Hauge, H K; Nyen, P A

    1997-01-30

    In 1990 a "waiting list guarantee" was introduced in the Norwegian health care system to secure treatment within six months for patients belonging to priority group II. (Priority group II are patients in need of treatment to avoid health hazards or serious long-term effects.) This guarantee has been difficult to honour and has caused considerable political unrest in the recent years. In an attempt to reform the guarantee, an analysis of our hospitals' capacity problems has been carried out, based on the general theory of queues. One result was that in order to fulfill the guarantee it is necessary to drastically reduce the queues and increase the capacity to deliver health services. This article presents the reasoning behind the analysis, in order to demonstrate the necessary foundation for a health policy that aims to reduce the time Norwegian patients have to wait for treatment in hospital.

  8. THE EXPERIENCE OF WAITING LIST MANAGEMENT FOR LIVER TRANSPLANTATION IN EKATERINBURG

    Directory of Open Access Journals (Sweden)

    E. N. Bessonova

    2011-01-01

    Full Text Available Gaining the experience of liver transplantation waiting list formation is the important condition of transplant cen- ter successful work. In the era of transplant organ shortage careful medical examination of the patient before the operation and detection of unfavorable facts and transplantation contraindications are of paramount importance. At the same time evaluation of the structure of potential liver transplant recipients category allows to develop maximal effective management of waiting list patients and prevention of fatal complications before operation. 

  9. Race/ethnicity and the receipt of watchful waiting for the initial management of prostate cancer.

    Science.gov (United States)

    Shavers, Vickie L; Brown, Martin L; Potosky, Arnold L; Klabunde, Carrie N; Davis, W W; Moul, Judd W; Fahey, Angela

    2004-02-01

    Several recent studies have noted that African Americans disproportionately receive "watchful waiting" for the initial management of their prostate cancer. To determine whether racial/ethnic differences in the receipt of watchful waiting are explained by differences in clinical presentation and life expectancy at the time of diagnosis, we examined Surveillance, Epidemiology, and End Results (SEER)-Medicare data for men diagnosed with prostate cancer in 1994 to 1996. Race/ethnicity, comorbidity, stage, grade, age, and expected lifespan and their association with the receipt of watchful waiting were examined in multivariate logistic regression analyses. Race-stratified logistic regression analyses were also used to examine racial/ethnic variation in the association of clinical and demographic factors with the receipt of watchful waiting among African-American, Hispanic, and non-Hispanic white men. African-American (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.3 to 1.6) and Hispanic men (OR, 1.3; 95% CI, 1.1 to 1.5) were significantly more likely than non-Hispanic white men to receive watchful waiting in a multivariate model adjusted for age, comorbidity, stage, grade, and life expectancy. Advanced stage and grade, lower life expectancy, older age, and high comorbidity indices were also significantly associated with an increase in the odds of receipt of watchful waiting in multivariate analyses. In general, the association between the receipt of watchful waiting and the clinical characteristics (i.e., stage, grade, and age) were similar for the three racial/ethnic groups. In race-stratified logistic regression analyses, life expectancy was associated with an increase in the odds of receiving watchful waiting but results were statistically significant for whites only. There was also a statistically significant increase in the odds of receiving watchful waiting for African-American and white men with high comorbidity indices but not Hispanic men. The odds of

  10. Reactions to a Targeted Intervention to Increase Fecal Occult Blood Testing among Average-Risk Adults Waiting for Screening Colonoscopy

    Directory of Open Access Journals (Sweden)

    S Elizabeth McGregor

    2011-01-01

    Full Text Available BACKGROUND: Increasing demand combined with limited capacity has resulted in long wait times for average-risk adults referred for screening colonoscopy for colorectal cancer. Management of patients on these growing wait lists is an emerging clinical issue.

  11. Set methods of left-turn waiting zone at signalized intersection

    Institute of Scientific and Technical Information of China (English)

    DING Wei; YANG Xiao-guang; YANG Xiao-long

    2009-01-01

    To maximize the number of vehicles passing by the stop-line in a cycle and improve the operation ef-ficiency of intersection in China, the settlement of left-turn lane waiting-zone is becoming prevailing. Based on conflicting-point method, the internal mechanism of left-turn flow after stopping line was analyzed through taking postposition left-turn lane waiting-zone intersection for instance. The relationship between the first left-turn vehi-cle and the last vehicle of previous phase passing the conflicting point was expounded. According to the time of successive arriving of two vehicle flows at conflicting-point, the reasonable layout for waiting area of left-turn ve-hicles was researched when the clearance index was less than O. The results suggest that the appropriate layoutfor waiting area of left-turning vehicles can improve the operation efficiency of intersections.

  12. Waiting Game Over for Carrefour

    Institute of Scientific and Technical Information of China (English)

    MICHAELO'NEILL

    2004-01-01

    Carrefour's strong showing on the CTR-CIB ranking has a timely ring to it.In March,the French retail giant opened its newest store in the Zhongguancun area of Beijing.At the same time,the Ministry of Commerce(MOFCOM)announced that in accordance with its WTO commitments,China will lift previous limitations on foreign chain retail operators by December 2004 and that all restrictions on foreign retailers will be removed by 2007,fully opening the country's retail market.

  13. Housing Lease Market: Waiting to Be Explored

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    @@ Want to buy a house in China? As an expat, you have to wait at least one year to qualify for leasing after going through a series of complex procedures.If you are a newcomer to China or are staying heretemporarily, in the light of the high costs of hotel accommodations, perhaps renting an apartment is your best bet.

  14. Waiting on More than 64 Handles

    Science.gov (United States)

    2015-10-01

    parameter stuct is comprised of an array of handles with a maximum size of MAX_WAIT_OBJECTS and an integer holding the total quantity. Once all the...GIDEP Operations Center P.O. Box 8000 Corona , CA 91718-8000 gidep@gidep.org UNCLASSIFIED Approved for public release; distribution is unlimited. 4 Patricia Alameda Patricia Alameda Andrew Pskowski

  15. 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

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

    Directory of Open Access Journals (Sweden)

    Rong-Hwa Huang

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Levy Adrian R

    2005-09-01

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

  18. 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...

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

    Science.gov (United States)

    Wang, Jianfeng

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

  20. 8 CFR 207.5 - Waiting lists and priority handling.

    Science.gov (United States)

    2010-01-01

    ... REFUGEES § 207.5 Waiting lists and priority handling. Waiting lists are maintained for each designated refugee group of special humanitarian concern. Each applicant whose application is accepted for filing by... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Waiting lists and priority handling....

  1. A Formula of the Distribution Density of Waiting Time for a Class of Doubly Stochastic Poisson Process and It's Application in Forecasting Insects%一类重随机Poisson过程的等待时间的分布密度公式及其在害虫预测预报中的应用

    Institute of Scientific and Technical Information of China (English)

    李时银

    2000-01-01

    对具有强度过程λt(X)=Xa V(t)(a∈R+)的重随机Poisson过程{Nt:t≥t0},推导出其等待时间Wn的分布密度函数fwn(t)的表达式;讨论了进一步推广所得结果的途径;利用所得结果解决了一个预测害虫最适防治时刻的问题.%In this paper, a formula of distribution density function fwn(t) of waiting time for the doubly stochastic poisson process{Nt:t≥t0} with intensity process λt(X)=Xa V(t)(a∈R+) is deduced; the way to extend the results is discussed and the problem of forecasting the optimal time of preventing pests is solved by applying the results acquired.

  2. Mobile Technology Waiting for the 3G Rush

    Institute of Scientific and Technical Information of China (English)

    HAYET SELLAMI

    2006-01-01

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

  3. 等待或拒绝唯有时间--时间在王家卫电影意义生成过程中的作用分析%Waiting and Refusing Depend on Plot Time:Analysis of Time Effect in the Process of Meaning Generation in Wong Kar Wai’s Film

    Institute of Scientific and Technical Information of China (English)

    王冬冬; 林梓浩

    2014-01-01

    柏格森把时间划分为空间化的时间与绵延两种。在电影中与两种性质时间对应的是因果逻辑叙事和心理逻辑叙事,分别表现为由人物行动产生的时间和人物心理活动或者生存状态产生的时间。时间对于香港导演王家卫来说,是他电影中意义产生不可缺少的组成部分。他从故事和叙事结构两个层面,通过讲述男女之间的情感纠葛以及碎片化的叙事策略,使得时间从运动当中独立出来,当它再反射到故事中时影片就获得了更丰富的意义---让我们相信在无边的时间之网中我们能做的唯有拒绝与等待。%Henri Bergson has classified time as“mechanistic time”and“lived time”which he called as“real duration”. The two narrating methods corresponding to the two properties of time are causal logic narrating and psychological logic narrating,which refer to the time caused by people’s action and time caused by people’s mental activity or survival con-dition respectively.And the “lived time”is an indispensable part in Hong Kong director Wong Kar-wai’s films.From the story and narrative structure,he has illustrated the emotional entanglements between men and women,with the frag-mented narrative strategy he has made it possible for time to appear independently in movement.It has become much more meaningful as it is reflected in the stories.It makes us believe that in the infinite web of time the only thing we could do is refusal and waiting.

  4. 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...... the colonizers leave so that the colonized people could decide for themselves. Many anti-imperial struggles settled for nation-states each acquiring a separate, formal sovereignty-based international status. More recent versions of postcolonialism, inspired by poststructuralism and critical constructivism, have...

  5. 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.

  6. 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.

  7. Addition of long-distance heart procurement promotes changes in heart transplant waiting list status

    Directory of Open Access Journals (Sweden)

    Fernando Antibas Atik

    2014-09-01

    Full Text Available Objective: Evaluate the addition of long-distance heart procurement on a heart transplant program and the status of heart transplant recipients waiting list. Methods: Between September 2006 and October 2012, 72 patients were listed as heart transplant recipients. Heart transplant was performed in 41 (57%, death on the waiting list occurred in 26 (36% and heart recovery occurred in 5 (7%. Initially, all transplants were performed with local donors. Long-distance, interstate heart procurement initiated in February 2011. Thirty (73% transplants were performed with local donors and 11 (27% with long-distance donors (mean distance=792 km±397. Results: Patients submitted to interstate heart procurement had greater ischemic times (212 min ± 32 versus 90 min±18; P<0.0001. Primary graft dysfunction (distance 9.1% versus local 26.7%; P=0.23 and 1 month and 12 months actuarial survival (distance 90.1% and 90.1% versus local 90% and 86.2%; P=0.65 log rank were similar among groups. There were marked incremental transplant center volume (64.4% versus 40.7%, P=0.05 with a tendency on less waiting list times (median 1.5 month versus 2.4 months, P=0.18. There was a tendency on reduced waiting list mortality (28.9% versus 48.2%, P=0.09. Conclusion: Incorporation of long-distance heart procurement, despite being associated with longer ischemic times, does not increase morbidity and mortality rates after heart transplant. It enhances viable donor pool, and it may reduce waiting list recipient mortality as well as waiting time.

  8. Definitive Chemoradiotherapy ("Watch-and-Wait" Approach).

    Science.gov (United States)

    Goodman, Karyn A

    2016-07-01

    Preoperative chemoradiotherapy (CRT) followed by total mesorectal excision has been the standard of care for locally advanced patients with rectal cancer. Some patients achieve a pathologic complete response (pCR) to CRT and the oncologic outcomes are particularly favorable in this group. The role of surgery in patients with a pCR is now being questioned as radical rectal resection is associated with significant morbidity and long-term effects on quality of life. In an attempt to better tailor therapy, there is an interest in a "watch-and-wait" approach in patients who have a clinical complete response (cCR) after CRT with the goal of omitting surgery and allowing for organ preservation. However, a cCR does not always indicate a pCR, and improved clinical and imaging modalities are needed to better predict which patients have achieved a pCR and therefore can safely undergo a "watch-and-wait" approach. This article reviews the current data on nonoperative management and on-going controversies associated with this approach.

  9. 南京市某医院门诊患者就医等候时间分析及网络化流程再造设想%Analysis of the Outpatients'waiting Time and the Thinking of BPR Based on Internet in a Hospital, Nanjing

    Institute of Scientific and Technical Information of China (English)

    周静; 缪轶; 肖黎

    2014-01-01

    目的:通过分析门诊流程与患者就诊时间的关系,将门诊流程再造,从而减少患者无效等待时间、提高医院工作效率。方法:对南京某三甲医院某一天门诊患者进行随机抽样调查,同时运用文献检索分析法和流程分析法进行分析。结果:有95.8%的患者以现金支付,62.5%的患者未咨询直接挂号,患者在挂号处的平均等待时间为6.96分钟,划价和交费次数多;医生问诊时间不超过15分钟;患者平均门诊总时间为88.13分钟;门诊过程较繁琐。结论:对门诊流程进行网络化再造和优化,可显著降低患者的无效等待时间,提高医疗服务效率,增加患者满意度。%Objective: This thesis aims at reducing patients'useless waiting time and improving medical service's efficiency by analyzing the relationship between the outpatient department process and patient's time spent in hospital and reengineering the outpatient department's process. Methods: The author investigated randomly patients in the outpatient department of a Nanjing-based tertiary hospital, and studied their behavior with the method of literature researches and business process analysis.Results:95.8% of the patients paid in cash;62.5% of the patients regis-tered without consulting;the average waiting time at registered office was 6.96 minutes;designated price and pay more often;fewer doctor visiting time, almost less than 15 minutes;the average total time for outpatient is 88.13 minutes;the process is cumbersome.Conclusion:The outpatient department's process should be reengineered, so that we can obviously improve both medical service's efficiency and patients'satisfaction.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-06-01

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

  11. 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.

  12. Mass Measurement on the rp-Process Waiting Point 72Kr

    CERN Document Server

    Rodríguez, D; Audi, G; Äystö, J; Beck, D; Blaum, K; Bollen, G; Herfurth, F; Jokinen, A; Kellerbauer, A G; Kluge, H J; Oinonen, M; Schatz, H; Sauvan, E; Schwarz, S

    2004-01-01

    The mass of one of the three major waiting points in the astrophysical rp-process 72Kr was measured for the first time with the Penning trap mass spectrometer ISOLTRAP. The measurement yielded a relative mass uncertainty of delta m/m = 1.2x10-7 (delta m=8keV). Other Kr isotopes, also needed for astrophysical calculations, were measured with more than one order of magnitude improved accuracy. We use the ISOLTRAP masses of 72-74Kr to reanalyse the role of the 72Kr waiting point in the rp-process during X-ray bursts.

  13. Use of patient flow analysis to improve patient visit efficiency by decreasing wait time in a primary care-based disease management programs for anticoagulation and chronic pain: a quality improvement study.

    Science.gov (United States)

    Potisek, Nicholas M; Malone, Robb M; Shilliday, Betsy Bryant; Ives, Timothy J; Chelminski, Paul R; DeWalt, Darren A; Pignone, Michael P

    2007-01-15

    Patients with chronic conditions require frequent care visits. Problems can arise during several parts of the patient visit that decrease efficiency, making it difficult to effectively care for high volumes of patients. The purpose of the study is to test a method to improve patient visit efficiency. We used Patient Flow Analysis to identify inefficiencies in the patient visit, suggest areas for improvement, and test the effectiveness of clinic interventions. At baseline, the mean visit time for 93 anticoagulation clinic patient visits was 84 minutes (+/- 50 minutes) and the mean visit time for 25 chronic pain clinic patient visits was 65 minutes (+/- 21 minutes). Based on these data, we identified specific areas of inefficiency and developed interventions to decrease the mean time of the patient visit. After interventions, follow-up data found the mean visit time was reduced to 59 minutes (+/-25 minutes) for the anticoagulation clinic, a time decrease of 25 minutes (t-test 39%; p pain clinic was reduced to 43 minutes (+/- 14 minutes) a time decrease of 22 minutes (t-test 34 %; p effective technique to identify inefficiencies in the patient visit and efficiently collect patient flow data. Once inefficiencies are identified they can be improved through brief interventions.

  14. 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…

  15. Can the UroLift prostatic implant device treat the symptoms of benign prostatic hypertrophy, avoid sexual dysfunction and reduce hospital TURP waiting times? A single centre, single surgeon experience and review of the literature.

    Science.gov (United States)

    Bardoli, Antonio D; Taylor, Will St J; Mahmalji, Wasim

    2017-09-01

    BPH associated with LUTS and sexual dysfunction is common. We performed UroLift on 11 patients, average age 71 years (range 56-90). IPSS improved by an average of 9 points post-procedure. Pre-operatively their post-void residuals were 306.3 ml (range 120-499 ml SD [120.6]) and their QMAX was 7 ml/s (range 4-14 SD [2.8] ml/s). Post-procedure the post-void residual decreased by 35.4% at 4 months (mean difference - 106.3 ml). QMAX improved by an average of 1.7 ml/s, which was not statistically significant. No patients suffered any sexual dysfunction side effects and all patients were satisfied with their result. Hospital stay and theatre time were significantly reduced. Average length of stay was just 10.6 (6-18) hours and average theatre time just 18.7 (12-30) min. This is significantly faster than other surgery for LUTS. We therefore feel that there are significant benefits for both the patients, who are able to go home much faster, and also the hospital, who are able to perform far more surgeries for their patients. Patients also do not require an inpatient bed so patients should not be cancelled on the day of theatre.

  16. Influence of Waiting List in Recurrence Disease of Hepatocellular Carcinoma.

    Science.gov (United States)

    San Miguel, C; Vílchez, A; Villegas, T; Granero, K M; Becerra, A; López, M Á; Expósito, M; Fundora, Y

    2015-11-01

    We describe the results of our liver transplantation (LT) patients for hepatocellular carcinoma (HCC) in 2004 to 2012 to determine the differences on the basis of time on the waiting list to establish the risk of recurrence of liver disease. Clinical variables were recorded for both donors and recipients as well as variables of diagnosis, the use of transarterial chemoembolization during the waiting list time (WLT), complications, re-transplantation, and exitus. Fifty-eight patients were analyzed. Mean age was 57 ± 8 years (men, 83%; 48 patients). Viral etiology of HCC was 50% (n = 29); alcoholic, 26% (n = 15); and others, 24% (n = 14). Exitus was established in 24 patients (41%); only 5 patients (7%) were attributable to HCC. In the cohort of patients with less than 6 months of WLT, we registered both higher rates of downstaging protocols (10.7% vs 7.5%) and tumor size (3 cm vs 2 cm) compared with the other group. Bivariate studies were conducted according to the WLT (WLT <6 months, WLT ≥6 months), finding differences in recurrence of liver disease (P < .05). This fact was confirmed after a binary logistic regression. Our results in a subgroup of less than 6 months of WLT included patients with increased tumor size or presentation of multiple nodes, with a worse prognosis and therefore to be prioritized in the treatment of LT. Therefore, in our population there is a significant risk of tumor recurrence in patients with less WLT for LT, but it cannot be overestimated to all type of patients with HCC. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. 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.

  18. Predictors of fecundability and conception waits among the Dogon of Mali.

    Science.gov (United States)

    Strassmann, B I; Warner, J H

    1998-02-01

    Surprisingly little is known about the mechanisms that underlie variation in female fertility in humans. Data on this topic are nonetheless vital to a number of pragmatic and theoretical enterprises, including population planning, infertility treatment and prevention, and evolutionary ecology. Here we study female fertility by focusing on one component of the interbirth interval: the waiting time to conception during menstrual cycling. Our study population is a Dogon village of 460 people in Mali, West Africa. This population is pronatalist and noncontracepting. In accordance with animist beliefs, the women spend five nights sleeping at a menstrual hut during menses. By censusing the women present at the menstrual huts in the study village on each of 736 consecutive nights, we were able to monitor women's conception waits prospectively. Hormonal profiles confirm the accuracy of the data on conception waits obtained from the menstrual hut census (Strassmann [1996], Behavioral Ecology 7:304-315). Using survival analysis, we identified significant predictors of the waiting time to conception: wife's age (years), husband's age ( 49 years), marital duration (years), gravidity (number of prior pregnancies), and breast-feeding status. Additional variables were not significant, including duration of postpartum amenorrhea, sex of the last child, nutritional status, economic status, polygyny, and marital status (fiancée vs. married). We fit both continuous and discrete time survival models, but the former appeared to be a better choice for these data.

  19. 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.

  20. 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

  1. 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.

  2. Spatial structure increases the waiting time for cancer

    DEFF Research Database (Denmark)

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

    2011-01-01

    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...... been experiencing increasing interest in recent years. Many efforts have been made to better understand and predict the progression to cancer using mathematical models; these mostly consider the evolution of a well-mixed cell population, even though pre-cancerous cells often evolve in highly structured...... epithelial tissues. In this study, we propose a novel model of cancer progression that considers a spatially structured cell population where clones expand via adaptive waves. This model is used to asses two different paradigms of asexual evolution that have been suggested to delineate the process of cancer...

  3. Telehealth Business: Boom Times, but Profits May Wait.

    Science.gov (United States)

    Calandra, Robert

    2017-04-01

    What we have here is irrational telehealth exuberance. Investors are plowing millions into startups. And even though millennials could be eager adopters, these are still early days for the industry. It may take years-and some regulatory changes-for profits to materialize.

  4. Cumulative incidence for wait-list death in relation to length of queue for coronary-artery bypass grafting: a cohort study

    Directory of Open Access Journals (Sweden)

    Levy Adrian R

    2006-08-01

    Full Text Available Abstract Background In deciding where to undergo coronary-artery bypass grafting, the length of surgical wait lists is often the only information available to cardiologists and their patients. Our objective was to compare the cumulative incidence for death on the wait list according to the length of wait lists at the time of registration for the operation. Methods The study cohort included 8966 patients who registered to undergo isolated coronary-artery bypass grafting (82.4% men; 71.9% semi-urgent; 22.4% non-urgent. The patients were categorized according to wait-list clearance time at registration: either "1 month or less" or "more than 1 month". Cumulative incidence for wait-list death was compared between the groups, and the significance of difference was tested by means of regression models. Results Urgent patients never registered on a wait list with a clearance time of more than 1 month. Semi-urgent patients registered on shorter wait lists more often than non-urgent patients (79.1% vs. 44.7%. In semi-urgent and non-urgent patients, the observed proportion of wait-list deaths by 52 weeks was lower in category "1 month or less" than in category "more than 1 month" (0.8% [49 deaths] vs. 1.6% [39 deaths], P P Conclusion Long wait lists for coronary-artery bypass grafting are associated with increased probability that a patient dies before surgery. Physicians who advise patients where to undergo cardiac revascularization should consider the risk of pre-surgical death that is associated with the length of a surgical wait list.

  5. 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.

  6. Predictors of mortality in patients on the waiting list for liver transplantation

    Directory of Open Access Journals (Sweden)

    Lívia Garcia Ferreira

    2013-06-01

    Full Text Available Background and aim: The demand for liver transplantation (LTx increases every year, which is in contrast to the stagnation in the number of donors. This phenomenon has given rise to longer waiting times, which results in higher pre-transplantation mortality. Thus, our aim for this study was to identify risk factors, including nutritional variables, for mortality for patients who are on the waiting list for LTx. Methods: Patients on the waiting list were assessed to identify risk factors for mortality. Data related to demographic, socioeconomic, and etiologic factors, liver disease severity, complications, medications, and biochemical tests related to disease, nutritional status, diet intake, and physical activity were collected. Results: There were 159 patients followed, and 47.8% (76 were transplanted. The mortality rate while on the waiting list was 25.7% patient-years, and 40 patients died (28.0%. Variables associated with mortality during this period (p < 0.05 were the following: severe malnutrition (OR 2.5/CI: 1.2-5.3, low serum sodium values (OR: 1.1/CI: 1.01-1.2, and cryptogenic cirrhosis (OR: 2.2/CI: 1.1-4.6. Conclusions: Special attention should be given to patients with low serum sodium, those who are diagnosed with cryptogenic cirrhosis and the severely malnourished. An early diagnosis of malnutrition and an appropriate nutritional intervention is mandatory in such patients.

  7. Financial cost to institutions on patients waiting for gall bladder disease surgery.

    Science.gov (United States)

    Waqas, Ahmed; Qasmi, Shahzad Ahmed; Kiani, Faran; Raza, Ahmed; Khan, Khizar Ishtiaque; Manzoor, Shazia

    2014-01-01

    The aim of this study was to determine the financial costs to institution on patients waiting for gall bladder disease surgery and suggest measures to reduce them. This multi-centre prospective descriptive survey was performed on all patients who underwent an elective cholecystectomy by three consultants at secondary care hospitals in Pakistan between Jan 2010 to Jan 2012. Data was collected on demographics, the duration of mean waiting time, specific indications and nature of disease for including the patients in the waiting list, details of emergency re-admissions while awaiting surgery, investigations done, treatment given and expenditures incurred on them during these episodes. A total of 185 patients underwent elective open cholecystectomy. The indications for listing the patients for surgery were biliary colic in 128 patients (69%), acute cholecystitis in 43 patients (23%), obstructive jaundice in 8 patients (4.5%) and acute pancreatitis in 6 patients (3.2%). 146 (78.9%) and 39 (21.1%) of patients were listed as outdoor electives and indoor emergencies respectively. Of the 185 patients, 54 patients (29.2%) were re-admitted. Financial costs in Pakistani rupees per episode of readmission were 23050 per episode in total and total money spent on all readmissions was Rs. 17,05,700/-. Financial costs on health care institutions due to readmissions in patients waiting for gall bladder disease surgery are high. Identifying patients at risk for these readmissions and offering them early laparoscopic cholecystectomy is very important.

  8. 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.

  9. Truckers' Poor Health: An Accident Waiting to Happen?

    Science.gov (United States)

    ... https://medlineplus.gov/news/fullstory_163147.html Truckers' Poor Health: An Accident Waiting to Happen? Multiple medical ... pain and diabetes -- that have been linked with poor driving performance. Truck drivers with three or more ...

  10. Who gets a family physician through centralized waiting lists?

    OpenAIRE

    Breton, Mylaine; Brousselle, Astrid; Boivin, Antoine; Roberge, Dani?le; Pineault, Raynald; Berbiche, Djamal

    2015-01-01

    Background North American patients are experiencing difficulties in securing affiliations with family physicians. Centralized waiting lists are increasingly being used in Organisation for Economic Co-operation and Development countries to improve access. In 2011, the Canadian province of Quebec introduced new financial incentives for family physicians? enrolment of orphan patients through centralized waiting lists, the Guichet d?acc?s aux client?les orphelines, with higher payments for vulner...

  11. 5 CFR 531.405 - Waiting periods for within-grade increase.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Waiting periods for within-grade increase... REGULATIONS PAY UNDER THE GENERAL SCHEDULE Within-Grade Increases § 531.405 Waiting periods for within-grade increase. (a) Length of waiting period. (1) For an employee with a scheduled tour of duty, the waiting...

  12. 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.

  13. 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.

  14. Cholelithiasis in patients on the kidney transplant waiting list

    Science.gov (United States)

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

    2010-01-01

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

  15. Health-related quality of life in patients waiting for major joint replacement. A comparison between patients and population controls

    Directory of Open Access Journals (Sweden)

    Seitsalo Seppo

    2006-01-01

    Full Text Available Abstract Background Several quality-of-life studies in patients awaiting major joint replacement have focused on the outcomes of surgery. Interest in examining patients on the elective waiting list has increased since the beginning of 2000. We assessed health-related quality of life (HRQoL in patients waiting for total hip (THR or knee (TKR replacement in three Finnish hospitals, and compared patients' HRQoL with that of population controls. Methods A total of 133 patients awaiting major joint replacement due to osteoarthritis (OA of the hip or knee joint were prospectively followed from the time the patient was placed on the waiting list to hospital admission. A sample of controls matched by age, gender, housing and home municipality was drawn from the computerised population register. HRQoL was measured by the generic 15D instrument. Differences between patients and the population controls were tested by the independent samples t-test and between the measurement points by the paired samples t-test. A linear regression model was used to explain the variance in the 15D score at admission. Results At baseline, 15D scores were significantly different between patients and the population controls. Compared with the population controls, patients were worse off on the dimensions of moving (P Conclusion Although patients' HRQoL did not deteriorate while waiting, a consistently worse HRQoL was observed in patients waiting for major joint replacement compared with population controls.

  16. 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.

  17. 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

  18. Mass measurements beyond the major r-process waiting point $^{80}$Zn

    CERN Document Server

    Baruah, S; Blaum, K; Dworschak, M; George, S; Guenaut, C; Hager, U; Herfurth, F; Herlert, A; Kellerbauer, A G; Kluge, H J; Lunney, D; Schatz, H; Schweikhard, L; Yazidjian, C

    2008-01-01

    High-precision mass measurements on neutron-rich zinc isotopes $^{71m,72-81}$Zn have been performed with the Penning trap mass spectrometer ISOLTRAP. For the first time the mass of $^{81}$Zn has been experimentally determined. This makes $^{80}$Zn the first of the few major waiting points along the path of the astrophysical rapid neutron capture process where neutron separation energy and neutron capture $Q$-value are determined experimentally. As a consequence, the astrophysical conditions required for this waiting point and its associated abundance signatures to occur in $r$-process models can now be mapped precisely. The measurements also confirm the robustness of the $N = 50$ shell closure for $Z = 30$ farther from stability.

  19. Policy strategies to reduce waits for elective care: a synthesis of international evidence.

    Science.gov (United States)

    Kreindler, Sara A

    2010-01-01

    This synthesis seeks to assess and explain the effectiveness of policy interventions to reduce elective wait times or lists. PubMed, EMBASE, EconLit, and grey literature were systematically searched for relevant studies and reviews. Strategies with the strongest evidence base include paying for activity, buying capacity locally and setting targets with strong incentives. There is also evidence for improving the use of existing capacity. Limiting demand through rationing can reduce waits, but is ethically problematic. Short-term injections of funding, cross-border treatment schemes, unenforced targets and promotion of private health insurance had the weakest evidence. Available evidence favours options that act fairly directly on supply, demand or local organizations' behaviour, over indirect strategies that depend on a 'domino effect'. Further research is needed to determine how to achieve major, system-wide improvements in the use of capacity.

  20. Trading with the waiting-list: the justice of living donor list exchange.

    Science.gov (United States)

    den Hartogh, Govert

    2010-05-01

    In a Living Donor List Exchange program, the donor makes his kidney available for allocation to patients on the postmortal waiting-list and receives in exchange a postmortal kidney, usually an O-kidney, to be given to the recipient he favours. The program can be a solution for a candidate donor who is unable to donate directly or to participate in a paired kidney exchange because of blood group incompatibility or a positive cross-match. Each donation within an LDLE program makes an additional organ available for transplantation. But because most of the pairs making use of the program will be A/O incompatible, it will also tend to increase the waiting time for patients with blood group O, who already have the longest waiting time. It has therefore been objected that the program is materially unjust, because it further disadvantages the least advantaged. This objection appeals to John Rawls' difference principle. However, the context for which Rawls proposed that difference principle, is significantly different from the present one. Applying the principle here amounts to a lop-sided trade-off between considerations of need and considerations of overall utility. Considerations of formal justice, however, may lead to a stronger objection to LDLE programs. Such a program means that one O-patient on the waiting list is exempted from the application of the general criteria used in constructing the list because he has a special bargaining advantage. This objection is spelled out and weighed against the obvious attraction of LDLE in a situation of (extreme) organ scarcity.

  1. Coping with worry while waiting for diagnostic results

    DEFF Research Database (Denmark)

    Lou, Stina; Nielsen, Camilla P; Hvidman, Lone;

    2016-01-01

    ' during this period, however, not enough is known about how high-risk women and their partners cope while waiting for diagnostic results. The aim of this study was to identify the strategies employed to cope with worry and uncertainty. METHODS: Qualitative, semi-structured interviews with 16 high......BACKGROUND: It is well documented that pregnant women experience increased worry and uncertainty following a high-risk prenatal screening result. While waiting for diagnostic results this worry continues to linger. It has been suggested that high-risk women put the pregnancy mentally 'on hold......-risk couples who underwent diagnostic testing. The couples were recruited at a university hospital fetal medicine unit in Denmark. Data were analysed using thematic analysis. RESULTS: All couples reported feeling worried and sad upon receiving a high-risk screening result. While waiting for diagnostic results...

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  3. Identificación y caracterización de mudas de transporte, procesos, movimientos y tiempos de espera en nueve pymes manufactureras incorporando la perspectiva del nivel operativo Identifying and characterizing of wastes (Muda in transportation, processes, movements, and waiting time, in nine manufacturing SMEs incorporating the perspective of the operational level

    Directory of Open Access Journals (Sweden)

    Jorge Pérez Rave

    2011-12-01

    Full Text Available Se identifica y se caracteriza en términos de: cantidad, tipo, localización y manifestación, los transportes, tiempos de espera, movimientos y procesos innecesarios en nueve pymes manufactureras de la ciudad de Medellín. El procedimiento constó de las etapas: selección de procesos a estudiar (uno por empresa, capacitación al personal operativo (7 mudas, 5S y gerencia visual, sesión en profundidad con administración de formulario de identificación del muda, verificación en el gemba, y resultados y análisis. Consolidando los hallazgos para las nueve empresas, 151 trabajadores fueron capacitados, los cuales contribuyeron a identificar 1.085 actividades que no aportan valor al cliente, con un promedio de 121 por proceso-empresa, la mayoría fueron transportes (31% y movimientos innecesarios (29%. Se brindan elementos metodológicos que facilitan la comunicación entre el nivel operativo y los demás, así como la capacitación y la participación activa del mismo, posibilitando identificar oportunidades de mejora para las empresas. Se ofrece información de interés para la academia, el gobierno, los centros de desarrollo tecnológico y el sector productivo.Is identified and characterized in terms of: quantity, type, location and expression, transportation, waiting times, movements, and unnecessary processes, in nine manufacturing SMEs in the city of Medellin. The procedure consisted of the stages: selection of processes to be studied (one per company, operating personnel training (7 Wastes (Muda, 5S and visual management, deep session with management of the Muda identification form, verifying in the shop floor (Gemba, results and analysis. Consolidating the findings for the nine companies, 151 workers were trained, which helped to identify 1.085 activities that do not add value to the customer, with an average of 121 per process-company, most were transportation (31% and unnecessary movements (29%. Methodological elements are provided

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

    Science.gov (United States)

    Alrutz, Stowe; Moyes, Simon

    2014-01-01

    Objective To explore the basis for patient complaints about the oldness of most magazines in practice waiting rooms. Design Cohort study. Setting Waiting room of a general practice in Auckland, New Zealand. Participants 87 magazines stacked into three mixed piles and placed in the waiting room: this included non-gossipy magazines (Time magazine, the Economist, Australian Women’s Weekly, National Geographic, BBC History) and gossipy ones (not identified for fear of litigation). Gossipy was defined as having five or more photographs of celebrities on the front cover and most gossipy as having up to 10 such images. Interventions The magazines were marked with a unique number on the back cover, placed in three piles in the waiting room, and monitored twice weekly. Main outcome measures Disappearance of magazines less than 2 months old versus magazines 3-12 months old, the overall rate of loss of magazines, and the rate of loss of gossipy versus non-gossipy magazines. Results 47 of the 82 magazines with a visible date on the front cover were aged less than 2 months. 28 of these 47 (60%) magazines and 10 of the 35 (29%) older magazines disappeared (P=0.002). After 31 days, 41 of the 87 (47%, 95% confidence interval 37% to 58%) magazines had disappeared. None of the 19 non-gossipy magazines (the Economist and Time magazine) had disappeared compared with 26 of the 27 (96%) gossipy magazines (Pmagazines and all 19 of the non-gossipy magazines had disappeared by 31 days. The study was terminated at this point. Conclusions General practice waiting rooms contain mainly old magazines. This phenomenon relates to the disappearance of the magazines rather than to the supply of old ones. Gossipy magazines were more likely to disappear than non-gossipy ones. On the grounds of cost we advise practices to supply old copies of non-gossipy magazines. A waiting room science curriculum is urgently needed. PMID:25500116

  5. On the Absurd Characteristics in Waiting for Godot

    Institute of Scientific and Technical Information of China (English)

    任欢

    2016-01-01

    In 1950s and 1960s,a literature school,called “Absurd Theatre”prevailed in Europe and America.It subverts the inherent charac-teristics of the traditional play by demonstrating plays in an unexpected way.The plays,without plots,conflicts,or exciting scenes,aim at reflecting the meaninglessness,hopelessness,emptiness and nothingness of man.Waiting for Godot,an archetypical work of “Absurd Theatre”,classically ex-pounds the absurd situation man are in.This thesis is devoted to analyzing the absurd characteristics in Waiting for Godot from different perspectives.

  6. Who gets a family physician through centralized waiting lists?

    Science.gov (United States)

    Breton, Mylaine; Brousselle, Astrid; Boivin, Antoine; Roberge, Danièle; Pineault, Raynald; Berbiche, Djamal

    2015-02-05

    North American patients are experiencing difficulties in securing affiliations with family physicians. Centralized waiting lists are increasingly being used in Organisation for Economic Co-operation and Development countries to improve access. In 2011, the Canadian province of Quebec introduced new financial incentives for family physicians' enrolment of orphan patients through centralized waiting lists, the Guichet d'accès aux clientèles orphelines, with higher payments for vulnerable patients. This study analyzed whether any significant changes were observed in the numbers of patient enrolments with family physicians' after the introduction of the new financial incentives. Prior to then, financial incentives had been offered for enrolment of vulnerable patients only and there were no incentives for enrolling non-vulnerable patients. After 2011, financial incentives were also offered for enrolment of non-vulnerable patients, while those for enrolment of vulnerable patients were doubled. A longitudinal quantitative analysis spanning a five-year period (2008-2013) was performed using administrative databases covering all patients enrolled with family physicians through centralized waiting lists in the province of Quebec (n = 494,697 patients). Mixed regression models for repeated-measures were used. The number of patients enrolled with a family physician through centralized waiting lists more than quadrupled after the changes in financial incentives. Most of this increase involved non-vulnerable patients. After the changes, 70% of patients enrolled with a family physician through centralized waiting lists were non-vulnerable patients, most of whom had been referred to the centralized waiting lists by the physician who enrolled them, without first being registered in those lists or having to wait because of their priority level. Centralized waiting lists linked to financial incentives increased the number of family physicians' patient enrolments. However, although

  7. An Improved Spray and Wait with Probability Choice Routing for Opportunistic Networks

    Directory of Open Access Journals (Sweden)

    Daru Pan

    2012-09-01

    Full Text Available Opportunistic networks are sparse multi-hop ad hoc networks in which nodes exploit any pair-wise contact opportunities to share and forward messages. The main challenge for this environment is that conventional routing schemes do not work properly.  Among the existing Opportunistic Networks routing algorithms, the epidemic routing and probabilistic  routing could provide higher delivery  probability and shorter delays, but is with a large overhead, while the spay and wait routing could reduce the overhead, but is with low delivery probability and high delay.  This paper proposes the Spray and Wait with Probability Choice (SWPC routing, where continuous encounter time is used to describe the encounter opportunity; a delivery probability function is set up to direct the different number of copies to the destination during the spray phase; and a forwarding scheme is implemented in the wait phase. Simulation results show that proposed SWPC shows prominent superiority in the delivery rate, the average delay and the communication overhead, and adapted for the frequently disconnected opportunistic network.

  8. Tutorial in medical decision modeling incorporating waiting lines and queues using discrete event simulation.

    Science.gov (United States)

    Jahn, Beate; Theurl, Engelbert; Siebert, Uwe; Pfeiffer, Karl-Peter

    2010-01-01

    In most decision-analytic models in health care, it is assumed that there is treatment without delay and availability of all required resources. Therefore, waiting times caused by limited resources and their impact on treatment effects and costs often remain unconsidered. Queuing theory enables mathematical analysis and the derivation of several performance measures of queuing systems. Nevertheless, an analytical approach with closed formulas is not always possible. Therefore, simulation techniques are used to evaluate systems that include queuing or waiting, for example, discrete event simulation. To include queuing in decision-analytic models requires a basic knowledge of queuing theory and of the underlying interrelationships. This tutorial introduces queuing theory. Analysts and decision-makers get an understanding of queue characteristics, modeling features, and its strength. Conceptual issues are covered, but the emphasis is on practical issues like modeling the arrival of patients. The treatment of coronary artery disease with percutaneous coronary intervention including stent placement serves as an illustrative queuing example. Discrete event simulation is applied to explicitly model resource capacities, to incorporate waiting lines and queues in the decision-analytic modeling example.

  9. Limitations of the MELD score in predicting mortality or need for removal from waiting list in patients awaiting liver transplantation

    Directory of Open Access Journals (Sweden)

    Schmidt Jan

    2009-09-01

    Full Text Available Abstract Background Decompensated cirrhosis is associated with a poor prognosis and liver transplantation provides the only curative treatment option with excellent long-term results. The relative shortage of organ donors renders the allocation algorithms of organs essential. The optimal strategy based on scoring systems and/or waiting time is still under debate. Methods Data sets of 268 consecutive patients listed for single-organ liver transplantation for nonfulminant liver disease between 2003 and 2005 were included into the study. The Model for End-Stage Liver Disease (MELD and Child-Turcotte-Pugh (CTP scores of all patients at the time of listing were used for calculation. The predictive ability not only for mortality on the waiting list but also for the need for withdrawal from the waiting list was calculated for both scores. The Mann-Whitney-U Test was used for the univariate analysis and the AUC-Model for discrimination of the scores. Results In the univariate analysis comparing patients who are still on the waiting list and patients who died or were removed from the waiting list due to poor conditions, the serum albumin, bilirubin INR, and CTP and MELD scores as well as the presence of ascites and encephalopathy were significantly different between the groups (p Comparing the predictive abilities of CTP and MELD scores, the best discrimination between patients still alive on the waiting list and patients who died on or were removed from the waiting list was achieved at a CTP score of ≥9 and a MELD score of ≥14.4. The sensitivity and specificity to identify mortality or severe deterioration for CTP was 69.0% and 70.5%, respectively; for MELD, it was 62.1% and 72.7%, respectively. This result was supported by the AUC analysis showing a strong trend for superiority of CTP over MELD scores (AUROC 0.73 and 0.68, resp.; p = 0.091. Conclusion The long term prediction of mortality or removal from waiting list in patients awaiting liver

  10. 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...

  11. 24 CFR 982.205 - Waiting list: Different programs.

    Science.gov (United States)

    2010-04-01

    ... program, project-based voucher program or moderate rehabilitation program: (i) If the PHA's waiting list... public housing program, project-based voucher program or moderate rehabilitation program, the PHA must... list for its public housing program, project-based voucher program or moderate rehabilitation......

  12. 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.

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

    CERN Multimedia

    Mervis, J

    1995-01-01

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

  14. 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.

  15. 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.

  16. 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…

  17. Innovatus Interregnum: Waiting for a Paradigm Shift

    Science.gov (United States)

    English, Fenwick W.; Ehrich, Lisa Catherine

    2015-01-01

    Purpose: The purpose of this paper is to establish the case that innovation in the theory and practice of educational administration/leadership is very unlikely to occur within the existing "doxa" of our times. By innovation is meant a novel conceptual or practical change in the field of practice. By "doxa" is meant the…

  18. Optimal Research and Numerical Simulation for Scheduling No-Wait Flow Shop in Steel Production

    Directory of Open Access Journals (Sweden)

    Huawei Yuan

    2013-01-01

    Full Text Available This paper considers the m-machine flow shop scheduling problem with the no-wait constraint to minimize total completion time which is the typical model in steel production. First, the asymptotic optimality of the Shortest Processing Time (SPT first rule is proven for this problem. To further evaluate the performance of the algorithm, a new lower bound with performance guarantee is designed. At the end of the paper, numerical simulations show the effectiveness of the proposed algorithm and lower bound.

  19. Waiting for the W - and the Higgs

    Science.gov (United States)

    Tannenbaum, M. J.

    2016-10-01

    The search for the left-handed W ± bosons, the proposed quanta of the weak interaction, and the Higgs boson, which spontaneously breaks the symmetry of unification of electromagnetic and weak interactions, has driven elementary-particle physics research from the time that I entered college to the present and has led to many unexpected and exciting discoveries which revolutionized our view of subnuclear physics over that period. In this article I describe how these searches and discoveries have intertwined with my own career.

  20. Gather Strength and Wait for Opportunities

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    Since October 2008,China's social consumption of electricity had,for the first time,grown negatively compared to the same period of the previous year,and in November the negative growth range further expanded. The major pressure faced by the electricity industry has now turned from the contradiction between coal and electricity to electricity quantity. This is undoubtedly a true and new test to electricity enterprises which get used to high growth but are now suffering great losses. The reform of electricit...

  1. Waiting for the W. and the Higgs

    Science.gov (United States)

    Tannenbaum, M. J.

    2016-12-01

    The search for the left-handed W± bosons, the proposed quanta of the weak interaction, and the Higgs boson, which spontaneously breaks the symmetry of unification of electromagnetic and weak interactions, has driven elementary-particle physics research from the time that I entered college to the present and has led to many unexpected and exciting discoveries which revolutionized our view of subnuclear physics over that period. In this article I describe how these searches and discoveries have intertwined with my own career.

  2. Waiting for the W and the Higgs

    CERN Document Server

    Tannenbaum, M J

    2016-01-01

    The search for the left-handed $W^{\\pm}$ bosons, the proposed quanta of the weak interaction, and the Higgs boson, which spontaneously breaks the symmetry of unification of electromagnetic and weak interactions, has driven elementary-particle physics research from the time that I entered college to the present and has led to many unexpected and exciting discoveries which revolutionized our view of subnuclear physics over that period. In this article I describe how these searches and discoveries have intertwined with my own career.

  3. 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

  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

    completed questionnaires. Low specificity of the resources to one's condition and time poorness may have been barriers to engagement. Results suggest that with refinements, this study design can be implemented successfully when conducting a larger social media study. At present, comment cannot be made on what effect using social media can have on patients on hospital waiting lists, nor whether those who use social media while waiting in pain achieve better outcomes from eventual participation in a chronic pain program. Long-term follow-up should be included in future studies to answer this. Future research should focus on multicenter randomized controlled trials, involving patients in the intervention design for improved participation and outcomes and for evidence to be sound.

  5. A web-based appointment system to reduce waiting for outpatients: a retrospective study.

    Science.gov (United States)

    Cao, Wenjun; Wan, Yi; Tu, Haibo; Shang, Fujun; Liu, Danhong; Tan, Zhijun; Sun, Caihong; Ye, Qing; Xu, Yongyong

    2011-11-22

    Long waiting times for registration to see a doctor is problematic in China, especially in tertiary hospitals. To address this issue, a web-based appointment system was developed for the Xijing hospital. The aim of this study was to investigate the efficacy of the web-based appointment system in the registration service for outpatients. Data from the web-based appointment system in Xijing hospital from January to December 2010 were collected using a stratified random sampling method, from which participants were randomly selected for a telephone interview asking for detailed information on using the system. Patients who registered through registration windows were randomly selected as a comparison group, and completed a questionnaire on-site. A total of 5641 patients using the online booking service were available for data analysis. Of them, 500 were randomly selected, and 369 (73.8%) completed a telephone interview. Of the 500 patients using the usual queuing method who were randomly selected for inclusion in the study, responses were obtained from 463, a response rate of 92.6%. Between the two registration methods, there were significant differences in age, degree of satisfaction, and total waiting time (P0.05). Being ignorant of online registration, not trusting the internet, and a lack of ability to use a computer were three main reasons given for not using the web-based appointment system. The overall proportion of non-attendance was 14.4% for those using the web-based appointment system, and the non-attendance rate was significantly different among different hospital departments, day of the week, and time of the day (Pweb-based appointment system could significantly increase patient's satisfaction with registration and reduce total waiting time effectively. However, further improvements are needed for broad use of the system.

  6. A web-based appointment system to reduce waiting for outpatients: A retrospective study

    Directory of Open Access Journals (Sweden)

    Cao Wenjun

    2011-11-01

    Full Text Available Abstract Background Long waiting times for registration to see a doctor is problematic in China, especially in tertiary hospitals. To address this issue, a web-based appointment system was developed for the Xijing hospital. The aim of this study was to investigate the efficacy of the web-based appointment system in the registration service for outpatients. Methods Data from the web-based appointment system in Xijing hospital from January to December 2010 were collected using a stratified random sampling method, from which participants were randomly selected for a telephone interview asking for detailed information on using the system. Patients who registered through registration windows were randomly selected as a comparison group, and completed a questionnaire on-site. Results A total of 5641 patients using the online booking service were available for data analysis. Of them, 500 were randomly selected, and 369 (73.8% completed a telephone interview. Of the 500 patients using the usual queuing method who were randomly selected for inclusion in the study, responses were obtained from 463, a response rate of 92.6%. Between the two registration methods, there were significant differences in age, degree of satisfaction, and total waiting time (P P > 0.05. Being ignorant of online registration, not trusting the internet, and a lack of ability to use a computer were three main reasons given for not using the web-based appointment system. The overall proportion of non-attendance was 14.4% for those using the web-based appointment system, and the non-attendance rate was significantly different among different hospital departments, day of the week, and time of the day (P Conclusion Compared to the usual queuing method, the web-based appointment system could significantly increase patient's satisfaction with registration and reduce total waiting time effectively. However, further improvements are needed for broad use of the system.

  7. The interim service preferences of parents waiting for children's mental health treatment: a discrete choice conjoint experiment.

    Science.gov (United States)

    Cunningham, Charles E; Chen, Yvonne; Deal, Ken; Rimas, Heather; McGrath, Patrick; Reid, Graham; Lipman, Ellen; Corkum, Penny

    2013-08-01

    Parents seeking help for children with mental health problems are often assigned to a waiting list. We used a discrete choice conjoint experiment to model preferences for interim services that might be used while waiting for the formal assessment and treatment process to begin. A sample of 1,059 parents (92 % mothers) seeking mental health services for 4 to 16 year olds chose between hypothetical interim services composed by experimentally varying combinations of the levels of 13 interim service attributes. Latent Class analysis yielded a four-segment solution. All segments preferred interim options helping them understand how agencies work, enhancing their parenting knowledge and skill, and providing an opportunity to understand or begin dealing with their own difficulties. The Group Contact segment (35.1 %) preferred interim services in meetings with other parents, supported by phone contacts, frequent checkup calls, and wait-time updates. Virtual Contact parents (29.2 %) preferred to meet other parents in small internet chat groups supported by e-mail contact. Membership in this segment was linked to higher education and computer skills. Frequent Contact parents (24.4 %) preferred face-to-face interim services supported by weekly progress checks and wait time updates. Limited Contact parents (11.3 %) were less intent on using interim services. They preferred to pursue interim services alone, with contacts by phone, supported by fewer check-up calls and less frequent wait time updates. All segments were more likely to enroll in interim services involving their child.

  8. 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.

  9. Nursing interventions for family members waiting during cardiac procedures.

    Science.gov (United States)

    Trecartin, Kelly; Carroll, Diane L

    2011-08-01

    Anxiety is shared by patients and family members (FMs) and can increase throughout the FMs waiting during invasive cardiac procedures (ICP). The purpose of this study was to measure the effects of an informational report (IR) and a postprocedure visit (PPV), on the anxiety of waiting FMs. There were 151 FMs assigned to 3 groups; Group 1 (50 FMs: standard of care [SOC]), Group 2 (50 FMs: SOC + IR), and Group 3 (51 FMs: SOC + IR + PPV). Pre/ postvariables measured were: blood pressure (BP), heart rate (HR), skin temperature (ST), and anxiety. When comparing the BP, HR, ST, and anxiety there were no differences between groups with either SOC or IR. There was a significant reduction in anxiety, from baseline to the PPV in Group 3 (F = 10.1; p < .000). A PPV had an impact on FMs and a PPV should be incorporated as a nursing intervention during ICP.

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Indian Academy of Sciences (India)

    Imran Ali Chaudhry; Abdul Munem Khan

    2012-12-01

    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 previous approaches cited in the literature. Additionally, it is demonstrated that the current application is a general purpose approach whereby the objective function can be tailored without any change in the logic of the GA routine.

  12. The use of mobile technology in waiting rooms to leverage women's empowerment: A conceptual context.

    Science.gov (United States)

    Reychav, Iris; Parush, Avi; McHaney, Roger; Hazan, Maya; Moshonov, Rami

    2016-10-13

    This article focuses on a conceptual framework that can be applied to the use of mobile technology in the waiting room with the goal of empowering women recently diagnosed with abnormal Pap test results. It further describes trends which indicate a need for improved and timely information dissemination. Genecology practice outpatients report a predominant feeling of worry on receipt of abnormal medical test results, along with a clearly expressed wish for additional information. This research suggests that there is room for improvement in existing processes through use of mobile technology with carefully vetted materials which indicate a doctor is interested in the patient's well-being.

  13. HYPOXIA AMONG PATIENTS ON THE LIVER-TRANSPLANT WAITING LIST

    Science.gov (United States)

    NACIF, Lucas Souto; ANDRAUS, Wellington; SARTORI, Kathryn; BENITES, Carlos Marlon; SANTOS, Vinicius Rocha; ROCHA-FILHO, Joel Avancini; D'ALBUQUERQUE, Luiz Carneiro

    2014-01-01

    Background Hepatopulmonary syndrome is formed by a triad of liver disease, intrapulmonary vascular dilatation and changes in blood gases. This condition is present in 4-32% of patients with cirrhosis. Aim To analyze the blood gas changes data of patients in liver-transplant waiting list. Method Clinical data of 279 patients in liver transplantation waiting list in May 2013 were studied. Overall patient was analyzed by the demographic aspects, laboratorial and image findings on exams that determine lung disease (hypoxemia) in these cirrhotic patients. The mean values and standard deviations were used to examine normally distributed variables. Results There was a high prevalence of male patients (68%); the mean age was 51(±5,89) years, and the predominant reason for listing was hepatitis C cirrhosis. The MELD score mean was 16±5,89, without prioritization or special situation. The most common blood type was O in 129 cases (46%) and the mean of body max index was 25,94±4,58. Regarding arterial blood gas tests was observed 214 patients with PaO2 transplant. Due to the high severity and morbidity, is suggested better monitoring and therapeutic support to hypoxemic patients on liver transplant waiting list. PMID:24676301

  14. 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

  15. Provisions on waiting periods in international investment protection treaties and their impact on the jurisdiction of arbitral tribunals

    Directory of Open Access Journals (Sweden)

    Đundić Petar

    2012-01-01

    Full Text Available Provisions on so-called waiting periods in international investment protection treaties give an investor from one contracting state an opportunity to initiate arbitration against the host state provided that the time designated by the treaty from the date on which the dispute arose has elapsed. The aim of those provisions is to enable parties to the dispute to use this time for consultations and attempt to reach a negotiated settlement. The paper analyzes the attitude of contemporary arbitral practice towards the legal nature and effect of those provisions on tribunals' jurisdiction in investment disputes. The analysis shows gradual and clear shift of position taken by the tribunals in cases in which claimants did not comply with waiting periods. Because arbitral tribunals today are more resolved to penalize premature submission of the dispute to arbitration than they were one decade ago, in the future one can expect much more cautious conduct of potential claimants in this regard.

  16. Hospital outpatient perceptions of the physical environment of waiting areas: the role of patient characteristics on atmospherics in one academic medical center

    Directory of Open Access Journals (Sweden)

    Sun Pi-hung

    2007-12-01

    Full Text Available Abstract Background This study examines hospital outpatient perceptions of the physical environment of the outpatient waiting areas in one medical center. The relationship of patient characteristics and their perceptions and needs for the outpatient waiting areas are also examined. Method The examined medical center consists of five main buildings which house seventeen primary waiting areas for the outpatient clinics of nine medical specialties: 1 Internal Medicine; 2 Surgery; 3 Ophthalmology; 4 Obstetrics-Gynecology and Pediatrics; 5 Chinese Medicine; 6 Otolaryngology; 7 Orthopedics; 8 Family Medicine; and 9 Dermatology. A 15-item structured questionnaire was developed to rate patient satisfaction covering the four dimensions of the physical environments of the outpatient waiting areas: 1 visual environment; 2 hearing environment; 3 body contact environment; and 4 cleanliness. The survey was conducted between November 28, 2005 and December 8, 2005. A total of 680 outpatients responded. Descriptive, univariate, and multiple regression analyses were applied in this study. Results All of the 15 items were ranked as relatively high with a range from 3.362 to 4.010, with a neutral score of 3. Using a principal component analysis' summated scores of four constructed dimensions of patient satisfaction with the physical environments (i.e. visual environment, hearing environment, body contact environment, and cleanliness, multiple regression analyses revealed that patient satisfaction with the physical environment of outpatient waiting areas was associated with gender, age, visiting frequency, and visiting time. Conclusion Patients' socio-demographics and context backgrounds demonstrated to have effects on their satisfaction with the physical environment of outpatient waiting areas. In addition to noticing the overall rankings for less satisfactory items, what should receive further attention is the consideration of the patients' personal

  17. FRACTAL DIMENSION RESULTS FOR CONTINUOUS TIME RANDOM WALKS.

    Science.gov (United States)

    Meerschaert, Mark M; Nane, Erkan; Xiao, Yimin

    2013-04-01

    Continuous time random walks impose random waiting times between particle jumps. This paper computes the fractal dimensions of their process limits, which represent particle traces in anomalous diffusion.

  18. The experiences of adults who are on dialysis and waiting for a renal transplant from a deceased donor: a systematic review.

    Science.gov (United States)

    Burns, Tania; Fernandez, Ritin; Stephens, Moira

    2015-03-12

    Kidney transplantation has been recognized as the best renal replacement therapy option for people with end stage renal disease. With an estimated 170,000 people waiting for a kidney transplant around the world and a limited supply of donor organs, the waiting time is often prolonged for many years. The aim of this review was to examine the existing evidence of patients' experiences of living on dialysis and waiting for a renal transplant from a deceased donor. This review considered studies that included adult patients aged 18 years and over who had been on dialysis (hemodialysis or peritoneal dialysis) for up to 15 years and who were waiting for a renal transplant from a deceased donor. Types of intervention(s)/phenomena of interest: The phenomena of interest were the experiences of adults waiting for a renal transplant from a deceased donor and more specifically, the impact of waiting on their lifestyle and day to day living. Types of studies: This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. Types of outcomes: This review considered studies that included the experiences of people who were waiting on dialysis for a kidney transplant from a deceased donor. The search strategy aimed to find both published and unpublished studies through electronic databases, reference list searches and the World Wide Web. Extensive searches were undertaken of the CINAHL, Embase, Medline and PsychInfo databases of published literature, the Cochrane Database of Systematic Reviews and the Virginia Henderson International Nursing Library, OpenGrey and the New York Academy of Medicine databases of unpublished literature. Each study was assessed for methodological quality by two independent reviewers using the Joanna Briggs Institute Qualitative Assessment and Review Instrument checklist. Disagreements between the reviewers were resolved

  19. The Application of Waiting Lines System in Improving Customer Service Management: The Examination of Malaysia Fast Food Restaurants Industry

    Science.gov (United States)

    Ismail, Zurina; Shokor, Shahrul Suhaimi AB

    2016-03-01

    Rapid life time change of the Malaysian lifestyle had served the overwhelming growth in the service operation industry. On that occasion, this paper will provide the idea to improve the waiting line system (WLS) practices in Malaysia fast food chains. The study will compare the results in between the single server single phase (SSSP) and the single server multi-phase (SSMP) which providing Markovian Queuing (MQ) to be used for analysis. The new system will improve the current WLS, plus intensifying the organization performance. This new WLS were designed and tested in a real case scenario and in order to develop and implemented the new styles, it need to be focusing on the average number of customers (ANC), average number of customer spending time waiting in line (ACS), and the average time customers spend in waiting and being served (ABS). We introduced new WLS design and there will be prompt discussion upon theories of benefits and potential issues that will benefit other researchers.

  20. A Heuristic Genetic Algorithm for No-Wait Flowshop Scheduling Problem

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    No-wait flowshop scheduling problems with the objective to minimize the total flow time is an important sequencing problem in the field of developing production plans and has a wide engineering background.Genetic algorithm (GA) has the capability of global convergence and has been proven effective to solve NP-hard combinatorial optimization problems, while simple heuristics have the advantage of fast local convergence and can be easily implemented.In order to avoid the defect of slow convergence or premature, a heuristic genetic algorithm is proposed by incorporating the simple heuristics and local search into the traditional genetic algorithm.In this hybridized algorithm, the structural information of no-wait flowshops and high-effective heuristics are incorporated to design a new method for generating initial generation and a new crossover operator.The computational results show the developed heuristic genetic algorithm is efficient and the quality of its solution has advantage over the best known algorithm.It is suitable for solving the large scale practical problems and lays a foundation for the application of meta-heuristic algorithms in industrial production.

  1. Rationing scarce organs for transplantation: healthcare provider perspectives on wait-listing and organ allocation.

    Science.gov (United States)

    Tong, Allison; Jan, Stephen; Wong, Germaine; Craig, Jonathan C; Irving, Michelle; Chadban, Steven; Cass, Alan; Howard, Kirsten

    2013-01-01

    Ongoing debate about how to maximize the benefit of scarce organs while maintaining equity of access to transplantation exists. This study aims to synthesize healthcare provider perspectives on wait-listing and organ allocation. MEDLINE, Embase, and PsycINFO were searched till February 21, 2011. Quantitative data were extracted, and a qualitative synthesis of the studies was conducted. Twenty studies involving 4254 respondents were included. We identified two goals underpinning healthcare provider preferences for organ allocation: (i) maximize clinical benefit (quality of life gains, patient survival, treatment adherence, and graft survival) and social outcomes (social support, productivity, and valuation); (ii) achieve equity (waiting time, patient preferences, access to live donation, and medical urgency). Maximizing clinical or social outcomes meant organs would be preferentially given to patients expected to achieve good transplant outcomes or wider social gain. Achieving equity meant all patients should have an equal chance of transplant, or patients deemed more urgent receive higher priority. A tension between equity and efficiency is apparent. Balanced against dimensions of efficiency were considerations to instill a degree of perceived fairness in organ allocation. Ongoing engagement with stakeholders is needed to enhance transparency, a reasonable balance between efficiency and equity, and avoid discrimination against specific populations.

  2. "Wait and see" vaccinating behaviour during a pandemic: a game theoretic analysis.

    Science.gov (United States)

    Bhattacharyya, Samit; Bauch, Chris T

    2011-07-26

    During the 2009 H1N1 pandemic, many individuals did not seek vaccination immediately but rather decided to "wait and see" until further information was available on vaccination costs. This behaviour implies two sources of strategic interaction: as more individuals become vaccinated, both the perceived vaccination cost and the probability that susceptible individuals become infected decline. Here we analyze the outcome of these two strategic interactions by combining game theory with a disease transmission model during an outbreak of a novel influenza strain. The model exhibits a "wait and see" Nash equilibrium strategy, with vaccine delayers relying on herd immunity and vaccine safety information generated by early vaccinators. This strategic behaviour causes the timing of the epidemic peak to be strongly conserved across a broad range of plausible transmission rates, in contrast to models without such adaptive behaviour. The model exhibits not only feedback mechanisms but also a feed-forward mechanism: a high initial perceived vaccination cost perpetuates high perceived vaccine costs (and lower vaccine coverage) throughout the remainder of the outbreak. This suggests that any effect of risk communication at the start of a pandemic outbreak will be amplified compared to the same amount of risk communication effort distributed throughout the outbreak.

  3. Safety evaluation of signalized intersections with left-turn waiting area in China.

    Science.gov (United States)

    Jiang, Xinguo; Zhang, Guopeng; Bai, Wei; Fan, Wenbo

    2016-10-01

    In recent years the metropolitans in China have seen the surging installations of the left-turn waiting area (LWA) at the signalized intersections. The design allows the left-turning vehicles to enter the intersection at the onset of the through green phase (of the same approach) and wait for the exclusive left-turn signal at the LWA. The LWA layout can effectively reduce the probability of stranded and queue overflow of the left-turn vehicles, but no study is conducted yet to assess the safety performance of the signalized intersections with LWA. The paper adopts the traffic conflict technique (represented by post-encroachment time), compares the discrepancy of conflict types between intersections with LWA and without, and develops the severity models to identify the contributing factors for the left-turn conflicts. Results demonstrate that the left-turn volume, driving outside the LWA, running red light, the presence of secondary conflicts, and the rear-end conflicts significantly increase the severities of traffic conflicts at the LWA. The findings serve to provide recommendations to revise the current design standard of the LWA (GB5768-2009) and consequently improve the safety operations of signalized intersections with LWA in China. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Watch and wait approach to rectal cancer: A review

    Institute of Scientific and Technical Information of China (English)

    Marcos; E; Pozo; Sandy; H; Fang

    2015-01-01

    In 2014, there were an estimated 136800 new cases of colorectal cancer, making it the most common gastrointestinal malignancy. It is the second leadingcause of cancer death in both men and women in the United States and over one-third of newly diagnosed patients have stage Ⅲ(node-positive) disease. For stage Ⅱ and Ⅲ colorectal cancer patients, the mainstay of curative therapy is neoadjuvant therapy, followed by radical surgical resection of the rectum. However, the consequences of a proctectomy, either by low anterior resection or abdominoperineal resection, can lead to very extensive comorbidities, such as the need for a permanent colostomy, fecal incontinence, sexual and urinary dysfunction, and even mortality. Recently, trends of complete regression of the rectal cancer after neoadjuvant chemoradiation therapy have been confirmed by clinical and radiographic evaluationthis is known as complete clinical response(cC R). The "watch and wait" approach was first proposed by Dr. Angelita Habr-Gama in Brazil in 2009. Those patients with c CR are followed with close surveillance physical examinations, endoscopy, and imaging. Here, we review management of rectal cancer, the development of the "watch and wait" approach and its outcomes.

  5. 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.

  6. Surviving the wait: defining support while awaiting breast cancer surgery.

    Science.gov (United States)

    Dickerson, Suzanne S; Alqaissi, Nesreen; Underhill, Meghan; Lally, Robin M

    2011-07-01

    This paper is a report of a descriptive study of the common meanings, shared experiences and practices of social support of women within the days between breast cancer diagnosis and treatment initiation. Support needs, types of social support and support outcomes during and after breast cancer treatment have been explored worldwide. However, to promote women's psychological wellbeing it is essential to understand how women define support in the highly stressful period initially following diagnosis. Secondary analysis of narrative texts using interpretive phenomenology from 18 women in the Midwestern United States newly diagnosed with breast cancer who were interviewed in 2005 for a study of women's pretreatment thought processes. 'Surviving the wait for surgery by balancing support needs to maintain a hopeful outlook' was the overarching pattern linking six other related themes: (1) controlling access to information for self and to others, (2) knowing which supportive network members to access, (3) controlling anxiety through distraction to maintain hope while waiting, (4) being in good hands and comfortable with decision (provider support), (5) protecting others through concealment and being strong to maintain hope and (6) accepting care from others vs. maintaining a nurturing role. Implications for nurses working with women in the days following breast cancer diagnosis include assessing women's definitions and availability of support; respecting varied needs for informational support; providing a supportive clinical environment; educating clinicians, family and friends regarding unsupportive responses within the cultural context and validating women's control and balancing of support needs. © 2011 Blackwell Publishing Ltd.

  7. Clinical characteristics of Japanese candidates for lung transplant for interstitial lung disease and risk factors for early death while on the waiting list.

    Science.gov (United States)

    Higo, Hisao; Kurosaki, Takeshi; Ichihara, Eiki; Kubo, Toshio; Miyoshi, Kentaroh; Otani, Shinji; Sugimoto, Seiichiro; Yamane, Masaomi; Miyahara, Nobuaki; Kiura, Katsuyuki; Miyoshi, Shinichiro; Oto, Takahiro

    2017-07-01

    Lung transplants have produced very favorable outcomes for patients with interstitial lung disease (ILD) in Japan. However, because of the severe donor lung shortage, patients must wait approximately 2.5 years before they can undergo transplantation and many candidates die before allocation. We reveal the clinical characteristics of Japanese patients with ILD who are candidates for lung transplants and the risk factors for early death while on the waiting list. We retrospectively reviewed the clinical data of patients registered in the Japan Organ Transplant Network from Okayama University Hospital who are candidates for cadaveric lung transplants for ILD between 1999 and 2015. Fifty-three patients with ILD were included (24 patients with idiopathic pulmonary fibrosis and 29 others). They had severe pulmonary dysfunction and low exercise tolerability. The median waiting time for transplantation was 462 days, and 22 patients died before allocation. Patients who died before 462 days without undergoing transplantation had more severe dyspnea, shorter 6-minute walk distance (6MWD), and lower performance status than those who waited ≥462 days. Japanese candidates for cadaveric lung transplants for ILD have severe pulmonary dysfunction. Severe dyspnea, short 6MWD, and low performance status are risk factors for early death while on the waiting list. Copyright © 2017 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

  8. EMG reactivity and oral habits among facial pain patients in a scheduled-waiting competitive task.

    Science.gov (United States)

    Nicholson, R A; Lakatos, C A; Gramling, S E

    1999-12-01

    For individuals with temporomandibular disorder (TMD) it has been theorized that stressful events trigger oral habits (e.g., teeth grinding), thereby increasing masticatory muscle tension and subsequent pain. Recent research involving adjunctive behaviors found an increase in masseter surface EMG (sEMG) and oral habits when students with TMD symptomatology were placed on a fixed-time reinforcement schedule. The current study used a treatment-seeking community sample with TMD symptomatology in a competitive task designed to be a more naturalistic Fixed Time task. The experiment consisted of Adaptation, Free-Play, Scheduled-Play, and Recovery phases. During the Scheduled-Play phase participants played, and waited to play, an electronic poker game. Results indicated that masseter muscle tension in the Scheduled-Play phase was significantly higher (p oral habits and overall affect were significantly higher (p's oral habits may lead to TMD symptomatology.

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

    Science.gov (United States)

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

    2016-01-01

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

  10. 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.

  11. Do women spend longer on wait lists for coronary bypass surgery? Analysis of a population-based registry in British Columbia, Canada

    Directory of Open Access Journals (Sweden)

    Kuramoto Lisa

    2007-08-01

    Full Text Available Abstract Background Studies have shown patients who are delayed for surgical cardiac revascularization are faced with increased risks of symptom deterioration and death. This could explain the observation that operative mortality among persons undergoing coronary artery bypass surgery (CABG is higher among women than men. However, in jurisdictions that employ priority wait lists to manage access to elective cardiac surgery, there is little information on whether women wait longer than men for CABG. It is therefore difficult to ascertain whether higher operative mortality among women is due to biological differences or to delayed access to elective CABG. Methods Using records from a population-based registry, we compared the wait-list time between women and men in British Columbia (BC between 1990 and 2000. We compared the number of weeks from registration to surgery for equal proportions of women and men, after adjusting for priority, comorbidity and age. Results In BC in the 1990s, 9,167 patients aged 40 years and over were registered on wait lists for CABG and spent a total of 136,071 person-weeks waiting. At the time of registration for CABG, women were more likely to have a comorbid condition than men. We found little evidence to suggest that women waited longer than men for CABG after registration, after adjusting for comorbidity and age, either overall or within three priority groups. Conclusion Our findings support the hypothesis that higher operative mortality during elective CABG operations observed among women is not due to longer delays for the procedure.

  12. 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.

  13. 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.

  14. Differences in waiting list prioritization preferences of occupational therapists, elderly people and persons with disabilities: a discrete choice experiment.

    Science.gov (United States)

    Raymond, Marie-Hélène; Demers, Louise; Feldman, Debbie E

    2017-08-07

    To compare the preferences of occupational therapists, elderly people and adults with disabilities regarding prioritization criteria for occupational therapy waiting lists in home care. Discrete choice experiment survey. Respondents completed eight choice tasks where they were asked to choose which of two referral scenarios should be prioritized for services. Scenarios varied in terms of four attributes reflecting competing issues that come into play in waiting list prioritization: the person's ability to shower, ability to enter and exit the home, history of falls and time already spent on the waiting list. The survey was mailed to occupational therapists working in home care and community-dwelling elderly or disabled persons. Not applicable. 241 home-based occupational therapists, 226 elderly persons from a bank of research participants and 247 adults with physical disabilities recruited through community organizations. The dependent variable was whether the referral scenario was prioritized or not in each question. Results were analyzed through logistic regression using conditional logit models. Prioritization preferences differed between groups (p Occupational therapists most strongly prioritized people who had had a few falls (OR vs. no falls = 48.9) whereas elderly people and adults with disabilities most strongly prioritized people who were unable to enter and exit the home (OR vs. no difficulty entering and exiting the home = 30.8 for elderly people and 16.9 for persons with disabilities.) CONCLUSIONS: Our results highlight the gap between the priorities of home-based occupational therapists and their target clientele. Although further inquiry is needed to inform priority-setting, the findings emphasize the importance of public or patient involvement in decisions on waiting list prioritization. Copyright © 2017. Published by Elsevier Inc.

  15. 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

  16. The Effects of Waiting for Treatment: A Meta-Analysis of Waitlist Control Groups in Randomized Controlled Trials for Social Anxiety Disorder.

    Science.gov (United States)

    Steinert, Christiane; Stadter, Katja; Stark, Rudolf; Leichsenring, Falk

    2016-07-22

    Social anxiety disorder (SAD) is a highly prevalent mental disorder. However, little is known about how SAD changes in subjects who do not receive treatment. Waitlist control groups (WLCGs) are frequently included in randomized controlled trials (RCTs) on the treatment of mental disorders. Data from WLCGs are of value as they provide information on the untreated short-term course of a disorder and may serve as disorder-specific norms of change (benchmarks) against which treatment outcomes of SAD can be compared. Thus, we performed a meta-analysis focusing on the effects occurring in WLCGs of RCTs for SAD. Our study was conducted along the PRISMA guidelines. Thirty RCTs (total n = 2460) comprising 30 WLCGs and 47 treatment groups were included. Mean waiting time was 10.6 weeks. The pooled effect of waiting on SAD measures was g = 0.128 (95% CI: 0.057-0.199). Effects regarding other forms of anxiety, depression and functioning were of similarly small size. In contrast, change in the treatment groups was large, both within (g = 0.887) and between groups (g = 0.860). Our results show that for SAD, changes occurring in WLCGs of RCTs are small. The findings may serve as benchmarks in pilot studies of a new treatment or as an additional comparison in studies comparing two active treatments. For psychotherapy research in general, the small effect sizes found in WLCGs confirm that testing a treatment against a waiting list is not a very strict test. Further research on WLCGs in specific mental disorders is required, for example examining the expectancies of patients randomized to waiting. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message In clinical practice, patients suffering from a mental disorder often have to wait for treatment. By analyzing data from waitlist control groups we can gain estimates of symptom change that occur during waiting. It could be seen that waiting for treatment only results in a negligible effect. Thus, in the

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

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez, D.; Beck, D.; Herfurth, F.; Kluge, H.-J. [GSI, Darmstadt (Germany); Kolhinen, V.S.; Aeystoe, J.; Jokinen, A. [University of Jyvaeskylae, Jyvaeskylae (Finland); Audi, G. [CSNSM-IN2P3-CNRS, Orsay-Campus (France); Blaum, K. [GSI, Darmstadt (Germany); University of Mainz, Institute of Physics, Mainz (Germany); Bollen, G.; Schwarz, S. [Michigan State University, NSCL, East Lansing, MI (United States); Kellerbauer, A.; Sauvan, E. [CERN, Physics Department, Geneva (Switzerland); Oinonen, M. [University of Helsinki, Helsinki Institute of Physics, Helsinki (Finland); Schatz, H. [Michigan State University, NSCL, East Lansing, MI (United States); Michigan State University, Joint Institute for Nuclear Astrophysics, East Lansing, MI (United States)

    2005-09-01

    With the aim of improving nucleosynthesis calculations, we performed for the first time, a direct high-precision mass measurement on the waiting point in the astrophysical rp-process {sup 72}Kr. We used the ISOLTRAP Penning trap mass spectrometer located at ISOLDE/CERN. The measurement yielded a relative mass uncertainty of {delta}m/m=1.2 x 10{sup -7}. In addition, the masses of {sup 73}Kr and {sup 74}Kr were measured directly with relative mass uncertainties of 1.0 x 10{sup -7} and 3 x 10{sup -8}, respectively. We analyzed the role of {sup 72}Kr in the rp-process during X-ray bursts using the ISOLTRAP and previous mass values of {sup 72-74}Kr. (orig.)

  18. 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

    per cent still had good hearing at the end of the observation period. However, in patients with even a small initial speech discrimination loss, only 55 per cent maintained good hearing at the end of the observation period. Conclusion: After comparing the hearing results of hearing preservation......: At the time of diagnosis, 334 patients (53 per cent) had good hearing and speech discrimination of better than 70 per cent; at the end of the 10-year observation period, this latter percentage was 31 per cent. In 17 per cent of the patients, speech discrimination at diagnosis was 100 per cent; of these, 88...... 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...

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

    DEFF Research Database (Denmark)

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

    on hospital discharge diagnoses for the 2004-2005 period, extracted from population-based healthcare databases in the former County of Aarhus, Denmark, and subsequently validated in the National Danish Cancer Registry. All patients with a first-time diagnosis of colon, rectal, lung, skin, breast, or prostate...... after diagnosis, and we used Cox regression to estimate mortality rate ratios as a function of diagnostic delay using restricted cubic splines, and adjusting for gender, age, and co-morbidity. We identified 1080 cancer patients. For all cancers, except breast cancer, mortality after diagnosis decreased...... with longer diagnostic interval until the reference point of 30 days. For colon, rectal, skin, and breast cancer mortality seemed to increase with diagnostic interval longer than 30 days. The waiting list paradox is manifest in Denmark. We speculate that medical professionals organise the diagnostic pathway...

  20. 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. Keywords: Irish, postcolonialsim, absurdism, universality, placlessness, colonizer, colonized

  1. A Modern Review of Waiting for Godot-A Study of absurdity in the play

    Institute of Scientific and Technical Information of China (English)

    陈子丽; 陈启亮

    2013-01-01

    Waiting for Godot is often regarded as Beckett’s masterpiece. This paper is to explore the possible themes in the play. Waiting for the unrealizable tomorrow is a most dominant theme of the play. Through a brief analysis of the plot, the dominant theme can be demonstrated very clearly.

  2. 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

    2005-01-01

    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

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

    NARCIS (Netherlands)

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

    2010-01-01

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

  4. 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.

  5. Ladies in waiting: the timeliness of first trimester services in New Zealand

    Directory of Open Access Journals (Sweden)

    Ashton Toni

    2010-07-01

    Full Text Available Abstract Background Termination of pregnancy (TOP services are a core service in New Zealand. However, compared to other developed countries, TOP services are accessed significantly later in the first trimester, increasing the risk for complications. The aim of this study is to examine the timeliness of access to first trimester TOP services and establish the length of delay between different points in the care pathway for these services. Methodology Data were collected from all patients attending nine TOP clinics around the country between February and May 2009 (N = 2950. Patient records were audited to determine the timeline between the first point of entry to the health system to the date of termination. In addition, women were invited to fill out a questionnaire to identify personal level factors affecting access to services (N = 1086, response rate = 36.8%. Results Women waited an average of almost 25 days between the date of the first visit with the referring doctor and the date of their termination procedure. There was a delay of 10 days between the first visit with the referring doctor and the date that the appointment for the procedure was booked, and a further 10 days delay between the date the appointment was booked and the first appointment date. Over half of the women in this study had their pregnancy terminated at ten weeks or above. Conclusion Women in New Zealand are subject to a lengthy delay while seeking TOP services. Efforts should be made by TOP clinics as well as referring doctors to reduce the waiting times for this service.

  6. STS-103 crew wait inside Discovery for simulated countdown exercise

    Science.gov (United States)

    1999-01-01

    STS-103 Mission Commander Curtis L. Brown Jr. sits inside orbiter Discovery waiting for the start of a simulated countdown exercise. The simulation is part of Terminal Countdown Demonstration Test (TCDT) activities. The TCDT also provides the crew with emergency egress training and opportunities to inspect their mission payload in the orbiter's payload bay. Other crew members taking part in the TCDT are Pilot Scott J. Kelly, and Mission Specialists Steven L. Smith, C. Michael Foale (Ph.D.), John M. Grunsfeld (Ph.D.), Jean-Fran'''ois Clervoy of France, and Claude Nicollier of Switzerland. Clervoy and Nicollier are with the European Space Agency. STS-103 is a 'call-up' mission due to the need to replace and repair portions of the Hubble Space Telescope, including the gyroscopes that allow the telescope to point at stars, galaxies and planets. The STS-103 crew will be replacing a Fine Guidance Sensor, an older computer with a new enhanced model, an older data tape recorder with a solid-state digital recorder, a failed spare transmitter with a new one, and degraded insulation on the telescope with new thermal insulation. The crew will also install a Battery Voltage/Temperature Improvement Kit to protect the spacecraft batteries from overcharging and overheating when the telescope goes into a safe mode. Four EVA's are planned to make the necessary repairs and replacements on the telescope. The mission is targeted for launch Dec. 6 at 2:37 a.m. EST.

  7. 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.

  8. Asymptotic Analysis of SPTA-Based Algorithms for No-Wait Flow Shop Scheduling Problem with Release Dates

    Directory of Open Access Journals (Sweden)

    Tao Ren

    2014-01-01

    Full Text Available We address the scheduling problem for a no-wait flow shop to optimize total completion time with release dates. With the tool of asymptotic analysis, we prove that the objective values of two SPTA-based algorithms converge to the optimal value for sufficiently large-sized problems. To further enhance the performance of the SPTA-based algorithms, an improvement scheme based on local search is provided for moderate scale problems. New lower bound is presented for evaluating the asymptotic optimality of the algorithms. Numerical simulations demonstrate the effectiveness of the proposed algorithms.

  9. 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

  10. Gradual vs. wait-and-gradual discontinuation in antipsychotic switching: A meta-analysis.

    Science.gov (United States)

    Takeuchi, Hiroyoshi; Thiyanavadivel, Sadhana; Agid, Ofer; Remington, Gary

    2017-02-24

    To address whether wait discontinuation (i.e., introducing the new antipsychotic while maintaining the first for a period before initiating its discontinuation) is superior to non-wait discontinuation (i.e., initiating the first antipsychotic's discontinuation when introducing the new antipsychotic) in antipsychotic switching, we conducted a meta-analysis of randomized controlled trials comparing gradual vs. wait-and-gradual antipsychotic discontinuation in patients with schizophrenia. The meta-analysis of 5 studies (n=410) demonstrated no significant differences in any clinical outcomes, including study discontinuation, psychopathology, extrapyramidal symptoms, and treatment-emergent adverse events, between the two groups. These findings indicate either strategy can be used in clinical practice.

  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. 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

  13. 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.

  14. Learning During Processing: Word Learning Doesn't Wait for Word Recognition to Finish.

    Science.gov (United States)

    Apfelbaum, Keith S; McMurray, Bob

    2017-04-01

    Previous research on associative learning has uncovered detailed aspects of the process, including what types of things are learned, how they are learned, and where in the brain such learning occurs. However, perceptual processes, such as stimulus recognition and identification, take time to unfold. Previous studies of learning have not addressed when, during the course of these dynamic recognition processes, learned representations are formed and updated. If learned representations are formed and updated while recognition is ongoing, the result of learning may incorporate spurious, partial information. For example, during word recognition, words take time to be identified, and competing words are often active in parallel. If learning proceeds before this competition resolves, representations may be influenced by the preliminary activations present at the time of learning. In three experiments using word learning as a model domain, we provide evidence that learning reflects the ongoing dynamics of auditory and visual processing during a learning event. These results show that learning can occur before stimulus recognition processes are complete; learning does not wait for ongoing perceptual processing to complete. Copyright © 2016 Cognitive Science Society, Inc.

  15. 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...

  16. '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

  17. 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.

  18. Watchful waiting for minor depression in primary care: remission rates and predictors of improvement.

    Science.gov (United States)

    Hegel, Mark T; Oxman, Thomas E; Hull, Jay G; Swain, Karin; Swick, Holly

    2006-01-01

    The objectives of this study were to determine remission rates and predictors of improvement for minor depression following a 1-month watchful waiting period in primary care and to describe the watchful waiting processes. Prior to randomization into a clinical trial for minor depression, 111 participants were entered into a 1-month watchful waiting period. Depression severity and predictors of improvement were measured at the start of watchful waiting. At the end of watchful waiting, remission rates were calculated and predictor variables were analyzed for their contribution toward predicting improvement. Remission rates were low, ranging from 9% to 13%, depending on the measure. Avoidant coping style and frequency of engaging in active pleasant events at baseline accounted for the majority of change in depression. During watchful waiting, about one fifth of the sample (21%) had at least one contact with their physician and 27% reported using self-initiated treatments. There is a low likelihood of spontaneous remission for treatment-seeking samples with minor depression in primary care. An avoidant coping style seriously interferes with remission, and engaging in regular active pleasant events confers an advantage. Feasible interventions for primary care that promote activity and decrease avoidant coping styles may improve outcomes. These findings may not generalize to community and non-treatment-seeking samples.

  19. Retrospective review of bone mineral metabolism management in end-stage renal disease patients wait-listed for renal transplant

    Directory of Open Access Journals (Sweden)

    Chavlovski A

    2012-09-01

    Full Text Available Anna Chavlovski,1 Greg A Knoll,1–3 Timothy Ramsay,4 Swapnil Hiremath,1–3 Deborah L Zimmerman1–31University of Ottawa, 2Ottawa Hospital, 3Kidney Research Centre, Ottawa Hospital Research Institute, 4Ottawa Methods Centre, Ottawa, ON, CanadaBackground: In patients with end-stage renal disease, use of vitamin D and calcium-based phosphate binders have been associated with progression of vascular calcification that might have an impact on renal transplant candidacy. Our objective was to examine management of mineral metabolism in patients wait-listed for renal transplant and to determine the impact on cardiac perfusion imaging.Methods: Data was collected retrospectively on patients wait-listed for a renal transplant (n = 105, being either active (n = 73 and on hold (n = 32. Demographic data, medications, serum concentrations of calcium, phosphate, parathyroid hormone, and cardiac perfusion imaging studies were collected from the electronic health record. Chi-square and Student’s t-tests were used to compare active and on-hold patients as appropriate. Logistic regression was used to examine variables associated with worsening cardiac imaging studies.Results: The wait-listed patients were of mean age 56 ± 14 years and had been on dialysis for 1329 ± 867 days. On-hold patients had received a significantly greater total dose of calcium (2.35 ± .94 kg versus 1.49 ± 1.52 kg; P = 0.02 and were more likely to have developed worsening cardiovascular imaging studies (P = 0.03. Total doses of calcium and calcitriol were associated with worsening cardiovascular imaging studies (P = 0.05.Conclusion: Patients on hold on the renal transplant waiting list received higher total doses of calcium. A higher total dose of calcium and calcitriol was also associated with worsening cardiovascular imaging. Time on dialysis before transplant has been associated with worse post-transplant outcomes, and it is possible that the total calcium and calcitriol dose

  20. 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.

  1. DVD training for depression identification and treatment in older adults: a two-group, randomized, wait-list control study.

    Science.gov (United States)

    Lysack, Cathy; Leach, Carrie; Russo, Theresa; Paulson, Daniel; Lichtenberg, Peter A

    2013-01-01

    OBJECTIVE. To test the effectiveness of an educational intervention aimed at improving mental health knowledge and skills in occupational therapists working with older rehabilitation patients. METHOD. The DVD-format educational intervention was evaluated using a two-group randomized wait-list control design. Occupational therapists (n = 75) completed a 32-item knowledge questionnaire at three time points. Patient charts were reviewed (n = 960) at 3 months before and 3 and 6 months after DVD training to evaluate clinical practice change. RESULTS. A two-way analysis of variance showed knowledge scores increased significantly for both groups after DVD training. A significant Group × Time interaction and significant main effects for time and group were found. Chart review data also showed significant increases in desired clinical behaviors in both groups after training. The greatest single item of clinical practice change was use of a standardized depression screen. CONCLUSION. DVD-based training can significantly improve mental health practice.

  2. A two-phase fuzzy programming model for a complex bi-objective no-wait flow shop scheduling

    Directory of Open Access Journals (Sweden)

    Reza Tavakkoli-Moghaddam

    2012-08-01

    Full Text Available In this paper, we study no-wait flow shop problem where setup times depend on sequence of operations. The proposed problem considers sequence-independent removal times, release date with an additional assumption that there are some preliminary setup times. There are two objectives of weighted mean tardiness and makespan associated with the proposed model of this paper. We formulate the resulted problem as a mixed integer programming, where a two-phase fuzzy programming is implemented to solve the model. To examine the performance of the proposed model, we generate several sample data, randomly and compare the results with other methods. The preliminary results indicate that the proposed two-phase model of this paper performed relatively better than Zimmerman's single-phase fuzzy method.

  3. Transient probabilities for queues with applications to hospital waiting list management.

    Science.gov (United States)

    Joy, Mark; Jones, Simon

    2005-08-01

    In this paper we study queuing systems within the NHS. Recently imposed government performance targets lead NHS executives to investigate and instigate alternative management strategies, thereby imposing structural changes on the queues. Under such circumstances, it is most unlikely that such systems are in equilibrium. It is crucial, in our opinion, to recognise this state of affairs in order to make a balanced assessment of the role of queue management in the modern NHS. From a mathematical perspective it should be emphasised that measures of the state of a queue based upon the assumption of statistical equilibrium (a pervasive methodology in the study of queues) are simply wrong in the above scenario. To base strategic decisions around such ideas is therefore highly questionable and it is one of the purposes of this paper to offer alternatives: we present some (recent) research whose results generate performance measures and measures of risk, for example, of waiting-times growing unacceptably large; we emphasise that these results concern the transient behaviour of the queueing model-there is no asssumption of statistical equilibrium. We also demonstrate that our results are computationally tractable.

  4. Multidimensional measures of impulsivity in obsessive-compulsive disorder: cannot wait and stop.

    Directory of Open Access Journals (Sweden)

    Sung Yun Sohn

    Full Text Available OBJECTIVE: Although the relationship between obsessive compulsive disorder (OCD and impulsivity has long been debated, impulsivity has not been systematically examined in clinical samples of OCD. Meanwhile, recent findings suggest that impulsivity is multi-dimensional construct that can be examined through several constructs. Therefore, this study is aimed to evaluate multiple facets of impulsivity in OCD. METHOD: The recruitment includes 80 OCD and 76 healthy control participants. Participants completed a test battery comprising three behavioral tasks of stop signal task (SST, delay discounting task (DDT and balloon analog risk test (BART, and one self-report measure of the Barratt Impulsiveness scale (BIS-11. RESULTS: OCD subjects showed significantly lower stop signal reaction time of SST reflecting higher action impulsivity and higher delay discounting parameter of DDT suggesting increased choice impulsivity but significantly lower adjusted mean pump of BART implying lower risk taking propensity of BART than healthy control. CONCLUSION: Increased Action and choice impulsivity, and decreased risk taking propensities were found in OCD. These findings seem to be consistent with clinical characteristics of OCD such as greater preference for or avoid risky situations (avoidance, inability to wait tension relief may provoke safety behaviors (compulsion and inability to stop already started behaviors (repetition.

  5. Study of Sound Environment Influenced by the Crowd in Waiting Areas in General Hospitals

    Institute of Scientific and Technical Information of China (English)

    Xin Qin; Jian Kang; Hong Jin

    2014-01-01

    In this study, the crowd has been investigated and analyzed in waiting areas in large general hospitals in China in order to find the rules the variations of sound environment with the change of crowd. The field investigation, questionnaire, field-testing and computer simulation have been adopted. The results show that:the social/demographic characteristics of staff and patients are not significantly related to the satisfaction evaluation of sound environment;there is a significant correlation between the population density and LAeq of the background noise in waiting areas;when population density is 0, the LAeq of background noise is not 0 in waiting areas; the loudspeaker should be set in the waiting areas. Loudspeaker arrangements should be integrated into the ceiling lamp or construct facilities along the depth direction of the layout, and the two adjacent speakers recommended distance should be controlled at about 4 m. If the population density is controlled in the reasonable range, and sound absorption, noise reduction processing and electronic queuing system are adopted, sound environment of waiting areas will be built with noise interference relatively small in different population densities.

  6. Queuing for coronary angiography during severe supply-demand mismatch in a US public hospital: analysis of a waiting list registry.

    Science.gov (United States)

    Rosanio, S; Tocchi, M; Cutler, D; Uretsky, B F; Stouffer, G A; deFilippi, C R; MacInerney, E J; Runge, S R; Aaron, J; Otero, J; Garg, S; Runge, M S

    1999-07-14

    Adverse cardiac events have been reported in patients waiting for either coronary surgery or angioplasty. However, data on the risk of adverse events while awaiting coronary angiography are limited, and none are available from a US population. To quantify cardiac outcomes in patients waiting for elective coronary angiography. Observational cohort study of 381 adult outpatients (mean [SD] age, 55 [12] years; 64% male; 61% white) on a waiting list for coronary angiography at a US tertiary care public teaching hospital during 1993-1994. Rates of cardiac death, nonfatal myocardial infarction, and hospitalizations for unstable angina or heart failure as a function of amount of time spent on a waiting list. Sixty-six patients were dropped from the waiting list but were included in the study analysis. During a mean (SD) follow-up of 8.4 (6.5) months, cardiac death, myocardial infarction, and hospitalization occurred in 6 (1.6%), 4 (1.0%), and 26 (6.8%) patients, respectively. The probability of events was minimal in the first 2 weeks and increased steadily between 3 and 13 weeks. By Cox multivariate analysis, 2 variables independently identified an increased risk of adverse events: a strongly positive treadmill exercise electrocardiogram or positive stress imaging result at referral (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.22-4.16; P=.01) and the use of 2 to 3 anti-ischemic medications (OR, 1.98; 95% CI, 1.19-3.96; P=.04). Among 311 patients who ultimately underwent angiography, those with adverse events had a higher prevalence of coronary disease (96% vs 60%; P<.001), more frequently required revascularization (93% vs 53%; P<.001), and had longer hospital stays (mean [SD], 6.2 [4.3] vs 1.3 [0.7] days; P=.001). Our data suggest that in a cohort referred for coronary angiography, delaying the procedure places some patients at risk for death, myocardial infarction, unplanned hospitalization, a longer hospital stay, and, potentially, a poorer prognosis. Waits

  7. The Impact of the Introduction of MELD on the Dynamics of the Liver Transplantation Waiting List in São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Eleazar Chaib

    2014-01-01

    Full Text Available Until July 15, 2006, the time on the waiting list was the main criterion for allocating deceased donor livers in the state of São Paulo, Brazil. After this date, MELD has been the basis for the allocation of deceased donor livers for adult transplantation. Our aim was to compare the waitlist dynamics before MELD (1997–2005 and after MELD (2006–2012 in our state. A retrospective study was conducted including the data from all the liver transplant candidate waiting lists from July 1997 to December 2012. The data were related to the actual number of liver transplantations (Tr, the incidence of new patients on the list (I, and the number of patients who died while being on the waitlist (D from 1997 to 2005 (the pre-MELD era and from 2006 to 2012 (the post-MELD era. The number of transplantations from 1997 to 2005 and from 2006 to 2012 increased nonlinearly, with a clear trend to levelling to equilibrium at approximately 350 and 500 cases per year, respectively. The implementation of the MELD score resulted in a shorter waiting time until liver transplantation. Additionally, there was a significant effect on the waitlist dynamics in the first 4 years; however, the curves diverge from there, implying a null long-range effect on the waitlist by the MELD scores.

  8. Patient and staff perspective of a nurse-led support programme for patients waiting for cardiac surgery: participant perspective of a cardiac support programme.

    Science.gov (United States)

    Goodman, Helen; Davison, June; Preedy, Michael; Peters, Emma; Waters, Phillip; Persaud-Rai, Bibi; Shuldham, Caroline; Pepper, John; Cowie, Martin R

    2009-03-01

    A nurse-led support and education programme for patients waiting for coronary artery bypass surgery was evaluated in a randomised controlled trial of 188 patients at a tertiary centre in the UK. To add a qualitative perspective to the evaluation by exploring patients' experience while taking part in the trial and staff views of the patients' experience and the intervention. A purposive sample of 19 patients was interviewed and the transcriptions read to staff during focus groups. They discussed what they learned from the stories and their own experience of the programme. The patients appreciated support from the nurses but felt communication and physical assessment could be improved. The patients varied in their understanding of the programme and their degree of motivation to improve their health. The staff varied in their approach to preparing patients for surgery. External factors influencing the intervention's impact were length of time on the waiting list and the increasing contribution of local rehabilitation services. Staff need to improve communication both between themselves and with the patients. Patients appreciate physical and psychological preparation for surgery, but the waiting period is not the optimal time to address their risk factors for coronary disease.

  9. Influence of Waiting Time after Insertion of Base Chamber into Soil on Produced Greenhouse Gas Fluxes Influencia del Tiempo de Espera Después de la Inserción de la Base de la Cámara en el Suelo en los Flujos de Gases de Efecto Invernadero Producidos

    Directory of Open Access Journals (Sweden)

    Cristina Muñoz

    2011-12-01

    Full Text Available The soil chamber technique is most commonly used for measuring gas exchange between soil surfaces and the atmosphere, to understand regulatory processes relevant to determine the greenhouse gas (GHG emissions from soils and to improve the emissions inventory of agricultural systems. The chambers are inserted into the soil to avoid the lateral diffusion of the gases. However, soil disturbance caused by chamber insertion causes in degassing and can result in erroneous flux data from measurements made immediately following chamber insertion. Here we assess the effect of soil disturbance associated with the insertion of the chambers on nitrous oxide (N2O and methane (CH4 fluxes with and without N fertilization, from a New Zealand pasture soil. We collected gas samples from the chambers at 0, 2, 4, 24, 96 and 168 h after chambers insertion. Our results show elevated levels of N2O inside the chambers (1.7 fold those of atmospheric concentrations outside the chambers and greater fluxes within the first 4 h of installation compared to the values observed at 24 h and later; and negative CH4 flux in the same time period, but near to zero after 24 h. Our results suggest that for accurate measurement of gas fluxes, measurements should be taken after 24 h of chambers installation to avoid the degassing effect.La técnica de la cámara es la más comúnmente usada para medir el intercambio de gases entre la superficie del suelo y la atmósfera, entender los procesos regulatorios relevantes para determinar las emisiones de gases de efecto invernadero (GHG desde los suelos, y mejorar los inventarios de emisiones de sistemas agrícolas. Las cámaras se insertan en el suelo para evitar la difusión lateral de los gases. Sin embargo, la alteración en el suelo causada por la inserción de las cámaras causa pérdida de gases y puede resultar en datos de flujos erróneos desde las mediciones realizadas inmediatamente posteriores a la inserción de las c

  10. Waiting can be an optimal conservation strategy, even in a crisis discipline.

    Science.gov (United States)

    Iacona, Gwenllian D; Possingham, Hugh P; Bode, Michael

    2017-09-26

    Biodiversity conservation projects confront immediate and escalating threats with limited funding. Conservation theory suggests that the best response to the species extinction crisis is to spend money as soon as it becomes available, and this is often an explicit constraint placed on funding. We use a general dynamic model of a conservation landscape to show that this decision to "front-load" project spending can be suboptimal if a delay allows managers to use resources more strategically. Our model demonstrates the existence of temporal efficiencies in conservation management, which parallel the spatial efficiencies identified by systematic conservation planning. The optimal timing of decisions balances the rate of biodiversity decline (e.g., the relaxation of extinction debts, or the progress of climate change) against the rate at which spending appreciates in value (e.g., through interest, learning, or capacity building). We contrast the benefits of acting and waiting in two ecosystems where restoration can mitigate forest bird extinction debts: South Australia's Mount Lofty Ranges and Paraguay's Atlantic Forest. In both cases, conservation outcomes cannot be maximized by front-loading spending, and the optimal solution recommends substantial delays before managers undertake conservation actions. Surprisingly, these delays allow superior conservation benefits to be achieved, in less time than front-loading. Our analyses provide an intuitive and mechanistic rationale for strategic delay, which contrasts with the orthodoxy of front-loaded spending for conservation actions. Our results illustrate the conservation efficiencies that could be achieved if decision makers choose when to spend their limited resources, as opposed to just where to spend them.

  11. Intensity dependent waiting time for strong electron trapping events in speckle stimulated raman scatter

    Energy Technology Data Exchange (ETDEWEB)

    Rose, Harvey [Los Alamos National Laboratory; Daughton, W [Los Alamos National Laboratory; Yin, L [Los Alamos National Laboratory

    2009-01-01

    The onset of Stimulated Raman scatter from an intense laser speckle is the simplest experimentally realizable laser-plasma-interaction environment. Despite this data and recent 3D particle simulations, the controlling mechanism at the onset of backscatter in the kinetic regime when strong electron trapping in the daughter Langmuir wave is a dominant nonlinearity is not understood. This paper explores the consequences of assuming that onset is controlled by large thermal fluctuations. A super exponential dependence of mean reflectivity on speckle intensity in the onset regime is predicted.

  12. Approximations for the waiting time distribution in an M/G/c priority queue

    NARCIS (Netherlands)

    Al Hanbali, A.M.; Alvarez, E.M.; Heijden, van der M.C.

    2013-01-01

    We investigate the use of priority mechanisms when assigning service engineers to customers as a tool for service differentiation. To this end, we analyze a non-preemptive M/G/c priority queue with various customer classes. For this queue, we present various accurate and fast methods to estimate the

  13. Why Wait? A Century of Education, Marriage Timing and Gender Roles

    OpenAIRE

    Iyigun, Murat; Jeanne LAFORTUNE

    2016-01-01

    We document that, over the 20th century, age at first marriage followed a U-shaped pattern, while the gender education gap tracked an inverted-U path in the United States. To explain this, we propose a multi-period frictionless matching model where educational and marriage decisions are endogenous. Two key assumptions are made: marriage requires a fixed cost and married couples cannot study simultaneously. This simple model can replicate the aforementioned stylized facts and is consistent wit...

  14. Resolving the impact of waiting time distributions on the persistence of measles

    OpenAIRE

    Conlan, Andrew J. K.; Rohani, Pejman; Lloyd, Alun L.; Keeling, Matthew; Grenfell, Bryan T.

    2009-01-01

    Measles epidemics in human populations exhibit what is perhaps the best empirically characterized, and certainly the most studied, stochastic persistence threshold in population biology. A critical community size (CCS) of around 250 000–500 000 separates populations where measles is predominantly persistent from smaller communities where there are frequent extinctions of measles between major epidemics. The fundamental mechanisms contributing to this pattern of persistence, which are long-las...

  15. Investigating the Relationship between Customer Wait Time and Operational Availability through Simulation Modeling

    Science.gov (United States)

    2012-12-01

    considered whether based on seasonality , operational tempo, or some other identifiable factor. Without proper communication, both the intermediate and...Technical Information Center website: http://www.dtic.mil Hu, Hao. (2008). Poisson distribution and application. Department of Physics and Astronomy

  16. Still Waiting for Mister Right? Asymmetric Information, Abortion Laws and the Timing of Marriage

    OpenAIRE

    Simon W. Bowmaker; Emerson, Patrick M

    2009-01-01

    Previous studies have suggested that more liberal abortion laws should lead to a decrease in marriage rates among young women as 'shotgun weddings' are no longer necessary. Empirical evidence from the United States lends support to that hypothesis. This paper presents an alternative theory of abortion access and marriage based on asymmetric information, which suggests that more liberal abortion laws may actually promote young marriage. An empirical examination of marriage data from Eastern Eu...

  17. VA Mental Health: Clearer Guidance on Access Policies and Wait-Time Data Needed

    Science.gov (United States)

    2015-10-01

    which assess VAMC performance across 25 quality measures, including death and medical complication rates, customer satisfaction , and access (based on...care, for our purposes, refers to the delivery of services by providers that are respectful of and responsive to the experiences, views, and needs... Services , Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be

  18. Time-Quality Tradeoff of Waiting Strategies for Tutors to Retrieve Relevant Teaching Methods

    Science.gov (United States)

    Shih, Wen-Chung; Tseng, Shian-Shyong; Yang, Che-Ching; Liang, Tyne

    2011-01-01

    As more and more undergraduate students act as voluntary tutors to rural pupils after school, there is a growing need for a supporting environment to facilitate adaptive instruction. Among others, a teaching method retrieval system is intended to help tutors find relevant teaching methods for teaching a particular concept. However, teaching…

  19. Heaven can wait - or down to earth in real time: Near-death experience revisited.

    Science.gov (United States)

    van Tellingen, C

    2008-10-01

    Near-death experience (NDE) is an intriguing phenomenon that invites more questions than answers. Hitherto emphasis has been laid on apparent similarities in accounts of NDE to prove a supernatural origin while in fact unique differences besides gross similarities support a neurophysiological explanation. A teleological approach is suggested to explain the neuroprotective strategies involved and accordingly a forme fruste of the biological concept of hibernation is put forward as an unifying hypothesis for clarification. (Neth Heart J 2008;16:359-62.).

  20. A multiplex network analysis of the Mexican banking system: link persistence, overlap, and waiting times

    NARCIS (Netherlands)

    Molina-Borboa, J.L.; Martínez-Jaramillo, S.; López-Gallo, F.; van der Leij, M.

    2015-01-01

    This paper analyzes the persistence and overlap of relationships between banks in a multiplex decomposition of the exposures network. Our analysis may be useful for researchers designing stress tests or models in which the behavior of banks is modeled explicitly. This has not been looked at previous

  1. Time-Quality Tradeoff of Waiting Strategies for Tutors to Retrieve Relevant Teaching Methods

    Science.gov (United States)

    Shih, Wen-Chung; Tseng, Shian-Shyong; Yang, Che-Ching; Liang, Tyne

    2011-01-01

    As more and more undergraduate students act as voluntary tutors to rural pupils after school, there is a growing need for a supporting environment to facilitate adaptive instruction. Among others, a teaching method retrieval system is intended to help tutors find relevant teaching methods for teaching a particular concept. However, teaching…

  2. Minimizing ED Waiting Times and Improving Patient Flow and Experience of Care

    Directory of Open Access Journals (Sweden)

    Assaad Sayah

    2014-01-01

    Full Text Available We conducted a pre- and postintervention analysis to assess the impact of a process improvement project at the Cambridge Hospital ED. Through a comprehensive and collaborative process, we reengineered the emergency patient experience from arrival to departure. The ED operational changes have had a significant positive impact on all measured metrics. Ambulance diversion decreased from a mean of 148 hours per quarter before changes in July 2006 to 0 hours since April 2007. ED total length of stay decreased from a mean of 204 minutes before the changes to 132 minutes. Press Ganey patient satisfaction scores rose from the 12th percentile to the 59th percentile. ED patient volume grew by 11%, from a mean of 7,221 patients per quarter to 8,044 patients per quarter. Compliance with ED specific quality core measures improved from a mean of 71% to 97%. The mean rate of ED patients that left without being seen (LWBS dropped from 4.1% to 0.9%. Improving ED operational efficiency allowed us to accommodate increasing volume while improving the quality of care and satisfaction of the ED patients with minimal additional resources, space, or staffing.

  3. Waiting time before release increases the motivation to home in homing pigeons (Columba livia)

    National Research Council Canada - National Science Library

    Dell'Ariccia, Gaia; Costantini, David; Dell'Omo, Giacomo; Lipp, Hans-Peter

    2009-01-01

    .... Quite often, the last pigeons disappear straightforward from the release site. The question is whether this reflects improved orientation because of prolonged exposure to the release place or whether it reflects increased homing motivation...

  4. Intensity dependent waiting time for strong electron trapping events in speckle stimulated raman scatter

    Energy Technology Data Exchange (ETDEWEB)

    Rose, Harvey [Los Alamos National Laboratory; Daughton, W [Los Alamos National Laboratory; Yin, L [Los Alamos National Laboratory

    2009-01-01

    The onset of Stimulated Raman scatter from an intense laser speckle is the simplest experimentally realizable laser-plasma-interaction environment. Despite this data and recent 3D particle simulations, the controlling mechanism at the onset of backscatter in the kinetic regime when strong electron trapping in the daughter Langmuir wave is a dominant nonlinearity is not understood. This paper explores the consequences of assuming that onset is controlled by large thermal fluctuations. A super exponential dependence of mean reflectivity on speckle intensity in the onset regime is predicted.

  5. Oncological Evaluation by Positron-emission Tomography, Circulating Tumor Cells and Alpha Fetoprotein in Patients With Hepatocellular Carcinoma on the Waiting List for Liver Transplantation.

    Science.gov (United States)

    Ramirez, P; Sáenz, L; Cascales-Campos, P A; González Sánchez, M R; Llàcer-Millán, E; Sánchez-Lorencio, M I; Díaz-Rubio, E; De La Orden, V; Mediero-Valeros, B; Navarro, J L; Revilla Nuin, B; Baroja-Mazo, A; Noguera-Velasco, J A; Sánchez, B F; de la Peña, J; Pons-Miñano, J A; Sánchez-Bueno, F; Robles-Campos, R; Parrilla, P

    2016-11-01

    The objectives of this study are the determination of the number of circulating tumor cells (CTCs), by means of the IsoFlux enrichment system (Fluxion Biosciences Inc, San Francisco, California, United States) in patients with hepatocellular carcinoma (HCC) in compliance with the Milan criteria and on the waiting list for hepatic transplantation, as well as the study of its relation with the of α-fetoprotein levels (AFP) and positron-emission tomography-computed tomography (PET-CT) findings. An oncologycal evaluation with PET-CT, CTCs, and AFP was conducted in 24 consecutive patients with HCC eligible for orthotopic liver transplantation according to the Milan criteria. The diagnosis of HCC was made according to clinical, biological, and radiological findings. We detected CTCs in peripheral blood in 21 of 24 patients (87.5%) before liver transplantation, with a mean number CTCs of 156 ± 370 (range, 2 to 1768) with statistically significant association between number of CTCs detected in peripheral blood and the time within the waiting list (P  .05). PET-TC, CTCs, and AFP levels could be an essential key for the correct management of the patients with HCC on the waiting list for liver transplantation. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Indoor Temperatures in Patient Waiting Rooms in Eight Rural Primary Health Care Centers in Northern South Africa and the Related Potential Risks to Human Health and Wellbeing

    Directory of Open Access Journals (Sweden)

    Caradee Y. Wright

    2017-01-01

    Full Text Available Increased temperatures affect human health and vulnerable groups including infants, children, the elderly and people with pre-existing diseases. In the southern African region climate models predict increases in ambient temperature twice that of the global average temperature increase. Poor ventilation and lack of air conditioning in primary health care clinics, where duration of waiting time may be as long as several hours, pose a possible threat to patients seeking primary health care. Drawing on information measured by temperature loggers installed in eight clinics in Giyani, Limpopo Province of South Africa, we were able to determine indoor temperatures of waiting rooms in eight rural primary health care facilities. Mean monthly temperature measurements inside the clinics were warmer during the summer months of December, January and February, and cooler during the autumn months of March, April and May. The highest mean monthly temperature of 31.4 ± 2.7 °C was recorded in one clinic during February 2016. Maximum daily indoor clinic temperatures exceeded 38 °C in some clinics. Indoor temperatures were compared to ambient (outdoor temperatures and the mean difference between the two showed clinic waiting room temperatures were higher by 2–4 °C on average. Apparent temperature (AT incorporating relative humidity readings made in the clinics showed ‘realfeel’ temperatures were >4 °C higher than measured indoor temperature, suggesting a feeling of ‘stuffiness’ and discomfort may have been experienced in the waiting room areas. During typical clinic operational hours of 8h00 to 16h00, mean ATs fell into temperature ranges associated with heat–health impact warning categories of ‘caution’ and ‘extreme caution’.

  7. Indoor Temperatures in Patient Waiting Rooms in Eight Rural Primary Health Care Centers in Northern South Africa and the Related Potential Risks to Human Health and Wellbeing

    Science.gov (United States)

    Wright, Caradee Y.; Street, Renée A.; Cele, Nokulunga; Kunene, Zamantimande; Balakrishna, Yusentha; Albers, Patricia N.; Mathee, Angela

    2017-01-01

    Increased temperatures affect human health and vulnerable groups including infants, children, the elderly and people with pre-existing diseases. In the southern African region climate models predict increases in ambient temperature twice that of the global average temperature increase. Poor ventilation and lack of air conditioning in primary health care clinics, where duration of waiting time may be as long as several hours, pose a possible threat to patients seeking primary health care. Drawing on information measured by temperature loggers installed in eight clinics in Giyani, Limpopo Province of South Africa, we were able to determine indoor temperatures of waiting rooms in eight rural primary health care facilities. Mean monthly temperature measurements inside the clinics were warmer during the summer months of December, January and February, and cooler during the autumn months of March, April and May. The highest mean monthly temperature of 31.4 ± 2.7 °C was recorded in one clinic during February 2016. Maximum daily indoor clinic temperatures exceeded 38 °C in some clinics. Indoor temperatures were compared to ambient (outdoor) temperatures and the mean difference between the two showed clinic waiting room temperatures were higher by 2–4 °C on average. Apparent temperature (AT) incorporating relative humidity readings made in the clinics showed ‘realfeel’ temperatures were >4 °C higher than measured indoor temperature, suggesting a feeling of ‘stuffiness’ and discomfort may have been experienced in the waiting room areas. During typical clinic operational hours of 8h00 to 16h00, mean ATs fell into temperature ranges associated with heat–health impact warning categories of ‘caution’ and ‘extreme caution’. PMID:28067816

  8. THE M/M/c QUEUE WITH (e,d) SETUP TIME

    Institute of Scientific and Technical Information of China (English)

    Xiuli XU; Naishuo TIAN

    2008-01-01

    The authors present a new queueing model with (e, d) setup time. Using the quasi-birth-and-death process and matrix-geometric method, the authors obtain the stationary distribution of queue length and the LST of waiting time of a customer in the system. Furthermore, the conditional stochastic decomposition results of queue length and waiting time are given.

  9. Time Interval Between Endometrial Biopsy and Surgical Staging for Type I Endometrial Cancer: Association Between Tumor Characteristics and Survival Outcome

    National Research Council Canada - National Science Library

    Matsuo, Koji; Opper, Neisha R; Ciccone, Marcia A; Garcia, Jocelyn; Tierney, Katherine E; Baba, Tsukasa; Muderspach, Laila I; Roman, Lynda D

    2015-01-01

    OBJECTIVE:To examine whether wait time between endometrial biopsy and surgical staging correlates with tumor characteristics and affects survival outcomes in patients with type I endometrial cancer...

  10. 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

  11. Treatment outcome of supraglottoplasty vs. wait-and-see policy in patients with laryngomalacia

    NARCIS (Netherlands)

    van der Heijden, Martijn; Dikkers, Frederik G; Halmos, Gyorgy B

    2016-01-01

    In most cases, laryngomalacia presents as a mild disease, and the symptoms resolve after wait-and-see policy. Up to 20 % of patients present with severe laryngomalacia and may require surgery (i.e. supraglottoplasty); however, the indication for surgery is not firmly established yet. The goal of thi

  12. Trading with the waiting-list: the justice of Living Donor List Exchange

    NARCIS (Netherlands)

    den Hartogh, G.

    2010-01-01

    In a Living Donor List Exchange program, the donor makes his kidney available for allocation to patients on the postmortal waiting-list and receives in exchange a postmortal kidney, usually an O-kidney, to be given to the recipient he favours. The program can be a solution for a candidate donor who

  13. 24 CFR 882.513 - Public notice to low-income families; waiting list.

    Science.gov (United States)

    2010-04-01

    ... HOUSING FOR PERSONS WITH DISABILITIES PROGRAM) SECTION 8 MODERATE REHABILITATION PROGRAMS Special Procedures for Moderate Rehabilitation-Program Development and Operation § 882.513 Public notice to low... must maintain a waiting list for applicants for the Moderate Rehabilitation Program. This...

  14. Transplants in Foreign Countries Among Patients Removed from the US Transplant Waiting List.

    Science.gov (United States)

    Merion, R M; Barnes, A D; Lin, M; Ashby, V B; McBride, V; Ortiz-Rios, E; Welch, J C; Levine, G N; Port, F K; Burdick, J

    2008-04-01

    Transplant tourism, where patients travel to foreign countries specifically to receive a transplant, is poorly characterized. This study examined national data to determine the minimum scope of this practice. US national waiting list removal data were analyzed. Waiting list removals for transplant without a corresponding US transplant in the database were reviewed via a data validation query to transplant centers to identify foreign transplants. Additionally, waiting list removal records with text field entries indicating a transplant abroad were identified. We identified 373 foreign transplants (173 directly noted; 200 from data validation); most (89.3%) were kidney transplants. Between 2001 and 2006, the annual number of waiting list removals for transplant abroad increased. Male sex, Asian race, resident and nonresident alien status and college education were significantly and independently associated with foreign transplant. Recipients from 34 states, plus the District of Columbia, received foreign transplants in 35 countries, led by China, the Philippines and India. Transplants in foreign countries among waitlisted candidates in the US are increasingly performed. The data reported here represent the minimum number of cases and the full extent of this practice cannot be determined using existing data. Additional reporting requirements are needed.

  15. Stroke Education in an Emergency Department Waiting Room: a Comparison of Methods

    Directory of Open Access Journals (Sweden)

    Yu-Feng Yvonne Chan1

    2015-03-01

    Full Text Available Background: Since the emergency department (ED waiting room hosts a large, captive audience of patients and visitors, it may be an ideal location for conduct-ing focused stroke education. The aim of this study was to assess the effective-ness of various stroke education methods.Methods: Patients and visitors of an urban ED waiting room were randomized into one of the following groups: video, brochure, one-to-one teaching, combi-nation of these three methods, or control group. We administered a 13-question multiple-choice test to assess stroke knowledge prior to, immediately after, and at 1 month post-education to patients and visitors in the ED waiting room.Results: Of 4 groups receiving education, all significantly improved their test scores immediately post intervention (test scores 9.4±2.5-10.3±2.0, P<0.01. At 1 month, the combination group retained the most knowledge (9.4±2.4 exceed-ing pre-intervention and control scores (both 6.7±2.6, P<0.01.Conclusion: Among the various stroke education methods delivered in the ED waiting room, the combination method resulted in the highest knowledge reten-tion at 1-month post intervention.

  16. Group Therapy with Patients in the Waiting Room of an Oncology Clinic.

    Science.gov (United States)

    Arnowitz, Edward; And Others

    1983-01-01

    Describes a therapy group for cancer patients, conducted by cotherapists in an oncology waiting room. Group members provided mutual support and shared concerns and coping methods. Medical staff members became more involved and were more able to address the affective needs of the patients and their families. (JAC)

  17. 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…

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

    NARCIS (Netherlands)

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

    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

  19. Trading with the waiting-list: the justice of Living Donor List Exchange

    NARCIS (Netherlands)

    den Hartogh, G.

    2010-01-01

    In a Living Donor List Exchange program, the donor makes his kidney available for allocation to patients on the postmortal waiting-list and receives in exchange a postmortal kidney, usually an O-kidney, to be given to the recipient he favours. The program can be a solution for a candidate donor who

  20. 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…

  1. 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…

  2. [Immunization educational game in general practice waiting rooms. A comparative study].

    Science.gov (United States)

    Rolland, Marie-Aude; Gignon, Maxime

    2015-01-01

    The general practitioner’s (GP) waiting room is an ideal place to conduct health education actions. The use of tools in GP waiting rooms would appear to be a useful approach, but the available tools are not very efficient. The objective of this study was to study the efficacy of a game compared with two other health education strategies. A comparative study was conducted in two general practices. 212 patients were divided into three groups using a paper-game or a booklet or nothing in the waiting room, before a discussion about immunization with the practitioner. The capacity of the tool to encourage questions about immunization was estimated by the GP at the end of the consultation by a questionnaire. The use of a tool in the waiting room facilitated the discussion between patients and practitioners (34% vs 12%, pgame induced longer discussions than the booklet (1 minute 32 seconds vs 1 minute 14 seconds, pgame and the booklet had a comparable acceptability. Using a multistep education strategy facilitated discussion between the patient and the practitioner. However, the GP is required to trigger the conversation.

  3. A Desperate Comedy: Hope and Alienation in Samuel Beckett's "Waiting

    Science.gov (United States)

    Scott, Alan

    2013-01-01

    This article is both a personal response to Samuel Beckett's "Waiting for Godot" and an examination of the concept within literature of making the strange familiar and making the familiar strange. It discusses the educative force and potential of Beckett's strangers in a strange world by examining my own personal experiences…

  4. Watchful waiting versus colorectal resection after polypectomy for malignant colorectal polyps

    DEFF Research Database (Denmark)

    Levic, Katarina; Kjær, Monica; Bulut, Orhan;

    2015-01-01

    analysis of prospectively collected data on 50 patients with unexpected malignancy after a polypectomy treated between January 2003 and January 2008. A total of 27 patients (54%) were treated with watchful waiting, and 23 (46%) underwent subsequent surgery. The Mann-Whitney U-test and chi-square test were...

  5. Continuity of care for patients on a waiting list for institutional long-term care.

    NARCIS (Netherlands)

    Caris-Verhallen, W.M.C.M.; Kerkstra, A.

    2001-01-01

    The aim of this study was to examine patients' satisfaction with continuity of care while on a waiting list for residential care or nursing home care. Two hundred and seventy-eight patients participated in the study, all living in the community setting of two cities in the Netherlands. These patient

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

    NARCIS (Netherlands)

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

    2009-01-01

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

  7. Maternity waiting facilities for improving maternal and neonatal outcome in low-resource countries

    NARCIS (Netherlands)

    van Lonkhuijzen, L.; Stekelenburg, J.; van Roosmalen, J.

    2009-01-01

    Background A Maternity Waiting Home (MWH) is a facility, within easy reach of a hospital or health centre which provides Emergency Obstetric Care (EmOC). Women may stay in the MWH at the end of their pregnancy and await labour. Once labour starts, women move to the health facility so that labour and

  8. Epidemiology of grey mould in annual waiting-bed production of strawberry.

    NARCIS (Netherlands)

    Boff, P.; Kastelein, P.; Kraker, de J.; Gerlagh, M.; Köhl, J.

    2001-01-01

    The epidemiology of Botrytis cinerea was studied in five annual strawberry crops using waiting-bed transplants, a system widely adopted in the Netherlands. On dead leaves of transplants the incidence of B. cinerea varied from 26.7 o 52.6°but the leaf area with potential sporulation was low (3.5–15.6

  9. Stress, psychological distress, and coping in patients on the waiting list for lung transplantation : an exploratory study

    NARCIS (Netherlands)

    Vermeulen, KM; Bosma, OH; van der Bij, W; Koeter, GH; TenVergert, EM

    2005-01-01

    Little information is available in literature on quality of life, stress and coping during the period patients are waiting for lung transplantation. This study explored potential stressful events that patients experience during the waiting period assessed the level of anxiety and depression and expl

  10. 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 a

  11. 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…

  12. A Support Group for Parents of Children on a Waiting List for an Assessment for Autism Spectrum Disorder

    Science.gov (United States)

    Connolly, Micaela; Gersch, Irvine

    2013-01-01

    Parents of children waiting for a diagnostic assessment for autism spectrum disorder (ASD) experience distress and anxiety while they wait. The present small-scale study took place in a multi-disciplinary therapeutic service in Ireland for children with ASD and was run between April and September 2011. The first author, an educational psychologist…

  13. Wait, bond, and buy : Consumer responses to economic crisis

    NARCIS (Netherlands)

    Yabar, J.

    2012-01-01

    Although economic crises tend to be perceived as a time in which consumers cut back on expenditures (including cars, clothes, and houses), market data also shows that sales of certain products increase during economic downturns. How do consumers respond to an economic crisis? And what is the psychol

  14. 78 FR 10574 - Premerger Notification; Reporting and Waiting Period Requirements

    Science.gov (United States)

    2013-02-14

    ..., like any Social Security number, date of birth, driver's license number or other state identification... competitively sensitive information such as costs, sales statistics, inventories, formulas, patterns, devices... compliance without a timing agreement in place. The Commission understands that withdrawal procedures in this...

  15. Wait, bond, and buy: Consumer responses to economic crisis.

    OpenAIRE

    Yabar, J.

    2012-01-01

    Abstract: Although economic crises tend to be perceived as a time in which consumers cut back on expenditures (including cars, clothes, and houses), market data also shows that sales of certain products increase during economic downturns. How do consumers respond to an economic crisis? And what is the psychology behind such behavior? These are questions to which this dissertation is devoted. Three empirical chapters show that an economic crisis activates different fundamental human needs, whi...

  16. The million-year wait for macroevolutionary bursts.

    Science.gov (United States)

    Uyeda, Josef C; Hansen, Thomas F; Arnold, Stevan J; Pienaar, Jason

    2011-09-20

    We lack a comprehensive understanding of evolutionary pattern and process because short-term and long-term data have rarely been combined into a single analytical framework. Here we test alternative models of phenotypic evolution using a dataset of unprecedented size and temporal span (over 8,000 data points). The data are body-size measurements taken from historical studies, the fossil record, and among-species comparative data representing mammals, squamates, and birds. By analyzing this large dataset, we identify stochastic models that can explain evolutionary patterns on both short and long timescales and reveal a remarkably consistent pattern in the timing of divergence across taxonomic groups. Even though rapid, short-term evolution often occurs in intervals shorter than 1 Myr, the changes are constrained and do not accumulate over time. Over longer intervals (1-360 Myr), this pattern of bounded evolution yields to a pattern of increasing divergence with time. The best-fitting model to explain this pattern is a model that combines rare but substantial bursts of phenotypic change with bounded fluctuations on shorter timescales. We suggest that these rare bursts reflect permanent changes in adaptive zones, whereas the short-term fluctuations represent local variations in niche optima due to restricted environmental variation within a stable adaptive zone.

  17. 餐饮服务排队管理中等候区设置必要性研究%Research on the Necessity of Setting Waiting Room in Restaurant Queue Management

    Institute of Scientific and Technical Information of China (English)

    韩亚娟; 谢会

    2012-01-01

    To improve restaurant service quality and increase revenue, the issue of restaurant queue man-agement is discussed in an integrated perspective of both capacity management and the psychology of wait-ing in line. Two cases are considered: 1) there is no waiting room, leading to loss of customers; and 2) there is a waiting room, but some customers may renege because of the waiting time. With customer per-ception in waiting considered, queuing theory models are developed for both cases. To maximize profit, revenue functions for the models are derived. Then, simulation analysis is done by using Matlab. It shows that there is a strategy of setting waiting room such that maximum profit can be achieved, which indicates that the traditional view of conflict between service quality and cost can be overcome by integrating per-spective from both customers and the company. In addition, the number of dinner tables is negatively re-lated to the reneging parameter, whereas the number of waiting tables is positively related to the reneging parameter.%为了达到同时提高饭店服务质量和收益的双重目的,从顾客等待心理和饭店能力管理相结合的角度研究了饭店排队管理问题,提出了建立顾客等候区的排队管理策略.充分考虑顾客感知等待时间,采用排队论的方法分别建立了在不设置等候区时的损失制排队模型及设置等候区时的带有顾客中途退出的排队模型,并以饭店收益最大化为目标建立两种模型下的收益函数,最后用Matlab编程比较分析了两个模型.结果表明:设置等侯区能够使饭店获得更大的收益;同时,要保证利润最大,餐桌数与顾客中途退出指数成负相关,等候桌数与顾客中途退出指数成正相关,这为进行有效排队管理提供了理论依据.

  18. Queueing systems with constant service time and evaluation of M/D/1,k

    DEFF Research Database (Denmark)

    Iversen, Villy Bæk

    1997-01-01

    Systems with constant service times have the particular property that the customers leave the servers in the same order in which they areaccepted for service. Probabilitites of integral waiting times can be expressed by the state probabilities, and non-integral waiting timescan be expressed...

  19. El significado de la espera de un cáncer The meaning of waiting for cancer

    Directory of Open Access Journals (Sweden)

    María Eulàlia Juvé-Udina

    2009-03-01

    waiting during the pre-diagnosis stage of cancer. Method. A literature review was conducted using 4 databases. Convenience sampling technique was used to invite one participant. She was interviewed about feelings and thoughts on the experience and the perception on time, space, body and relationships. Analysis was conducted using the framework proposed by Vydenlingum: listening, transcribing, reading, identifying emerging themes, comparing, and building up clusters to reveal meaning. Findings. Themes emerged from the participant’s narrative of the experience. The phenomenological structure of waiting seems to be composed mainly by two opposite mechanisms: (1 responses against threat and (2 compensation and coping strategies. One third cluster was identified - Family preservation - . Results. should be read cautiously yet they are not intended to be generalized. Conclusions. Understanding the meaning of waiting should be considered by all health care professionals yet, waiting is, like pain and sorrow, one of the more frequent experiences during illness. Being aware that from the first symptom to the patient first contact with the health services, and to diagnosis statement, all these mechanisms are already on, is essential to provide comprehensive and sensitive health care.

  20. Structure and Decay at Rapid Proton Capture Waiting Points

    Science.gov (United States)

    Hove, D.; Garrido, E.; Jensen, A. S.; Fynbo, H. O. U.; Fedorov, D. V.; Zinner, N. T.

    2017-01-01

    We investigate the region of the nuclear chart around A ˜eq 70 from a three-body perspective, where we compute reaction rates for the radiative capture of two protons. One key quantity is here the photon dissociation cross section for the inverse process where two protons are liberated from the borromean nucleus by photon bombardment. We find a number of peaks at low photon energy in this cross section where each peak is located at the energy corresponding to population of a three-body resonance. Thus, for these energies the decay or capture processes proceed through these resonances. However, the next step in the dissociation process still has the option of following several paths, that is either sequential decay by emission of one proton at a time with an intermediate two-body resonance as stepping stone, or direct decay into the continuum of both protons simultaneously. The astrophysical reaction rate is obtained by folding of the cross section as function of energy with the occupation probability for a Maxwell-Boltzmann temperature distribution. The reaction rate is then a function of temperature, and of course depending on the underlying three-body bound state and resonance structures. We show that a very simple formula at low temperature reproduces the elaborate numerically computed reaction rate.

  1. A time fractional model to represent rainfall process

    Directory of Open Access Journals (Sweden)

    Jacques GOLDER

    2014-01-01

    Full Text Available This paper deals with a stochastic representation of the rainfall process. The analysis of a rainfall time series shows that cumulative representation of a rainfall time series can be modeled as a non-Gaussian random walk with a log-normal jump distribution and a time-waiting distribution following a tempered α-stable probability law. Based on the random walk model, a fractional Fokker-Planck equation (FFPE with tempered α-stable waiting times was obtained. Through the comparison of observed data and simulated results from the random walk model and FFPE model with tempered α-stable waiting times, it can be concluded that the behavior of the rainfall process is globally reproduced, and the FFPE model with tempered α-stable waiting times is more efficient in reproducing the observed behavior.

  2. No Need to Wait for the Clean Air Dividend

    Science.gov (United States)

    Shindell, Drew

    2012-01-01

    precursor is methane, which is also a powerful greenhouse gas in its own right. Control measures include reducing leaks from natural gas pipelines and storage tanks, and capturing it from coal, gas and oil extraction, landfills and wastewater treatment plants. Aeration of rice paddies and manure management can also reduce methane releases. Captured methane can often be sold or turned into power. In Monterrey, Mexico, for example, electricity generated from methane collected from the city landfill powers the public transportation system. So such measures can be beneficial even when ignoring the health and climate effects, as they can contribute to energy security and often pay for themselves. According to calculations by me and my colleagues, phasing in all these measures over the next 20 years would reduce global warming by about 0.5 degC in 2050, half of the projected increase between now and then (Science, vol 335, p 183). Regional benefits would be even greater, as black carbon disrupts rainfall patterns and magnifies warming and melting of snow and ice in parts of the world including the Arctic and the Himalayas. On top of the climate benefits, cutting black carbon and ozone would prevent over 3 million premature deaths from air pollution, and increase yields of staple crops by roughly 50 million tonnes a year. Improved cooking stoves would also decrease the demand for firewood in the developing world, reducing deforestation and freeing up time for those who collect wood - primarily women and children - to pursue other activities such as education. Similarly, improved brick kilns now being used in parts of Latin America and Asia require half as much fuel as traditional ones and are less time-intensive for the operators. This means that in addition to their environmental benefits, these measures can contribute to sustainable and human development. Tackling black carbon and methane is clearly a great idea, so why hasn't it been done already? There are many barriers. The

  3. Effect of a printed reminder in the waiting room to turn off mobile phones during consultation: a before and after study

    Directory of Open Access Journals (Sweden)

    de Aguiar Sylvia

    2009-03-01

    Full Text Available Abstract Background Telephone interruptions during consultations are one cause of work-related stress amongst general practitioners. Many health care centers recommend that patients turn off any mobile phones to avoid interruptions to the discussion with the physicians. Methods The purpose of this before and after study was to determine whether a printed reminder for turning off the mobile phone in the waiting room is helpful in decreasing the number of interruptions during consultation. A visual phone off sign utilizing the International "No" symbol of a diagonal line through a circle, along with a "please turn off your phone during consultation" reminder was used in the waiting room in the "after" period. Results A significant difference was found in the proportion of patients receiving or making a call during the consultation (8.8% vs. 13.5%, RR = 0.66; 95%CI 0.46–0.94; p = 0.021 and in the total number of calls (10.4% vs. 17.3%, RR = 0.60; 95%CI 0.44–0.83, p = 0.003 between the exposed and the non-exposed groups. However, no significant differences were found in the total time or the median time spent talking during consultation. The duration of the calls had median times of 20.5 seconds and 22.3 seconds in the exposed and the non-exposed groups respectively. Women from both groups who received a call during consultation answered significantly more when compared to men (70% vs. 52%; p = 0.05; Conclusion Our findings suggest that a printed reminder in the waiting room is helpful in decreasing the number of interruptions by mobile phone during consultation in our settings. The study provides the basis for further quantitative and qualitative research on this topic

  4. Reliable blood pressure self-measurement in the obstetric waiting room

    DEFF Research Database (Denmark)

    Wagner, Stefan; Kamper, C. H.; Rasmussen, Niels H

    2014-01-01

    patients scheduled for self-measuring their blood pressure (BP) in the waiting room at an obstetrics department's outpatient clinic to perform an additional BPSM using ValidAid. We then compared the automatically measured and classified values from ValidAid with our manual observations. Results: We found......Background: Patients often fail to adhere to clinical recommendations when using current blood pressure self-measurement (BPSM) methods and equipment. As existing BPSM equipment is not able to detect non-adherent behavior, this could result in misdiagnosis and treatment error. To overcome...... that a) the pregnant diabetics did not adhere to given instructions when performing BPSM in the waiting room, and that b) the ValidAid system was able to accurately classify patient adherence to the modeled recommendations. Conclusions: A new method for ensuring reliable BPSM based on the ValidAid system...

  5. 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.

  6. 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.

  7. [A higher place on the waiting list for kidney transplantation after earlier donation: a matter of give and take].

    Science.gov (United States)

    Hoitsma, Andries J

    2011-01-01

    In May 2011 the Dutch Health Council released an advice regarding living kidney donors who developed end-stage renal disease (ESRD) after donation. These donors with ESRD will have a high priority when they are on the waiting list for kidney transplantation. With this new rule the former donors will be transplanted within 6 weeks and transplantation can preferably be performed preemptively. It is expected that this measure shall prolong the waiting list for a donor kidney for the remaining patients with end stage renal disease by 6 days at most, on a total average waiting period of 4 years.

  8. Diabetes Mellitus and Prediabetes on Kidney Transplant Waiting List- Prevalence, Metabolic Phenotyping and Risk Stratification Approach.

    Directory of Open Access Journals (Sweden)

    Martina Guthoff

    Full Text Available Despite a significant prognostic impact, little is known about disturbances in glucose metabolism among kidney transplant candidates. We assess the prevalence of diabetes mellitus (DM and prediabetes on kidney transplant waiting list, its underlying pathophysiology and propose an approach for individual risk stratification.All patients on active kidney transplant waiting list of a large European university hospital transplant center were metabolically phenotyped.Of 138 patients, 76 (55% had disturbances in glucose metabolism. 22% of patients had known DM, 3% were newly diagnosed. 30% were detected to have prediabetes. Insulin sensitivity and-secretion indices allowed for identification of underlying pathophysiology and risk factors. Age independently affected insulin secretion, resulting in a relative risk for prediabetes of 2.95 (95%CI 1.38-4.83 with a cut-off at 48 years. Body mass index independently affected insulin sensitivity as a continuous variable.The prevalence of DM or prediabetes on kidney transplant waiting list is as high as 55%, with more than one third of patients previously undiagnosed. Oral glucose tolerance test is mandatory to detect all patients at risk. Metabolic phenotyping allows for differentiation of underlying pathophysiology and provides a basis for early individual risk stratification and specific intervention to improve patient and allograft outcome.

  9. Maternity waiting homes and institutional birth in Nicaragua: policy options and strategic implications.

    Science.gov (United States)

    García Prado, Ariadna; Cortez, Rafael

    2012-01-01

    With the aim of promoting institutional births and reducing the high maternal and child mortality rates in rural and poor zones, the government of Nicaragua is supporting the creation of maternity waiting homes. This study analyzes that strategy and examines the factors associated with the use of maternity waiting homes and institutional birth. To that end, we apply a quantitative approach, by means of an econometric analysis of the data extracted from surveys conducted in 2006 on a sample of women and parteras or traditional birth attendants, as well as a qualitative approach based on interviews with key informants. Results indicate that although the operation of the maternity waiting homes is usually satisfactory, there is still room for improvement along the following lines: (i) disseminating information about the homes to both women and men, as the latter frequently decide the course of women's healthcare, and to parteras, who can play an important role in referring women; (ii) strengthening the postpartum care; (iii) ensuring financial sustainability by obtaining regular financial support from the government to complement contributions from the community; and (iv) strengthening the local management and involvement of the regional government. These measures might be useful for health policy makers in Nicaragua and in other developing countries that are considering this strategy. Copyright © 2011 John Wiley & Sons, Ltd.

  10. The attitude toward xenocorneal transplantation in wait-listed subjects for corneal transplantation in Korea.

    Science.gov (United States)

    Lee, Jong Joo; Kim, Dong Hyun; Jang, Young Eun; Choi, Hyuk Jin; Kim, Mee Kum; Wee, Won Ryang

    2014-01-01

    Shortage of donor cornea is a significant problem in Asia, and xenocorneal transplantation is being actively studied to alleviate this problem. However, the attitudes of subjects who await corneal transplants toward xenocorneal transplantation are not known at all. Thus, this study aimed to investigate the attitudes of subjects on the waiting lists for corneal transplants, toward corneal xenotransplantation. A telephone questionnaire survey comprising six items was conducted in 132 subjects among the wait-listed individuals (n = 590) who were awaiting corneal transplantation or had undergone corneal transplantation at Seoul National University Hospital from July, 2003 to August, 2012. Among six inquiries, four questions were used to analyze attitudes toward corneal xenotransplantation. Each question pertained to (1) the acceptance of xenocorneal transplantation, (2) willingness to participate in clinical trials, (3) worries in xenocorneal transplantation, and (4) the concern of self-identity or social life after xenocorneal transplantation. To analyze demographic factors influencing the question, the subjects were arbitrarily divided into two groups: the young (age xenotransplantation. Younger subjects expressed more worry about xenotransplantation than elderly subjects. The well-educated expressed less concern over self-identity and social life than the less-educated. This survey among subjects who are wait-listed for corneal transplant or who have received a corneal transplant demonstrates that there is an interest in xenocorneal transplantation as an alternate procedure, although there are worries about the procedure that should be further explored in educational campaigns and future studies of the general population.

  11. Historical Data for Average Processing Time Until Hearing Held

    Data.gov (United States)

    Social Security Administration — This dataset provides historical data for average wait time (in days) from the hearing request date until a hearing was held. This dataset includes data from fiscal...

  12. A Brief Discussion on the Role of "Waiting" Education in Promoting Young Children's Self-growth%浅谈"等待"教育促进幼儿的自我成长

    Institute of Scientific and Technical Information of China (English)

    熊优良

    2016-01-01

    在多次聆听浙江省安吉幼教专家剖析安吉幼儿的游戏理念,多次观摩、学习安吉幼儿的游戏后,我发现原来静下心来看幼教,教师停下脚步观察、反思幼儿的学习与发展,会有更多的惊喜等着我们.本文从观察幼儿的案例中,阐述幼儿教育中等待的价值:等待让幼儿有自我认识和学习与发展的机会;等待让幼儿开启智慧之门;等待让幼儿勇往直前,克服惧怕.%After many times of learning from Anji preschool edu-cation experts' analyses of children's concepts of games as well as Anji children's games, the writer settled down to ponder preschool education, observed and reflected children's learning and development, finding that there are many surprises waiting ahead. Based on the observation of children's cases, this paper expounds the value of waiting in early childhood education:wait-ing provides children with the opportunities of individual recog-nition, learning and development;waiting opens the door of wis-dom for children;waiting endows children with courage to go for-ward and overcome the fear.

  13. Web-based stress management for newly diagnosed cancer patients (STREAM-1): a randomized, wait-list controlled intervention study.

    Science.gov (United States)

    Grossert, Astrid; Urech, Corinne; Alder, Judith; Gaab, Jens; Berger, Thomas; Hess, Viviane

    2016-11-03

    Being diagnosed with cancer causes major psychological distress, yet the majority of newly diagnosed cancer patients lack psychological support. Internet interventions overcome many barriers for seeking face-to-face support and allow for independence in time and place. We assess efficacy and feasibility of the first web-based stress management intervention (STREAM: STREss-Aktiv-Mindern) for newly diagnosed, German-speaking cancer patients. In a prospective, wait-list controlled trial 120 newly diagnosed cancer patients will be included within 12 weeks of starting anti-cancer treatment and randomized between an immediate (intervention group) or delayed (control group) 8-week, web-based intervention. The intervention consists of eight modules with weekly written feedback by a psychologist ("minimal-contact") based on well-established stress management manuals including downloadable audio-files and exercises. The aim of this study is to evaluate efficacy in terms of improvement in quality of life (FACT-F), as well as decrease in anxiety and depression (HADS), as compared to patients in the wait-list control group. A sample size of 120 patients allows demonstrating a clinically relevant difference of nine points in the FACT score after the intervention (T2) with a two-sided alpha of 0.05 and 80 % power. As this is the first online stress management intervention for German-speaking cancer patients, more descriptive outcomes are equally important to further refine the group of patients with the largest potential for benefit who then will be targeted more specifically in future trials. These descriptive endpoints include: patients' characteristics (type of cancer, type of treatment, socio-demographic factors), dropout rate and dropout reasons, adherence and satisfaction with the program. New technologies open new opportunities: minimal-contact psychological interventions are becoming standard of care in several psychological disorders, where their efficacy is often

  14. Analysis of Two-Level Support Systems with Time-Dependent Overflow - A Banking Application

    DEFF Research Database (Denmark)

    Barth, Wolfgang; Manitz, Michael; Stolletz, Raik

    2010-01-01

    is available. The analysis of such a system with time-dependent overflow is reduced to the analysis of a continuous-time Markov chain with state-dependent overflow probabilities. To approximate the system with time-dependent overflow, some waiting-based performance measures are modified. Numerical results......In this paper, we analyze the performance of call centers of financial service providers with two levels of support and a time-dependent overflow mechanism. Waiting calls from the front-office queue flow over to the back office if a waiting-time limit is reached and at least one back-office agent...

  15. Evaluation of wet-cupping therapy for persistent non-specific low back pain: a randomised, waiting-list controlled, open-label, parallel-group pilot trial

    Directory of Open Access Journals (Sweden)

    Kim Kun

    2011-06-01

    Full Text Available Abstract Background Persistent non-specific low back pain (PNSLBP is one of the most frequently experienced types of back pain around the world. Wet-cupping is a common intervention for various pain conditions, especially in Korea. In this context, we conducted a pilot study to determine the effectiveness and safety of wet-cupping treatment for PNSLBP. Methods We recruited 32 participants (21 in the wet-cupping group and 11 in the waiting-list group who had been having PNSLBP for at least 3 months. The participants were recruited at the clinical research centre of the Korea Institute of Oriental Medicine, Korea. Eligible participants were randomly allocated to wet-cupping and waiting-list groups. Following the practice of traditional Korean medicine, the treatment group was provided with wet-cupping treatment at two acupuncture points among the BL23, BL24 and BL25 6 times within 2 weeks. Usual care, including providing brochures for exercise, general advice for PNSLBP and acetaminophen, was allowed in both groups. Separate assessors participated in the outcome assessment. We used the 0 to100 numerical rating scale (NRS for pain, the McGill Pain Questionnaire for pain intensity (PPI and the Oswestry Disability Questionnaire (ODQ, and we assessed acetaminophen use and safety issues. Results The results showed that the NRS score for pain decreased (-16.0 [95% CI: -24.4 to -7.7] in the wet-cupping group and -9.1 [-18.1 to -0.1] in the waiting-list group, but there was no statistical difference between the groups (p = 0.52. However, the PPI scores showed significant differences between the two groups (-1.2 [-1.6 to -0.8] for the wet-cupping group and -0.2 [-0.8 to 0.4] for the waiting-list group, p Conclusion This pilot study may provide preliminary data on the effectiveness and safety of wet-cupping treatments for PNSLBP. Future full-scale randomised controlled trials will be needed to provide firm evidence of the effectiveness of this intervention

  16. 静待花开--试论如何让学生学会自主学习%Waiting for Blossoming--- Discuss on How to Make Students Learn to Study Independently

    Institute of Scientific and Technical Information of China (English)

    杨玉红

    2016-01-01

    Mathematics needs thinking, and thinking requires time. In Mathematics teaching, teachers should leave time for students to think. Teachers need to learn“waiting for blossom”. It's important to wait for students to find their enthusiasm, mistakes, comments, review, self-thinking and self-studying.%数学需要思考,思考需要时间。在数学教学中,教师要给学生更多静心思考的时间,需要教师教学时学会“静待花开”!等待学生的激情、发现、错误、评价和感悟,让学生学会自主思考和学习。

  17. The Effectiveness Analysis of Waiting Processes in the Different Branches of a Bank by Queue Model

    Directory of Open Access Journals (Sweden)

    Abdullah ÖZÇİL

    2015-06-01

    Full Text Available Despite the appreciable increase in the number of bank branches every year, nowadays queues for services don’t decrease and even become parts of our daily lives. By minimizing waiting processes the least, increasing customer satisfaction should be one of branch managers’ main goals. A quick and also customer oriented service with high quality is the most important factor for customer loyalty. In this study, Queueing theory, one of Operation Research techniques, is handled and in application, the data are obtained related to waiting in queue of customer in six different branches of two banks operating in Denizli and then they are analyzed by Queueing theory and also calculated the average effectiveness of the system. The study’s data are obtained by six branches of two banks called as A1, A2, A3, B1, B2 and B3. At the end of study it is presented to the company some advices that can bring benefits to the staff and customers. In this study, Queueing theory, one of Operation Research techniques, is handled and in application, the data are obtained related to waiting in queue of customer in three different branches of a bank operating in Denizli and then they are analyzed by Queueing theory and also calculated the average effectiveness of the system. The study’s data are obtained by three branches of the bank called A1, A2 and A3. At last it is presented to the company some advices that can bring more benefits to the staff and clients.

  18. The Frequency of Familial Mediterranean Fever Related Amyloidosis in Renal Waiting List for Transplantation

    Science.gov (United States)

    Keles, Mustafa; Eyerci, Nilnur; Uyanik, Abdullah; Aydinli, Bulent; Sahin, Gonul Zisan; Cetinkaya, Ramazan; Pirim, Ibrahim; Polat, Kamil Yalcin

    2010-01-01

    Objective: Our goal is to investigate the distribution of MEFV mutations in patients with renal amyloidosis who are in renal transplant waiting list which is prepared for transplantation. Materials and Methods: FMF was diagnosed in 25 of the 297 patients between the years 2004 and 2008, who were involved in the study (15 male, 10 female; age 34±7.8). 5 out of 25 patients were transplanted, remaining were waiting for Tx. Biopsy results were amyloidosis and taken from renal (n:16), rectal (n:8) and duodenal (1).All of them were carrier of mutations in both pyrin alleles.The primer cause of chronic renal failure in our group was secondary AA amyloidosis. DNA was isolated from 25 whole blood samples. The NanoChip Molecular Biology Workstation (Nanogen) uses electronic microarrays for mutation detection. Exon 2,3,5 and 10 of pyrin gene genotypes were identified in the NanoChip. Results: Genetic analysis of the patients demonstrated that each subject carries either homozygote or compound heterozygote mutations of the gene. The most common mutations were M694V, V726A, E148Q and M680I. Conclusions: The clinic manifestation and complain of our patients were febrile and painful attacks such as in the abdomen, chest and joints due to inflammation of the peritoneum, pleura and synovial membrane. The major problem in FMF is the occurrence of amyloidosis that primarily affects the kidneys causing proteinuria and renal failure. Dialysis and renal transplantation can be treatment, but it is important to diagnose FMF at earliest stages. The percentage of FMF patients in our waiting list was 8.4%. Moreover, in our region FMF incidence is highly frequent, so FMF should be chased by genetically so as to prevent chronic renal failure due to amyloidosis. PMID:25610112

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

    Energy Technology Data Exchange (ETDEWEB)

    Sarriguren, P., E-mail: sarriguren@iem.cfmac.csic.e [Instituto de Estructura de la Materia, CSIC, Serrano 123, E-28006 Madrid (Spain)

    2009-10-12

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

  20. Family members' experiences of "wait and see" as a communication strategy in end-of-life decisions.

    Science.gov (United States)

    Lind, Ranveig; Lorem, Geir F; Nortvedt, Per; Hevrøy, Olav

    2011-07-01

    The aim of this study is to examine family members' experiences of end-of-life decision-making processes in Norwegian intensive care units (ICUs) to ascertain the degree to which they felt included in the decision-making process and whether they received necessary information. Were they asked about the patient's preferences, and how did they view their role as family members in the decision-making process? A constructivist interpretive approach to the grounded theory method of qualitative research was employed with interviews of 27 bereaved family members of former ICU patients 3-12 months after the patient's death. The core finding is that relatives want a more active role in end-of-life decision-making in order to communicate the patient's wishes. However, many consider their role to be unclear, and few study participants experienced shared decision-making. The clinician's expression "wait and see" hides and delays the communication of honest and clear information. When physicians finally address their decision, there is no time for family participation. Our results also indicate that nurses should be more involved in family-physician communication. Families are uncertain whether or how they can participate in the decision-making process. They need unambiguous communication and honest information to be able to take part in the decision-making process. We suggest that clinicians in Norwegian ICUs need more training in the knowledge and skills of effective communication with families of dying patients.