Sample records for waiting point nuclide

  1. Waiting Points in Nova and X-ray Burst Nucleosynthesis

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Sunayama, Tomomi; Smith, Michael Scott; Lingerfelt, Eric J

    2008-01-01

    In nova and X-ray burst nucleosynthesis, waiting points are nuclei in the reaction path which interrupt the nuclear flow towards heavier nuclei, typically because of a weak proton capture reaction and a long beta+ lifetime. Waiting points can influence the energy generation and final abundances synthesized in these explosions. We have constructed a systematic, quantitative set of criteria to identify rp-process waiting points, and use them to search for waiting points in post-processing simulations of novae and X-ray bursts. These criteria have been incorporated into the Computational Infrastructure for Nuclear Astrophysics, online at nucastrodata.org, to enable anyone to run customizedmore » searches for waiting points.« less

  2. Waiting Points in Nova and X-ray burst Nucleosynthesis

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Sunayama, Tomomi; Oak Ridge Institute for Science Education, Oak Ridge, Tennessee 37831-0117; Smith, Michael S.

    2008-05-21

    In nova and X-ray burst nucleosynthesis, waiting points are nuclei in the reaction path which delay the nuclear flow towards heavier nuclei, typically because of a weak proton capture reaction and a long {beta}{sup +} lifetime. Waiting points can influence the energy generation and final abundances synthesized in these explosions. We have constructed a systematic, quantitative set of criteria to identify rp-process waiting points, and use them to search for waiting points in post-processing simulations of novae and X-ray bursts. These criteria have been incorporated into the Computational Infrastructure for Nuclear Astrophysics, online at nucastrodata.org, to enable anyone to runmore » customized searches for waiting points.« less

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

    NASA Astrophysics Data System (ADS)

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

    2010-08-01

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

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

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Smith, Michael S.; Hix, W. Raphael; Nesaraja, Caroline D.

    2010-08-12

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

  5. Mass Measurements beyond the Major r-Process Waiting Point {sup 80}Zn

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Baruah, S.; Herlert, A.; Schweikhard, L.

    2008-12-31

    High-precision mass measurements on neutron-rich zinc isotopes {sup 71m,72-81}Zn have been performed with the Penning trap mass spectrometer ISOLTRAP. For the first time, the mass of {sup 81}Zn has been experimentally determined. This makes {sup 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. 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.

  6. Nuclide Guide and International Chart of Nuclides - 2008

    NASA Astrophysics Data System (ADS)

    Golashvili, T.

    2009-08-01

    New versions of Nuclide Guide and Chart of the Nuclides were developed as a result of Russian-Chinese collaboration. The Nuclide Guide contains the basic information on more than 3000 radioactive and stable nuclides. The characteristics of isomers with half-lives more than 1 ms are included. For each nuclide spin, parity, mass of nuclide, magnetic moment (if available), mass excess, half-life or abundance, decay modes, branching ratios, emitted particles, energies of most intense gamma-rays and their intensities, decay energies and mean values of radiation energy per decay are given. For stable and natural long-lived nuclides cross-sections of thermal neutron induced activation are indicated. The information presented in the Guide was compiled from 5 sources: 1) ENSDF-2008, 2) atomic mass evaluation-2005 by Audi and Wapstra, 3) interactive data bases at web-sites , , 4) original evaluations of authors, 5) recent publications. The International Chart ot Nuclides was developed on the basis of information presented in Nuclide Guide.

  7. Workshop on Cosmogenic Nuclides

    NASA Technical Reports Server (NTRS)

    Reedy, R. C. (Editor); Englert, P. (Editor)

    1986-01-01

    Abstracts of papers presented at the Workshop on Cosmogenic Nuclides are compiled. The major topic areas covered include: new techniques for measuring nuclides such as tandem accelerator and resonance mass spectrometry; solar modulation of cosmic rays; pre-irradiation histories of extraterrestrial materials; terrestrial studies; simulations and cross sections; nuclide production rate calculations; and meteoritic nuclides.

  8. Electron Waiting Times in Mesoscopic Conductors

    NASA Astrophysics Data System (ADS)

    Albert, Mathias; Haack, Géraldine; Flindt, Christian; Büttiker, Markus

    2012-05-01

    Electron transport in mesoscopic conductors has traditionally involved investigations of the mean current and the fluctuations of the current. A complementary view on charge transport is provided by the distribution of waiting times between charge carriers, but a proper theoretical framework for coherent electronic systems has so far been lacking. Here we develop a quantum theory of electron waiting times in mesoscopic conductors expressed by a compact determinant formula. We illustrate our methodology by calculating the waiting time distribution for a quantum point contact and find a crossover from Wigner-Dyson statistics at full transmission to Poisson statistics close to pinch-off. Even when the low-frequency transport is noiseless, the electrons are not equally spaced in time due to their inherent wave nature. We discuss the implications for renewal theory in mesoscopic systems and point out several analogies with level spacing statistics and random matrix theory.

  9. Are seismic waiting time distributions universal?

    NASA Astrophysics Data System (ADS)

    Davidsen, Jörn; Goltz, Christian

    2004-11-01

    We show that seismic waiting time distributions in California and Iceland have many features in common as, for example, a power-law decay with exponent α ~ 1.1 for intermediate and with exponent γ ~ 0.6 for short waiting times. While the transition point between these two regimes scales proportionally with the size of the considered area, the full distribution is not universal and depends in a non-trivial way on the geological area under consideration and its size. This is due to the spatial distribution of epicenters which does not form a simple mono-fractal. Yet, the dependence of the waiting time distributions on the threshold magnitude seems to be universal.

  10. 2017 update of the discoveries of nuclides

    NASA Astrophysics Data System (ADS)

    Thoennessen, M.

    The 2017 update of the discovery of nuclide project is presented. 34 new nuclides were observed for the first time in 2017. However, the assignment of six previously identified nuclides had to be retracted.

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

    PubMed

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

    2012-09-18

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

  12. Ground-state proton decay of 69Br and implications for the rp -process 68Se waiting-point

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Rogers, Andrew M; Shapira, Dan; Lynch, William

    2011-01-01

    The first direct measurement of the proton separation energy, S p , for the proton-unbound nucleus 69Br is reported. Of interest is the exponential dependence of the 2 p-capture rate on S p which can bypass the 68Se waiting-point in the astrophysical rp process. An analysis of the observed proton decay spectrum is given in terms of the 69Se mirror nucleus and the influence of S p is explored within the context of a single-zone X-ray burst model.

  13. Impact of the single point of access referral system to reduce waiting times and improve clinical outcomes in an assistive technology service.

    PubMed

    Hosking, Jonathan; Gibson, Colin

    2016-07-01

    The introduction of a single point referral system that prioritises clients depending on case complexity and overcomes the need for re-admittance to a waiting list via a review system has been shown to significantly reduce maximum waiting times for a Posture and Mobility (Special Seating) Service from 102.0 ± 24.33 weeks to 19.2 ± 8.57 weeks (p = 0.015). Using this service model linear regression revealed a statistically significant improvement in the performance outcome of prescribed seating solutions with shorter Episode of Care completion times (p = 0.023). In addition, the number of Episodes of Care completed per annum was significantly related to the Episode of Care completion time (p = 0.019). In conclusion, it is recommended that it may be advantageous to apply this service model to other assistive technology services in order to reduce waiting times and to improve clinical outcomes.

  14. Alpha-emitting nuclides in the marine environment

    NASA Astrophysics Data System (ADS)

    Pentreath, R. J.

    1984-06-01

    The occurrence of alpha-emitting nuclides and their daughter products in the marine environment continues to be a subject of study for many reasons. Those nuclides which occur naturally, in the uranium, thorium and actinium series, are of interest because of their value in determining the rates of geological and geochemical processes in the oceans. Studies of them address such problems as the determination of rates of transfer of particulate matter, deposition rates, bioturbation rates, and so on. Two of the natural alpha-series nuclides in which a different interest has been expressed are 210Po and 226Ra, because their concentrations in marine organisms are such that they contribute to a significant fraction of the background dose rates sustained both by the organisms themselves and by consumers of marine fish and shellfish. To this pool of naturally-occurring nuclides, human activities have added the transuranium nuclides, both from the atmospheric testing of nuclear devices and from the authorized discharges of radioactive wastes into coastal waters and the deep sea. Studies have therefore been made to understand the chemistry of these radionuclides in sea water, their association with sedimentary materials, and their accumulation by marine organisms, the last of these being of particular interest because the transuranics are essentially "novel" elements to the marine fauna and flora. The need to predict the long-term behaviour of these nuclides has, in turn, stimulated research on those naturally-occurring nuclides which may behave in a similar manner.

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

    PubMed

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

    2016-05-01

    The aim of this study was to assess differences in perceived versus actual wait times among patients undergoing outpatient MRI examinations and to correlate those times with patient satisfaction. Over 15 weeks, 190 patients presenting for outpatient MR in a radiology department in which "patient experience" is one of the stated strategic priorities were asked to (1) estimate their wait times for various stages in the imaging process and (2) state their satisfaction with their imaging experience. Perceived times were compared with actual electronic time stamps. Perceived and actual times were compared and correlated with standardized satisfaction scores using Kendall τ correlation. The mean actual wait time between patient arrival and examination start was 53.4 ± 33.8 min, whereas patients perceived a mean wait time of 27.8 ± 23.1 min, a statistically significant underestimation of 25.6 min (P < .001). Both shorter actual and perceived wait times at all points during patient encounters were correlated with higher satisfaction scores (P < .001). Patients undergoing outpatient MR examinations in an environment designed to optimize patient experience underestimated wait times at all points during their encounters. Shorter perceived and actual wait times were both correlated with higher satisfaction scores. As satisfaction surveys play a larger role in an environment of metric transparency and value-based payments, better understanding of such factors will be increasingly important. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  16. Shielding and activity estimator for template-based nuclide identification methods

    DOEpatents

    Nelson, Karl Einar

    2013-04-09

    According to one embodiment, a method for estimating an activity of one or more radio-nuclides includes receiving one or more templates, the one or more templates corresponding to one or more radio-nuclides which contribute to a probable solution, receiving one or more weighting factors, each weighting factor representing a contribution of one radio-nuclide to the probable solution, computing an effective areal density for each of the one more radio-nuclides, computing an effective atomic number (Z) for each of the one more radio-nuclides, computing an effective metric for each of the one or more radio-nuclides, and computing an estimated activity for each of the one or more radio-nuclides. In other embodiments, computer program products, systems, and other methods are presented for estimating an activity of one or more radio-nuclides.

  17. Cosmogenic nuclide budgeting of floodplain sediment transfer

    NASA Astrophysics Data System (ADS)

    Wittmann, H.; von Blanckenburg, F.

    2009-08-01

    Cosmogenic nuclides produced in quartz may either decay or accumulate while sediment is moved through a river basin. A change in nuclide concentration resulting from storage in a floodplain is potentially important in large drainage basins in which sediment is prone to repeated burial and remobilization as a river migrates through its floodplain. We have modeled depth- and time-dependent cosmogenic nuclide concentration changes for 10Be, 26Al, and 14C during sediment storage and mixing in various active floodplain settings ranging from confined, shallow rivers with small floodplains to foreland-basin scale floodplains traversed by deep rivers. Floodplain storage time, estimated from channel migration rates, ranges from 0.4 kyr for the Beni River basin (Bolivia) to 7 kyr for the Amazon River basin, while floodplain storage depth, estimated from channel depth, ranges from 1 to 25 m. For all modeled active floodplain settings, the long-lived nuclides 10Be and 26Al show neither significant increase in nuclide concentration from irradiation nor decrease from decay. We predict a hypothetical response time after which changes in 10Be or 26Al concentrations become analytically resolvable. This interval ranges from 0.07 to 2 Myr and exceeds in all cases the typical residence time of sediment in a floodplain. Due to the much shorter half life of 14C, nuclide concentrations modeled for the in situ-produced variety of this nuclide are, however, sensitive to floodplain storage on residence times of < 20 kyr. The cosmogenic nuclide composition of old deposits in currently inactive floodplains that have been isolated for periods of millions of years from the river that once deposited them is predicted to either increase or decrease in 10Be and 26Al concentration, depending on the depositional depth. These conditions can be evaluated using the 26Al/ 10Be ratio that readily discloses the depth and duration of storage. We illustrate these models with examples from the Amazon basin

  18. Surficial Studies of Mars Using Cosmogenic Nuclides

    NASA Technical Reports Server (NTRS)

    Nishiizumi, K.

    2001-01-01

    Cosmogenic nuclides (CNs) are produced by cosmic-ray nuclear interactions with target nuclei in rocks, soils, ice, and the atmosphere. Cosmogenic nuclides have been widely used for investigation of solar system matter for several decades. Stable nuclides, such as He-3, Ne-21, and Ar-38, are built up over time as the surface is exposed to cosmic rays. The concentrations of cosmogenic radionuclides, such as Be-10, Al-26, and C-14 also build up with exposure time but reach saturation values after several half-lives. Especially since the development of accelerator mass spectrometry (AMS), CNs in terrestrial samples have been routinely used for geomorphic studies such as glaciation, surface erosion, and tectonics, and studies of atmospheric and ocean circulation. Cosmogenic nuclides on Mars will be able to answer questions of exposure ages, erosion rates, tectonic events, and deposition rates of sediments and/or volatiles. The concentrations of cosmogenic stable nuclides give the integrated exposure time of the rock/mineral, and the activities of radionuclides give recent records for times back as long as a few half-lives.

  19. Algorithm improvement program nuclide identification algorithm scoring criteria and scoring application.

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Enghauser, Michael

    2016-02-01

    The goal of the Domestic Nuclear Detection Office (DNDO) Algorithm Improvement Program (AIP) is to facilitate gamma-radiation detector nuclide identification algorithm development, improvement, and validation. Accordingly, scoring criteria have been developed to objectively assess the performance of nuclide identification algorithms. In addition, a Microsoft Excel spreadsheet application for automated nuclide identification scoring has been developed. This report provides an overview of the equations, nuclide weighting factors, nuclide equivalencies, and configuration weighting factors used by the application for scoring nuclide identification algorithm performance. Furthermore, this report presents a general overview of the nuclide identification algorithm scoring application including illustrative examples.

  20. Individual and system influences on waiting time for substance abuse treatment.

    PubMed

    Carr, Carey J A; Xu, Jiangmin; Redko, Cristina; Lane, D Timothy; Rapp, Richard C; Goris, John; Carlson, Robert G

    2008-03-01

    Waiting time is a contemporary reality of many drug abuse treatment programs, resulting in substantial problems for substance users and society. Individual and system factors that influence waiting time are diverse and may vary at different points in the treatment continuum. This study assessed waiting time preceding clinical assessment at a centralized intake unit and during the period after the assessment but before treatment entry. The present study included 577 substance abusers who were enrolled in a large clinical trial of two brief treatment interventions in a midsize metropolitan area in Ohio. Bivariate analyses identified individual and system factors that influenced preassessment and postassessment waiting time, as well as total wait to treatment services. Multivariate analyses demonstrated that longer wait time for an assessment is influenced by being court referred, less belief in having a substance abuse problem, and less desire for change. A shorter wait to actually enter treatment is predicted by having a case manager, being more ready for treatment, and having less severe employment and alcohol problems. The different influences present during the two waiting periods suggest that assessment and treatment programs need to implement system changes and entry enhancement interventions that are specific to the needs of substance abusers at each waiting period.

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

    ERIC Educational Resources Information Center

    Swift, J. Nathan; And Others

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

  2. 'The waiting game': are current chlamydia and gonorrhoea near-patient/point-of-care tests acceptable to service users and will they impact on treatment?

    PubMed

    Atkinson, Lindsay M; Vijeratnam, Dayan; Mani, Reena; Patel, Raj

    2016-07-01

    The objective of this study was to assess the length of time service users were prepared to wait for chlamydia and gonorrhoea (CT/GC) near-patient/point-of-care test (NP-POCT) results and to determine the possible effect on management. Individuals attending two UK clinics from November 2013 to February 2014 were surveyed asking the maximum length of time they would wait for CT/GC NP-POCT results after consultation. Linked CT/GC prevalence and treatment rates were analysed. A total of 1817 participants were surveyed, and 1356 provided CT/GC NAAT samples, in which it was found that 115 (8.5%) could wait over 90 minutes in clinic for their result. 115 received treatment at consultation, of which 50 were CT/GC negative and 12 were treated for urethritis or cervicitis; 38 attended as CT/GC contacts. Six of this population would have waited over 90 minutes were NP-POCTs available. A total of 129 tested CT/GC positive, of whom 65 were treated at their consultation, 61 at a later date, and three were untreated. Twelve of these 129 patients would also have waited over 90 minutes for a NP-POCT result. We conclude that 90-minute NP-POCTs are not acceptable to most clinic attendees and would not have impacted on treatment rates or inappropriate prescribing, and 20-minute NP-POCTs show a marginal benefit in treating CT/GC. While NP-POCTs for CT/GC are promising, they must meet client expectations and enhance disease management in order to be accepted by patients and clinicians. © The Author(s) 2015.

  3. Algorithm Improvement Program Nuclide Identification Algorithm Scoring Criteria And Scoring Application - DNDO.

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Enghauser, Michael

    2015-02-01

    The goal of the Domestic Nuclear Detection Office (DNDO) Algorithm Improvement Program (AIP) is to facilitate gamma-radiation detector nuclide identification algorithm development, improvement, and validation. Accordingly, scoring criteria have been developed to objectively assess the performance of nuclide identification algorithms. In addition, a Microsoft Excel spreadsheet application for automated nuclide identification scoring has been developed. This report provides an overview of the equations, nuclide weighting factors, nuclide equivalencies, and configuration weighting factors used by the application for scoring nuclide identification algorithm performance. Furthermore, this report presents a general overview of the nuclide identification algorithm scoring application including illustrative examples.

  4. [Gender and age differences in waiting time on hospital waiting list.].

    PubMed

    Thornórðardóttir, Steinunn; Halldórsson, Matthías; Guðmundsson, Sigurður

    2002-09-01

    The size of waiting lists has traditionally been viewed as a fairly good measure of the quality of health care services. No statistical analysis exists in Iceland of the length of waiting times and the potential variation between groups of patients. This study was conducted within the office of the Directorate of Health in Iceland. This location was convenient since standardized information on waiting lists is collected by the office three times a year. Variations in waiting times were studied based on gender on the one hand and on age on the other. Data from the largest waiting lists, those amounting to 400 or more patients, were included in the study. The most frequently awaited operations were identified and the groups of people waiting for them analyzed. The departments and prospective operations included in the study were: Dept. of General Surgery at the University Hospital (UH) (laparoscopic gastro-oesophageal antireflux operation), Opthalmology at UH (phakoemulsification with implantation of artificial lens in posterior chamber), Orthopedic Surgery at UH (primary total prosthetic replacement of hip joint using sement), The Rehabilitation Center at Reykjalundur (rehabilitation, not specified), Ear, Nose and Throat (ENT) at UH (tonsillectomy), and Reconstructive Surgery at UH (reduction mammoplasty with transposition of areola). The lists were sorted by gender and age, with the latter consisting of two categories, older and younger patients. Every attempt was made as to ensure similar sample sizes for both age groups within each department. Finally, the median waiting time was determined and a Mann-Whitney test conducted in order to test for significance. The median waiting time for males at the General Surgery Dept. was 73 weeks as compared to 60 weeks for females. This was the only department where the median waiting time was significantly longer for males than for females (p<0.05). At three of the departments the older group had a longer median waiting time

  5. Waiting for cataract surgery--effects of a maximum waiting-time guarantee.

    PubMed

    Hanning, Marianne; Lundström, Mats

    2007-01-01

    To evaluate the effects of the Maximum Waiting-time Guarantee (MWG) policy for cataract surgery on volume, indications, waiting times and priority setting in Sweden. Comparison between 1993 and 1994, when the guarantee had been in force for one year, and 1998 and 1999, when the policy had been terminated for one year. Data from the National Cataract Registry covering 156,657 cataract operations for the years studied. The number of operations increased by 43% between the two study periods. Of this increase, 61% were patients with a visual acuity above 0.5 in the better eye, i.e. low-priority patients. Waiting times were longer for all patient categories in the later period and differences in waiting times between patients with differing priority diminished. Variations among the units in priority setting and waiting times were substantial, and increased after the Guarantee was terminated. The Guarantee with its explicit indications was an effective policy instrument to limit waiting times and improve access for patients with the greatest need. It is unlikely that the Guarantee caused any 'crowding out' of other patient groups. When the Guarantee was not in force, indications for surgery widened. This, however, resulted in longer waiting times for all patient groups. After the Guarantee was terminated, the already substantial differences in access and indications among ophthalmic units became even greater.

  6. Cosmogenic nuclides in football-sized rocks.

    NASA Technical Reports Server (NTRS)

    Wahlen, M.; Honda, M.; Imamura, M.; Fruchter, J. S.; Finkel, R. C.; Kohl, C. P.; Arnold, J. R.; Reedy, R. C.

    1972-01-01

    The activity of long- and short-lived isotopes in a series of samples from a vertical column through the center of rock 14321 was measured. Rock 14321 is a 9 kg fragmental rock whose orientation was photographically documented on the lunar surface. Also investigated was a sample from the lower portion of rock 14310, where, in order to study target effects, two different density fractions (mineral separates) were analyzed. A few nuclides in a sample from the comprehensive fines 14259 were measured. This material has been collected largely from the top centimeter of the lunar soil. The study of the deep samples of 14321 and 14310 provided values for the activity of isotopes at points where only effects produced by galactic cosmic rays are significant.

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

    PubMed Central

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

    2010-01-01

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

  8. Ground-state proton decay of 69Br and implications for the 68Se astrophysical rp-process waiting point

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Rogers, Andrew M; Famiano, Micahel; Lynch, William

    2011-01-01

    We report on the first direct measurement of the proton separation energy for the proton-unbound nucleus {sup 69}Br. Bypassing the {sup 68}Se waiting point in the rp process is directly related to the 2p-capture rate through {sup 69}Br, which depends exponentially on the proton separation energy. We find a proton separation energy for {sup 69}Br of S{sub p}({sup 69}Br) = -785{sub -40}{sup +34} keV; this is less bound compared to previous predictions which have relied on uncertain theoretical calculations. The influence of the extracted proton separation energy on the rp process occurring in type I x-ray bursts is examined withinmore » the context of a one-zone burst model.« less

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

    PubMed

    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. The waiting time problem in a model hominin population.

    PubMed

    Sanford, John; Brewer, Wesley; Smith, Franzine; Baumgardner, John

    2015-09-17

    Functional information is normally communicated using specific, context-dependent strings of symbolic characters. This is true within the human realm (texts and computer programs), and also within the biological realm (nucleic acids and proteins). In biology, strings of nucleotides encode much of the information within living cells. How do such information-bearing nucleotide strings arise and become established? This paper uses comprehensive numerical simulation to understand what types of nucleotide strings can realistically be established via the mutation/selection process, given a reasonable timeframe. The program Mendel's Accountant realistically simulates the mutation/selection process, and was modified so that a starting string of nucleotides could be specified, and a corresponding target string of nucleotides could be specified. We simulated a classic pre-human hominin population of at least 10,000 individuals, with a generation time of 20 years, and with very strong selection (50% selective elimination). Random point mutations were generated within the starting string. Whenever an instance of the target string arose, all individuals carrying the target string were assigned a specified reproductive advantage. When natural selection had successfully amplified an instance of the target string to the point of fixation, the experiment was halted, and the waiting time statistics were tabulated. Using this methodology we tested the effect of mutation rate, string length, fitness benefit, and population size on waiting time to fixation. Biologically realistic numerical simulations revealed that a population of this type required inordinately long waiting times to establish even the shortest nucleotide strings. To establish a string of two nucleotides required on average 84 million years. To establish a string of five nucleotides required on average 2 billion years. We found that waiting times were reduced by higher mutation rates, stronger fitness benefits, and

  11. Identifying the Root Causes of Wait States in Large-Scale Parallel Applications

    DOE PAGES

    Böhme, David; Geimer, Markus; Arnold, Lukas; ...

    2016-07-20

    Driven by growing application requirements and accelerated by current trends in microprocessor design, the number of processor cores on modern supercomputers is increasing from generation to generation. However, load or communication imbalance prevents many codes from taking advantage of the available parallelism, as delays of single processes may spread wait states across the entire machine. Moreover, when employing complex point-to-point communication patterns, wait states may propagate along far-reaching cause-effect chains that are hard to track manually and that complicate an assessment of the actual costs of an imbalance. Building on earlier work by Meira Jr. et al., we present amore » scalable approach that identifies program wait states and attributes their costs in terms of resource waste to their original cause. Ultimately, by replaying event traces in parallel both forward and backward, we can identify the processes and call paths responsible for the most severe imbalances even for runs with hundreds of thousands of processes.« less

  12. Identifying the Root Causes of Wait States in Large-Scale Parallel Applications

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Böhme, David; Geimer, Markus; Arnold, Lukas

    Driven by growing application requirements and accelerated by current trends in microprocessor design, the number of processor cores on modern supercomputers is increasing from generation to generation. However, load or communication imbalance prevents many codes from taking advantage of the available parallelism, as delays of single processes may spread wait states across the entire machine. Moreover, when employing complex point-to-point communication patterns, wait states may propagate along far-reaching cause-effect chains that are hard to track manually and that complicate an assessment of the actual costs of an imbalance. Building on earlier work by Meira Jr. et al., we present amore » scalable approach that identifies program wait states and attributes their costs in terms of resource waste to their original cause. Ultimately, by replaying event traces in parallel both forward and backward, we can identify the processes and call paths responsible for the most severe imbalances even for runs with hundreds of thousands of processes.« less

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

    PubMed

    Gravelle, Hugh; Siciliani, Luigi

    2009-08-01

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

  14. Cosmogenic-nuclide production by primary cosmic-ray protons

    NASA Technical Reports Server (NTRS)

    Reedy, R. C.

    1985-01-01

    The production rates of cosmogenic nuclides were calculated for the primary protons in the galactic and solar cosmic rays. At 1 AU, the long-term average fluxes of solar protons usually produce many more atoms of cosmogenic nuclide than the primary protons in the galactic cosmic rays (GCR). Because the particle fluxes inside meteorites and other large objects in space include many secondary neutrons, the production rates and ratios inside large objects are often very different from those by just the primary GCR protons. It is possible to determine if a small object, was small in space or broken from a meteorite. Because heliospherical modulation and other interactions change the GCR particle spectrum, the production of cosmogenic nuclides by the GCR particles outside the heliosphere will be different from that by modulated GCR primaries.

  15. 46 CFR 9.10 - Waiting time.

    Code of Federal Regulations, 2010 CFR

    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. ...

  16. 46 CFR 9.10 - Waiting time.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Waiting time. 9.10 Section 9.10 Shipping COAST GUARD... § 9.10 Waiting time. The same construction should be given the act when charging for waiting time as... for duty the waiting time amounts to at least one hour. ...

  17. 46 CFR 9.10 - Waiting time.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 1 2011-10-01 2011-10-01 false Waiting time. 9.10 Section 9.10 Shipping COAST GUARD... § 9.10 Waiting time. The same construction should be given the act when charging for waiting time as... for duty the waiting time amounts to at least one hour. ...

  18. Consumer behaviour in the waiting area.

    PubMed

    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.

  19. Handgun waiting periods reduce gun deaths

    PubMed Central

    Luca, Michael; Malhotra, Deepak

    2017-01-01

    Handgun waiting periods are laws that impose a delay between the initiation of a purchase and final acquisition of a firearm. We show that waiting periods, which create a “cooling off” period among buyers, significantly reduce the incidence of gun violence. We estimate the impact of waiting periods on gun deaths, exploiting all changes to state-level policies in the Unites States since 1970. We find that waiting periods reduce gun homicides by roughly 17%. We provide further support for the causal impact of waiting periods on homicides by exploiting a natural experiment resulting from a federal law in 1994 that imposed a temporary waiting period on a subset of states. PMID:29078268

  20. Can We Predict Patient Wait Time?

    PubMed

    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.

  1. Handgun waiting periods reduce gun deaths.

    PubMed

    Luca, Michael; Malhotra, Deepak; Poliquin, Christopher

    2017-11-14

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

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

    PubMed

    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. 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

    PubMed Central

    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

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

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Joseph, A; Herrera, D; Hijal, T

    Purpose: Waiting times remain one of the most vexing patient satisfaction challenges facing healthcare. Waiting time uncertainty can cause patients, who are already sick or in pain, to worry about when they will receive the care they need. These waiting periods are often difficult for staff to predict and only rough estimates are typically provided based on personal experience. This level of uncertainty leaves most patients unable to plan their calendar, making the waiting experience uncomfortable, even painful. In the present era of electronic health records (EHRs), waiting times need not be so uncertain. Extensive EHRs provide unprecedented amounts ofmore » data that can statistically cluster towards representative values when appropriate patient cohorts are selected. Predictive modelling, such as machine learning, is a powerful approach that benefits from large, potentially complex, datasets. The essence of machine learning is to predict future outcomes by learning from previous experience. The application of a machine learning algorithm to waiting time data has the potential to produce personalized waiting time predictions such that the uncertainty may be removed from the patient’s waiting experience. Methods: In radiation oncology, patients typically experience several types of waiting (eg waiting at home for treatment planning, waiting in the waiting room for oncologist appointments and daily waiting in the waiting room for radiotherapy treatments). A daily treatment wait time model is discussed in this report. To develop a prediction model using our large dataset (with more than 100k sample points) a variety of machine learning algorithms from the Python package sklearn were tested. Results: We found that the Random Forest Regressor model provides the best predictions for daily radiotherapy treatment waiting times. Using this model, we achieved a median residual (actual value minus predicted value) of 0.25 minutes and a standard deviation residual of 6

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

    PubMed

    Gravelle, Hugh; Siciliani, Luigi

    2008-09-01

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

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

    PubMed

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

    2011-04-01

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

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

    NASA Astrophysics Data System (ADS)

    Nabi, Jameel-Un; Böyükata, Mahmut

    2017-01-01

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

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

    NASA Astrophysics Data System (ADS)

    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

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

    PubMed

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

    2014-12-01

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

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

    DOE Office of Scientific and Technical Information (OSTI.GOV)

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

    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 themore » 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)« less

  11. Nuclides Economy

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Ivanov, Evgeny; Subbotin, Stanislav

    2007-07-01

    Traditionally the subject of discussion about the nuclear technology development is focused on the conditions that facilitate the nuclear power deployment. The main objective of this work is seeking of methodological basis for analysis of the coupling consequences of nuclear development. Nuclide economy is the term, which defines a new kind of society relations, dependent on nuclear technology development. It is rather closed to the setting of problems then to the solving of them. Last year Dr. Jonathan Tennenbaum published in Executive Intelligence Review Vol. 33 no 40 the article entitled as 'The Isotope Economy' where main interconnections for nuclearmore » energy technologies and their infrastructure had been explained on the popular level. There he has given several answers and, therefore, just here we will try to expand this concept. We were interested by this publication because of similarity of our vision of resource base of technologies development. The main paradigm of 'Isotope economy' was expresses by Lyndon H. LaRouche: 'Instead of viewing the relevant resources of the planet as if they were a fixed totality, we must now assume responsibility of man's creating the new resources which will be more than adequate to sustain a growing world population at a constantly improved standard of physical per-capita output, and personal consumption'. We also consider the needed resources as a dynamic category. Nuclide economy and nuclide logistics both are needed for identifying of the future development of nuclear power as far we follow the holistic analysis approach 'from cave to grave'. Thus here we try to reasoning of decision making procedures and factors required for it in frame of innovative proposals development and deployment. The nuclear power development is needed in humanitarian scientific support with maximally deep consideration of all inter-disciplinary aspects of the nuclear power and nuclear technologies implementation. The main objectives for

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

    PubMed

    Sweeny, Kate; Howell, Jennifer L

    2017-10-01

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

  13. Ground-state proton decay of {sup 69}Br and implications for the {sup 68}Se astrophysical rapid proton-capture process waiting point.

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Rogers, A. M.; Famiano, M. A.; Lynch, W. G.

    2011-06-24

    We report on the first direct measurement of the proton separation energy for the proton-unbound nucleus {sup 69}Br. Bypassing the {sup 68}Se waiting point in the rp process is directly related to the 2p-capture rate through {sup 69}Br, which depends exponentially on the proton separation energy. We find a proton separation energy for {sup 69}Br of S{sub p}({sup 69}Br) = -785{sub -40}{sup +34} keV; this is less bound compared to previous predictions which have relied on uncertain theoretical calculations. The influence of the extracted proton separation energy on the rp process occurring in type I x-ray bursts is examined withinmore » the context of a one-zone burst model.« less

  14. Fault-tolerant wait-free shared objects

    NASA Technical Reports Server (NTRS)

    Jayanti, Prasad; Chandra, Tushar D.; Toueg, Sam

    1992-01-01

    A concurrent system consists of processes communicating via shared objects, such as shared variables, queues, etc. The concept of wait-freedom was introduced to cope with process failures: each process that accesses a wait-free object is guaranteed to get a response even if all the other processes crash. However, if a wait-free object 'crashes,' all the processes that access that object are prevented from making progress. In this paper, we introduce the concept of fault-tolerant wait-free objects, and study the problem of implementing them. We give a universal method to construct fault-tolerant wait-free objects, for all types of 'responsive' failures (including one in which faulty objects may 'lie'). In sharp contrast, we prove that many common and interesting types (such as queues, sets, and test&set) have no fault-tolerant wait-free implementations even under the most benign of the 'non-responsive' types of failure. We also introduce several concepts and techniques that are central to the design of fault-tolerant concurrent systems: the concepts of self-implementation and graceful degradation, and techniques to automatically increase the fault-tolerance of implementations. We prove matching lower bounds on the resource complexity of most of our algorithms.

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

    MedlinePlus

    ... 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 ...

  16. Waiting for thyroid surgery: a study of psychological morbidity and determinants of health associated with long wait times for thyroid surgery.

    PubMed

    Eskander, Antoine; Devins, Gerald M; Freeman, Jeremy; Wei, Alice C; Rotstein, Lorne; Chauhan, Nitin; Sawka, Anna M; Brown, Dale; Irish, Jonathan; Gilbert, Ralph; Gullane, Patrick; Higgins, Kevin; Enepekides, Danny; Goldstein, David

    2013-02-01

    Patients with thyroid pathology tend have longer surgical wait times. Uncertainty during this wait can have negative psychologically impact. This study aims to determine the degree of psychological morbidity in patients waiting for thyroid surgery. Prospectively assessing patients pre- and postoperative psychological morbidity (level 2c). Patients waiting for thyroidectomy were mailed a sociodemographic and four psychological morbidity questionnaires: Impact of Events Scale-Revised (IES-R), Illness Intrusiveness Ratings Scale (IIRS), Perceived Stress Scale (PSS) and Hospital Anxiety and Depression Scale (HADS). We assessed whether anxiety was related to length of wait and a number of clinical/sociodemographic factors. We achieved a 53% response rate over a 3-year period, with 176 patients providing complete preoperative data; and 74 (42%) completed postoperative data. The average age was 53 (± 12) years; 82% were female. Respondents with a suspicious or known malignancy waited an average of 107 days while those with benign neoplastic biopsies waited an average of 218 days for thyroidectomy. Respondents reported substantial psychological morbidity with high IES-R, IIRS, PSS, and HADS scores. There was no significant association between psychological morbidity and wait times, clinical or sociodemographic factors. Postoperative anxiety decreased significantly in all psychological morbidity measures except for the IIRS. Patients waiting for thyroid surgery have mild to moderate psychological morbidity and long wait times for surgery. These appear not to be related. Psychological morbidity decreases after surgery. Reducing wait time can potentially reduce the time that patients have to live with unnecessary stress and anxiety. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

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

    PubMed

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

    2015-10-01

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

  18. Designs for testing group-based interventions with limited numbers of social units: The dynamic wait-listed and regression point displacement designs

    PubMed Central

    Wyman, Peter A.; Brown, C. Hendricks

    2015-01-01

    The dynamic wait-listed design (DWLD) and regression point displacement design (RPDD) address several challenges in evaluating group-based interventions when there is a limited number of groups. Both DWLD and RPDD utilize efficiencies that increase statistical power and can enhance balance between community needs and research priorities. The DWLD blocks on more time units than traditional wait-listed designs, thereby increasing the proportion of a study period during which intervention and control conditions can be compared, and can also improve logistics of implementing intervention across multiple sites and strengthen fidelity. We discuss DWLDs in the larger context of roll-out randomized designs and compare it with its cousin the Stepped Wedge design. The RPDD uses archival data on the population of settings from which intervention unit(s) are selected to create expected posttest scores for units receiving intervention, to which actual posttest scores are compared. High pretest-posttest correlations give the RPDD statistical power for assessing intervention impact even when one or a few settings receive intervention. RPDD works best when archival data are available over a number of years prior to and following intervention. If intervention units were not randomly selected, propensity scores can be used to control for nonrandom selection factors. Examples are provided of the DWLD and RPDD used to evaluate, respectively, suicide prevention training (QPR) in 32 schools and a violence prevention program (CeaseFire) in 2 Chicago police districts over a 10-year period. How DWLD and RPDD address common threats to internal and external validity, as well as their limitations, are discussed. PMID:25481512

  19. Cosmogenic Nuclides Study of Large Iron Meteorites

    NASA Astrophysics Data System (ADS)

    Hutzler, A.; Smith, T.; Rochette, P.; Bourles, D. L.; Leya, I.; Gattacceca, J.

    2014-09-01

    Six large iron meteorites were selected (Saint-Aubin, Mont-Dieu, Caille, Morasko, Agoudal, and Gebel Kamil). We measured stable and radiogenic cosmogenic nuclides, to study pre-atmospheric size, cosmic-ray exposure ages and terrestrial ages.

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

    PubMed

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

    1999-04-01

    To elicit patients' maximal acceptable waiting times (MAWT) for non-urgent coronary artery bypass grafting (CABG), and to determine if MAWT is related to prior expectations of waiting times, symptom burden, expected relief, or perceived risks of myocardial infarction while waiting. Seventy-two patients on an elective CABG waiting list chose between two hypothetical but plausible options: a 1-month wait with 2% risk of surgical mortality, and a 6-month wait with 1% risk of surgical mortality. Waiting time in the 6-month option was varied up if respondents chose the 6-month/lower risk option, and down if they chose the 1-month/higher risk option, until the MAWT switch point was reached. Patients also reported their expected waiting time, perceived risks of myocardial infarction while waiting, current function, expected functional improvement and the value of that improvement. Only 17 (24%) patients chose the 6-month/1% risk option, while 55 (76%) chose the 1-month/2% risk option. The median MAWT was 2 months; scores ranged from 1 to 12 months (with two outliers). Many perceived high cumulative risks of myocardial infarction if waiting for 1 (upper quartile, > or = 1.45%) or 6 (upper quartile, > or = 10%) months. However, MAWT scores were related only to expected waiting time (r = 0.47; P < 0.0001). Most patients reject waiting 6 months for elective CABG, even if offered along with a halving in surgical mortality (from 2% to 1%). Intolerance for further delay seems to be determined primarily by patients' attachment to their scheduled surgical dates. Many also have severely inflated perceptions of their risk of myocardial infarction in the queue. These results suggest a need for interventions to modify patients' inaccurate risk perceptions, particularly if a scheduled surgical date must be deferred.

  1. Influence of nurse navigation on wait times for breast cancer care in a Canadian regional cancer center.

    PubMed

    Baliski, Christopher; McGahan, Colleen E; Liberto, Caitlyn M; Broughton, Sandra; Ellard, Susan; Taylor, Marianne; Bates, Janet; Lai, Anky

    2014-05-01

    The wait times for breast cancer care in our region do not meet acceptable benchmarks. We implemented the Interior Breast Rapid Access Investigation and Diagnosis (IB-RAPID) nurse navigation program to address this issue. The IB-RAPID prospective database was reviewed for patients entering the program between April 1, 2011 and April 30, 2012 (2011/2012 cohort), and was compared with patients from the same area in 2010. The main end point was the time between the 1st diagnostic imaging test and the surgery. Multiple linear regression was performed to investigate factors influencing the wait times. The wait times decreased with the introduction of IB-RAPID (59 vs 48 days; median). Stage of disease, total number of biopsies, and magnetic resonance imaging (MRI) use influenced wait times. MRI significantly delayed surgical intervention in both groups with those not having an MRI having a shorter wait time to surgery (68.5 vs 57.6 days; mean) in 2011/2012. The implementation of nurse navigation for patients with breast cancer appears to be effective at reducing the wait times for surgical treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

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

    PubMed

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

    2014-03-01

    Prolonged admit wait times in the emergency department (ED) for patients who require hospitalization lead to increased boarding time in the ED, a significant cause of ED congestion. This is associated with decreased quality of care, higher morbidity and mortality, decreased patient satisfaction, increased costs for care, ambulance diversion, higher numbers of patients who leave without being seen (LWBS), and delayed care with longer lengths of stay (LOS) for other ED patients. The objective was to assess the effect of a leadership-based program to expedite hospital admissions from the ED. This before-and-after observational study was undertaken from 2006 through 2011 at one community hospital ED. A team of ED and hospital leaders implemented a program to reduce admit wait times, using a computerized hospital-wide tracking system to monitor inpatient and ED bed status. The team collaboratively and consistently moved ED patients to their inpatient beds within an established goal of 60 minutes after an admission decision was reached. Top leadership actively intervened in real time by contacting staff whenever delays occurred to expedite immediate solutions to achieve the 60-minute goal. The primary outcome measures were the percentage of ED patients who were admitted to inpatient beds within 60 minutes from the time the beds were requested and ED boarding time. LOS, patient satisfaction, LWBS rate, and ambulance diversion hours were also measured. After ED census, hospital admission rates, and ED bed capacity were controlled for using a multivariable linear regression analysis, the admit wait time reduction program contributed to an increase in patients being admitted to the hospital within 60 minutes by 16 percentage points (95% confidence intervals [CI] = 10 to 22 points; p < 0.0001) and a decrease in boarding time per admission of 46 minutes (95% CI = 63 to 82 minutes; p < 0.0001). LOS decreased for admitted patients by 79 minutes (95% CI = 55 to 104 minutes; p < 0

  3. Interactive Chart of Nuclides

    Science.gov Websites

    Chart of Nuclides Click on a nucleus for information Color code Half-life Decay Mode Qβ- QEC QÎ Radiation Help - Glossary This site is better seen using the latest version of internet browsers. Database ²+ Sn Sp Qα S2n S2p Q2β- Q2EC QECp Qβ-n BE/A (BE-LDM Fit)/A E1st ex. st. E2+ E3- E4+ E4+/E2+ β2 B(E2

  4. Stochastic nature of series of waiting times.

    PubMed

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

    2013-06-01

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

  5. Stochastic nature of series of waiting times

    NASA Astrophysics Data System (ADS)

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

    2013-06-01

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

  6. Abortion Patients' Experience and Perceptions of Waiting Periods: Survey Evidence before Arizona's Two-visit 24-hour Mandatory Waiting Period Law.

    PubMed

    Karasek, Deborah; Roberts, Sarah C M; Weitz, Tracy A

    2016-01-01

    More than one-half of U.S. states now have laws requiring women to wait at least 24 hours between receiving information about abortion and the actual abortion procedure, with a few requiring longer waits, and one-fourth requiring that women receive this information in person. Although public discussions of waiting periods focus on how they affect women, we know little about abortion patients' perceptions of these requirements. We collected data from 379 women seeking abortion care at an abortion facility in Arizona before Arizona's 24-hour waiting period two-visit requirement went into effect. Surveys focused on patients' experiences receiving abortion care before the waiting period and perceptions about how the additional clinic visit would affect them. Most women reported one or more financial or logistical challenges in obtaining abortion care. More than two-thirds reported difficulty paying abortion appointment-related expenses. These expenses prevented or delayed almost one-half from paying other expenses, such as rent, bills, and food, with lower income women more affected. The majority expected that the additional visit would result in additional financial and logistical hardships and delay them in having an abortion, with 90% reporting that the waiting period would lead to at least one hardship. Eight percent reported that the waiting period would have a positive effect on emotional well-being, and more than one-half reported that it would have a negative effect on emotional well-being. Only a small minority of women seeking abortion care view a two-visit waiting period law as benefiting them; the overwhelming majority expect a waiting period to have adverse consequences. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  7. Waiting time distributions in financial markets

    NASA Astrophysics Data System (ADS)

    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.

  8. Electron Waiting Times of a Cooper Pair Splitter

    NASA Astrophysics Data System (ADS)

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

    2018-02-01

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

  9. Cosmogenic nuclide production within the atmosphere and long period comets

    NASA Astrophysics Data System (ADS)

    Overholt, Andrew C.

    The Earth is constantly bombarded by cosmic rays. These high energy particles collide with target nuclei, producing a shower of secondary particles. These secondaries contribute significantly to the radiation background at sea level and in the atmosphere, as well as producing rare cosmogenic nuclides. This contribution is variable over long time scales as astrophysical events change the cosmic ray flux incident on the Earth. Our work re-examines a previously proposed climate effect of increased cosmic ray flux due to galactic location. Although our work does not support this effect, cosmic ray secondaries remain a threat to terrestrial biota. We calculate the cosmogenic neutron flux within the atmosphere as a function of primary spectrum. This work is pivotal in determining the radiation dose due to any arbitrary astrophysical event where the primary spectrum is known. Additionally, this work can be used to determine the cosmogenic nuclide production from such an event. These neutrons are the fundamental source of cosmogenic nuclides within our atmosphere and extraterrestrial matter. We explore the idea that excursions in 14C and 10Be abundances in the atmosphere may arise from direct deposition by long-period comet impacts, and those in 26Al from any bolide. We find that the amount of nuclide mass on large long-period comets entering the Earth's atmosphere may be sufficient for creating anomalies in the records of 14C and 10Be from past impacts. In particular, the estimated mass of the proposed Younger Dryas comet is consistent with its having deposited sufficient isotopes to account for recorded nuclide increases at that time. The 26Al/10Be ratio is much larger in extraterrestrial objects than in the atmosphere, and so, we note that measuring this ratio in ice cores is a suitable further test for the Younger Dryas impact hypothesis. This portion of our work may be used to find possible impact events in the geologic record as well as determination of a large

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

    PubMed

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

    2015-01-01

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

  11. Waiting for hip arthroplasty: economic costs and health outcomes.

    PubMed

    Fielden, Jann M; Cumming, J M; Horne, J G; Devane, P A; Slack, A; Gallagher, L M

    2005-12-01

    This prospective cohort study of 153 patients aimed to determine the economic and health costs of waiting for total hip arthroplasty (THA). Health-related quality of life, using self-completed WOMAC and EQ-5D questionnaires, was assessed monthly from enrolment preoperatively to 6 months postsurgery. Monthly cost diaries were used to record costs. The mean waiting time was 5.1 months and mean total cost of waiting for surgery was NZ 4305 dollars(US 2876 dollars) per person (pp) (NZ 1 dollar = US 0.668 dollar). Waiting more than 6 months was associated with a higher total mean cost (NZ 4278 dollars/US 2858 dollars pp) than waiting less than 6 months (NZ 2828 dollars/US 1889 dollars pp; P < .01). Improvements from preoperative to postoperative WOMAC and EQ-5D scores were identified (P < or = .01). Waiting longer led to poorer physical function preoperatively (P < or = .01). Those with poor initial health status showed greater improvement in WOMAC (P = .0001) and EQ-5D (P = .003) measures by 6 months after surgery. Longer waits for total hip arthroplasty incur greater economic costs and deterioration in physical function while waiting.

  12. [Waiting list in general and digestive surgery: patient expectations, quality of life during waiting time and overall satisfaction].

    PubMed

    Parés, D; Duran, E; Hermoso, J; Comajuncosas, J; Gris, P; Lopez-Negre, J L; Urgellés, J; Orbeal, R; Vallverdú, H; Jimeno, J

    2013-01-01

    The structural resources of the National Health system are limited, and therefore early surgery cannot be performed on all patients. The objective was to analyse the satisfaction perceived by the patient as regards the delay of treatment by waiting list of three types of surgery. The influence of expectations on waiting times, and impaired quality of life due to the clinical symptoms during the delay, were studied. A prospective study was conducted using a postal questionnaire. We compared the expectations (scale of 1 to 5), the impact on quality of life for symptoms (scale of 1 to 5) and the level of patient satisfaction (scale of 1 to 5) with respect to time on the waitng list for cholelithiasis, inguinal hernia and haemorrhoids. The predictors of patient dissatisfaction were analysed. A total of 57 patients were included. When comparing the characteristics of patients with and without satisfaction over time on the waiting list, days on the waiting list (P=.044), the change in the quality of life due to the symptoms (P=.028), and expectations (P<.001) were significantly different between the two groups. In the multivariate analysis, the expectation was associated with patient dissatisfaction as regards the time on waiting list (OR: 3.14 95% CI: 5.91 to 220.73, P<.001). The level of patient dissatisfaction is associated with expectations about time in waiting list. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.

  13. A new nuclide transport model in soil in the GENII-LIN health physics code

    NASA Astrophysics Data System (ADS)

    Teodori, F.

    2017-11-01

    The nuclide soil transfer model, originally included in the GENII-LIN software system, was intended for residual contamination from long term activities and from waste form degradation. Short life nuclides were supposed absent or at equilibrium with long life parents. Here we present an enhanced soil transport model, where short life nuclide contributions are correctly accounted. This improvement extends the code capabilities to handle incidental release of contaminant to soil, by evaluating exposure since the very beginning of the contamination event, before the radioactive decay chain equilibrium is reached.

  14. Creation of a diagnostic wait times measurement framework based on evidence and consensus.

    PubMed

    Gilbert, Julie E; Dobrow, Mark J; Kaan, Melissa; Dobranowski, Julian; Srigley, John R; Jusko Friedman, Audrey; Irish, Jonathan C

    2014-09-01

    Public reporting of wait times worldwide has to date focused largely on treatment wait times and is limited in its ability to capture earlier parts of the patient journey. The interval between suspicion and diagnosis or ruling out of cancer is a complex phase of the cancer journey. Diagnostic delays and inefficient use of diagnostic imaging procedures can result in poor patient outcomes, both physical and psychosocial. This study was designed to develop a framework that could be adopted for multiple disease sites across different jurisdictions to enable the measurement of diagnostic wait times and diagnostic delay. Diagnostic benchmarks and targets in cancer systems were explored through a targeted literature review and jurisdictional scan. Cancer system leaders and clinicians were interviewed to validate the information found in the jurisdictional scan. An expert panel was assembled to review and, through a modified Delphi consensus process, provide feedback on a diagnostic wait times framework. The consensus process resulted in agreement on a measurement framework that identified suspicion, referral, diagnosis, and treatment as the main time points for measuring this critical phase of the patient journey. This work will help guide initiatives designed to improve patient access to health services by developing an evidence-based approach to standardization of the various waypoints during the diagnostic pathway. The diagnostic wait times measurement framework provides a yardstick to measure the performance of programs that are designed to manage and expedite care processes between referral and diagnosis or ruling out of cancer. Copyright © 2014 by American Society of Clinical Oncology.

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

    PubMed

    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 < .05). Given the current prescription-filling process, we do not expect that major, additional reductions in wait times could be produced. Many variables may account for the variability in any individual customer's wait time. Data from this study may provide useful preliminary benchmarking data for standard pharmacy wait times.

  16. Improving Patient Satisfaction with Waiting Time

    ERIC Educational Resources Information Center

    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…

  17. Influence of positive distractions on children in two clinic waiting areas.

    PubMed

    Pati, Debajyoti; Nanda, Upali

    2011-01-01

    To examine the influence of positive distraction on the behavior and activity of children in two clinic waiting areas. People spend a considerable proportion of time waiting in hospitals. Studies show that the quality of waiting environments influences the perception of quality of care and caregivers, that perception of waiting time is a better indicator of patient satisfaction than actual waiting time, and that the waiting environment contributes to the perception of wait time. In fact, the attractiveness of the physical environment in waiting areas has been shown to be significantly associated with higher perceived quality of care, less anxiety, and higher reported positive interaction with staff. Can positive distractions in waiting areas improve the waiting experience, as indicated by the behavior and activities of children waiting for treatment? Five distraction conditions were randomly introduced in the waiting area of the dental and cardiac clinics of a major pediatric tertiary care center through a single plasma screen intervention. The attention, behavior, and activities of waiting children were recorded. Data on 158 pediatric patients were collected over 12 days during December 2008 and January 2009. Data analysis shows that the introduction of distraction conditions was associated with more calm behavior and less fine and gross movement, suggesting significant calming effects associated with the distraction conditions. Data also suggest that positive distraction conditions are significant attention grabbers and could be an important contributor to improving the waiting experience for children in hospitals by improving environmental attractiveness.

  18. WebCN: A web-based computation tool for in situ-produced cosmogenic nuclides

    NASA Astrophysics Data System (ADS)

    Ma, Xiuzeng; Li, Yingkui; Bourgeois, Mike; Caffee, Marc; Elmore, David; Granger, Darryl; Muzikar, Paul; Smith, Preston

    2007-06-01

    Cosmogenic nuclide techniques are increasingly being utilized in geoscience research. For this it is critical to establish an effective, easily accessible and well defined tool for cosmogenic nuclide computations. We have been developing a web-based tool (WebCN) to calculate surface exposure ages and erosion rates based on the nuclide concentrations measured by the accelerator mass spectrometry. WebCN for 10Be and 26Al has been finished and published at http://www.physics.purdue.edu/primelab/for_users/rockage.html. WebCN for 36Cl is under construction. WebCN is designed as a three-tier client/server model and uses the open source PostgreSQL for the database management and PHP for the interface design and calculations. On the client side, an internet browser and Microsoft Access are used as application interfaces to access the system. Open Database Connectivity is used to link PostgreSQL and Microsoft Access. WebCN accounts for both spatial and temporal distributions of the cosmic ray flux to calculate the production rates of in situ-produced cosmogenic nuclides at the Earth's surface.

  19. Neogene basin infilling from cosmogenic nuclides (10Be and 21Ne) in Atacama, Chile

    NASA Astrophysics Data System (ADS)

    Sanchez, Caroline; Regard, Vincent; Carretier, Sébastien; Riquelme, Rodrigo; Blard, Pierre-Henri; Campos, Eduardo; Brichau, Stéphanie; Lupker, Marteen; Hérail, Gérard

    2017-04-01

    In the hyperarid Atacama Desert, northern Chile, Neogene sediments host copper rich layers (exotic supergene mineralization). Current mines are excavated into relatively thin (<200-300 m) Neogene basins whose infilling chronology is poorly constrained. We took advantage of one of these mining pits, and sampled for 10Be and 21Ne cosmogenic nuclide dosing. These cosmogenic nuclides help constraining the infilling chronology. Indeed, basin sediments were deposited with a cosmogenic nuclide content acquired on hillslopes. Then within the basin, cosmogenic nuclide concentrations evolved through the competing production (quickly decreasing with depth) and disintegration (not for 21Ne). Sampling depths are at ˜100 m and at ˜50 m below the desert surface. First, 21Ne gives lower boundaries for upstream erosion rates or local sedimentation rate. These bounds are between 2 and 10 m/Ma, which is quite important for the area. The ratio between the two cosmogenic nuclides indicate a maximum burial age of 12 Ma (minimal erosion rate of 15 m/Ma) and is surprisingly similar from bottom to top, indicating a probable rapid infilling. We finally processed a Monte-Carlo inversion. This inversion helps taking into account the post-deposition muonic production of cosmogenic nuclides. Inversion results is dependent on the muonic production scheme. Interestingly, the similarity in concentrations from bottom to top pleads for quite low production at depth. Our data finally indicates a quick infilling between 12.5 and 10 Ma BP accounting for ˜100 m of deposition (minimum sedimentation rate of 40 m/Ma).

  20. Impact of pharmacy automation on patient waiting time: an application of computer simulation.

    PubMed

    Tan, Woan Shin; Chua, Siang Li; Yong, Keng Woh; Wu, Tuck Seng

    2009-06-01

    This paper aims to illustrate the use of computer simulation in evaluating the impact of a prototype automated dispensing system on waiting time in an outpatient pharmacy and its potential as a routine tool in pharmacy management. A discrete event simulation model was developed to investigate the impact of a prototype automated dispensing system on operational efficiency and service standards in an outpatient pharmacy. The simulation results suggest that automating the prescription-filing function using a prototype that picks and packs at 20 seconds per item will not assist the pharmacy in achieving the waiting time target of 30 minutes for all patients. Regardless of the state of automation, to meet the waiting time target, 2 additional pharmacists are needed to overcome the process bottleneck at the point of medication dispense. However, if the automated dispensing is the preferred option, the speed of the system needs to be twice as fast as the current configuration to facilitate the reduction of the 95th percentile patient waiting time to below 30 minutes. The faster processing speed will concomitantly allow the pharmacy to reduce the number of pharmacy technicians from 11 to 8. Simulation was found to be a useful and low cost method that allows an otherwise expensive and resource intensive evaluation of new work processes and technology to be completed within a short time.

  1. Interior effects on comfort in healthcare waiting areas.

    PubMed

    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.

  2. How to report and monitor the performance of waiting list management.

    PubMed

    Torkki, Markus; Linna, Miika; Seitsalo, Seppo; Paavolainen, Pekka

    2002-01-01

    Potential problems concerning waiting list management are often monitored using mean waiting times based on empirical samples. However, the appropriateness of mean waiting time as an indicator of access can be questioned if a waiting list is not managed well, e.g., if the queue discipline is violated. This study was performed to find out about the queue discipline in waiting lists for elective surgery to reveal potential discrepancies in waiting list management. There were 1,774 waiting list patients for hallux valgus or varicose vein surgery or sterilization. The waiting time distributions of patients receiving surgery and of patients still waiting for an operation are presented in column charts. The charts are compared with two model charts. One model chart presents a high queue discipline (first in-first out) and another a poor queue discipline (random) queue. There were significant differences in waiting list management across hospitals and patient categories. Examples of a poor queue discipline were found in queues for hallux valgus and varicose vein operations. A routine waiting list reporting should be used to guarantee the quality of waiting list management and to pinpoint potential problems in access. It is important to monitor not only the number of patients in the waiting list but also the queue discipline and the balance between demand and supply of surgical services. The purpose for this type of reporting is to ensure that the priority setting made at health policy level also works in practise.

  3. Bayesian estimation of a source term of radiation release with approximately known nuclide ratios

    NASA Astrophysics Data System (ADS)

    Tichý, Ondřej; Šmídl, Václav; Hofman, Radek

    2016-04-01

    We are concerned with estimation of a source term in case of an accidental release from a known location, e.g. a power plant. Usually, the source term of an accidental release of radiation comprises of a mixture of nuclide. The gamma dose rate measurements do not provide a direct information on the source term composition. However, physical properties of respective nuclide (deposition properties, decay half-life) can be used when uncertain information on nuclide ratios is available, e.g. from known reactor inventory. The proposed method is based on linear inverse model where the observation vector y arise as a linear combination y = Mx of a source-receptor-sensitivity (SRS) matrix M and the source term x. The task is to estimate the unknown source term x. The problem is ill-conditioned and further regularization is needed to obtain a reasonable solution. In this contribution, we assume that nuclide ratios of the release is known with some degree of uncertainty. This knowledge is used to form the prior covariance matrix of the source term x. Due to uncertainty in the ratios the diagonal elements of the covariance matrix are considered to be unknown. Positivity of the source term estimate is guaranteed by using multivariate truncated Gaussian distribution. Following Bayesian approach, we estimate all parameters of the model from the data so that y, M, and known ratios are the only inputs of the method. Since the inference of the model is intractable, we follow the Variational Bayes method yielding an iterative algorithm for estimation of all model parameters. Performance of the method is studied on simulated 6 hour power plant release where 3 nuclide are released and 2 nuclide ratios are approximately known. The comparison with method with unknown nuclide ratios will be given to prove the usefulness of the proposed approach. This research is supported by EEA/Norwegian Financial Mechanism under project MSMT-28477/2014 Source-Term Determination of Radionuclide Releases

  4. [Has the time arrived for the management of waiting lists?].

    PubMed

    Bernal, E

    2002-01-01

    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 their "manipulation", and using programs of auto-coordination with the sole aim of reaching the end of the year without a waiting list of not more than six months, etc. The panorama is not completely bleak. Some management initiatives (and even Politics with a capital P) are opening the way forward and may enter the Agenda in the next few years. In this context, the application of guaranteed times of medical care or the prioritization of waiting lists according to explicit criteria should be highlighted. It is worth remembering that, except for the queues in the waiting rooms of health centers and emergency departments, waiting lists are mediated by the decision of the physician. Therefore, an essential strategy for managing waiting lists consists of attenuating the problems caused by uncertainty (or ignorance) of the patient's diagnosis or prognosis.

  5. Colour Consideration for Waiting areas in hospitals

    NASA Astrophysics Data System (ADS)

    Zraati, Parisa

    2012-08-01

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

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

    PubMed

    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.

  7. Why wait so long for child care? An analysis of waits, queues and work in a South African urban health centre.

    PubMed

    Bachmann, M O; Barron, P

    1997-01-01

    Long waits at large urban clinics obstruct primary care delivery, imposing time costs on patients, deterring appropriate utilization and causing patient dissatisfaction. This paper reports on an innovative attempt by staff in a large South African urban health centre to analyse a system of queues and preventive and curative services for pre-school children, and thereafter to evaluate changes. The study had a cross-sectional work study design, with repeated measurement of waiting times after 13 months. At baseline the preventive clinic was found to have several inessential processes and waits; these were eliminated or overlapped, and clinic sessions per week were increased. A year later median waiting times had decreased substantially in the preventive clinic, but had increased in the curative clinic. Simple research can explain long waits, inform and measure changes, and provide evidence to justify primary care integration and would be useful in health centres and hospital outpatient departments in developing countries.

  8. Waiting time care guarantees: necessity or nemesis?

    PubMed

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

    2006-01-01

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

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

    PubMed

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

    2014-04-01

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

  10. Identifying demand for health resources using waiting times information.

    PubMed

    Blundell, R; Windmeijer, F

    2000-09-01

    In this paper the differences in average waiting times are utilized to identify the determinants of demand for health services. The equilibrium waiting time framework is used, but the full equilibrium assumption is relaxed by selecting areas with low waiting times and by estimating a (semi-)parametric selection model. Determinants of supply are used as instruments for the endogeneity of waiting times. A model for the demand for acute services at the ward level in the UK is estimated. The model estimates, and their implications for health service allocations in the UK, are contrasted against more standard allocation models. The present results show that it is critically important to account for rationing by waiting times when identifying needs from care utilization data. Copyright 2000 John Wiley & Sons, Ltd.

  11. The Religious Meaning in "Waiting for Godot"

    ERIC Educational Resources Information Center

    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.

  12. Outcomes of videotape instruction in clinic waiting area.

    PubMed

    Oermann, Marilyn H; Webb, Sue A; Ashare, Jo Ann

    2003-01-01

    The purpose of our study was to examine the effectiveness of general health-promotion teaching for patients in the waiting room of a clinic, using focused videotape instruction. An experimental design was used. Subjects were patients (N = 215) in the waiting rooms of clinics in a university medical center in the Midwest. Patients were randomly assigned to two groups: focused videotape instruction in the clinic (n = 106) and control (no instruction in the clinic waiting area) (n = 109). The outcome measures included patient learning about a health education topic and patient satisfaction with overall care, explanations by the provider, and education received during the clinic visit. There was a significant gain in knowledge for patients who viewed the videotape in the waiting room (t = 5.43, df = 213, p < .0001), and they were more satisfied with their education compared with the control group (t = 4.73, df = 213, p < .0001). This study supports focused video instruction as an effective and efficient teaching intervention for disseminating health information in the waiting area.

  13. Outpatient Office Wait Times and Quality of Care for Medicaid Patients

    PubMed Central

    Oostrom, Tamar; Einav, Liran; Finkelstein, Amy

    2018-01-01

    Time spent in the doctor’s waiting room captures an important aspect of the healthcare experience. We analyzed data on 21 million outpatient visits obtained from electronic health record systems, allowing us to measure time spent in the waiting room beyond the scheduled appointment time. Median wait time was just over 4 minutes. Almost one-fifth of visits had waits longer than 20 minutes, and 10% were over 30 minutes. Waits were shorter for early morning appointments, younger patients, and at larger practices. Median wait time was 4.1 minutes for privately-insured and 4.6 minutes for Medicaid patients; adjusting for patient and appointment characteristics, Medicaid patients were 20% more likely than the privately-insured to wait longer than 20 minutes (P<0.001), with most of this disparity explained by differences in practices and providers they saw. Wait time for Medicaid patients relative to the privately-insured was longer in states with relatively lower Medicaid reimbursement rates. PMID:28461348

  14. The impact of diagnostic imaging wait times on the prognosis of lung cancer.

    PubMed

    Byrne, Suzanne C; Barrett, Brendan; Bhatia, Rick

    2015-02-01

    This study was performed to determine whether gaps in patient flow from initial lung imaging to computed tomography (CT) guided lung biopsy in patients with non-small cell lung cancer (NSCLC) was associated with a change in tumour size, stage, and thus prognosis. All patients who had a CT-guided lung biopsy in 2009 (phase I) and in 2011 (phase II) with a pathologic diagnosis of primary lung cancer (NSCLC) at Eastern Health, Newfoundland, were identified. Dates of initial abnormal imaging, confirmatory CT (if performed), and CT-guided biopsy were recorded, along with tumour size and resulting T stage at each time point. In 2010, wait times for diagnostic imaging at Eastern Health were reduced. The stage and prognosis of NSCLC in 2009 was compared with 2011. In phase 1, there was a statistically significant increase in tumour size (mean difference, 0.67 cm; P < .0001) and stage (P < .0001) from initial image to biopsy. There was a moderate correlation between the time (in days) between the images and change in size (r = 0.33, P = .008) or stage (r = 0.26, P = .036). In phase II, the median wait time from initial imaging to confirmatory CT was reduced to 7.5 days (from 19 days). At this reduced wait time, there was no statistically significant increase in tumour size (mean difference, 0.02; P > .05) or stage (P > .05) from initial imaging to confirmatory CT. Delays in patient flow through diagnostic imaging resulted in an increase in tumour size and stage, with a negative impact on prognosis of NSCLC. This information contributed to the hiring of additional CT technologists and extended CT hours to decrease the wait time for diagnostic imaging. With reduced wait times, the prognosis of NSCLC was not adversely impacted as patients navigated through diagnostic imaging. Copyright © 2015 Canadian Association of Radiologists. All rights reserved.

  15. 24 CFR 982.204 - Waiting list: Administration of waiting list.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... size (number of bedrooms for which family qualifies under PHA occupancy standards); (3) Date and time... list. (d) Family size. (1) The order of admission from the waiting list may not be based on family size, or on the family unit size for which the family qualifies under the PHA occupancy policy. (2) If the...

  16. [Dealing with Waiting Times in Health Systems - An International Comparative Overview].

    PubMed

    Finkenstädt, V

    2015-10-01

    Waiting times in the health system are a form of rationing that exists in many countries. Previous studies on this topic are mainly related to the problem of international comparability of waiting times or on the presentation of national strategies as to how they should be reduced. This review adds to this analysis and examines how the OECD countries deal with waiting times in the health-care system and investigates which information is published about waiting for what purpose. Furthermore, waiting times and the type of health system financing are compared. A systematic internet research on waiting times in the health-care system was conducted on the websites of the competent authorities (Ministry of Health or other authorities and institutions). The identified publications were then examined for the purpose of their deployment. Finally, the OECD Health Data were analysed to determine the relationship between tax and contribution financing of public health care expenditure. The primary form of financing was compared with the results of the waiting time analysis. 16 OECD countries are identified which officially collect and publish administrative data on waiting times on the Internet. The data are processed differently depending on the country. By providing this information, two main objectives are pursued: a public monitoring of waiting times in the health system (14 countries) and information for patients on waiting times (9 countries). Official statistics on waiting times exist mainly in countries with tax-financed health systems, whereas this is not the case in the majority of OECD countries with health systems that are funded through contributions. The publication of administrative waiting times data is primarily intended to inform the patient and as a performance indicator in terms of access to health care. Even if data on waiting times are published, the publication of indicators and the management of waiting lists alone will not solve the problem. Rather

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

    PubMed

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

    2013-08-29

    Early referral and management of high-risk chronic kidney disease may prevent or delay the need for dialysis. Automatic eGFR reporting has increased demand for out-patient nephrology consultations and in some cases, prolonged queues. In Canada, a national task force suggested the development of waiting time targets, which has not been done for nephrology. We sought to describe waiting time for outpatient nephrology consultations in British Columbia (BC). Data collection occurred in 2 phases: 1) Baseline Description (Jan 18-28, 2010) and 2) Post Waiting Time Benchmark-Introduction (Jan 16-27, 2012). Waiting time was defined as the interval from receipt of referral letters to assessment. Using a modified Delphi process, Nephrologists and Family Physicians (FP) developed waiting time targets for commonly referred conditions through meetings and surveys. Rules were developed to weigh-in nephrologists', FPs', and patients' perspectives in order to generate waiting time benchmarks. Targets consider comorbidities, eGFR, BP and albuminuria. Referred conditions were assigned a priority score between 1-4. BC nephrologists were encouraged to centrally triage referrals to see the first available nephrologist. Waiting time benchmarks were simultaneously introduced to guide patient scheduling. A post-intervention waiting time evaluation was then repeated. In 2010 and 2012, 43/52 (83%) and 46/57 (81%) of BC nephrologists participated. Waiting time decreased from 98(IQR44,157) to 64(IQR21,120) days from 2010 to 2012 (p = <.001), despite no change in referral eGFR, demographics, nor number of office hrs/wk. Waiting time improved most for high priority patients. An integrated, Provincial initiative to measure wait times, develop waiting benchmarks, and engage physicians in active waiting time management associated with improved access to nephrologists in BC. Improvements in waiting time was most marked for the highest priority patients, which suggests that benchmarks had an

  18. Waiting Online: A Review and Research Agenda.

    ERIC Educational Resources Information Center

    Ryan, Gerard; Valverde, Mireia

    2003-01-01

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

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

    PubMed Central

    Abdulkareem, Imran Haruna

    2014-01-01

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

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

    PubMed

    Abdulkareem, Imran Haruna

    2014-11-01

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

  1. Effects of bulk composition on production rates of cosmogenic nuclides in meteorites

    NASA Technical Reports Server (NTRS)

    Masarik, Jozef; Reedy, Robert C.

    1993-01-01

    The bulk chemical composition of meteorites has been suggested as a main factor influencing the production of cosmogenic nuclides. Numerical simulations with Los Alamos Monte Carlo production and transport codes were done for Ne-21/Ne-22 ratios and Ar-38 production rates in meteorites with a wide range of compositions. The calculations show that an enhanced flux of low-energy secondary particles in metal-rich phases is the essential key for the explanation of experimentally observed differences in nuclide production processes in various meteorite classes.

  2. Reprocessing system with nuclide separation based on chromatography in hydrochloric acid solution

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Suzuki, Tatsuya; Tachibana, Yu; Koyama, Shi-ichi

    2013-07-01

    We have proposed the reprocessing system with nuclide separation processes based on the chromatographic technique in the hydrochloric acid solution system. Our proposed system consists of the dissolution process, the reprocessing process, the minor actinide separation process, and nuclide separation processes. In the reprocessing and separation processes, the pyridine resin is used as a main separation media. It was confirmed that the dissolution in the hydrochloric acid solution is easily achieved by the plasma voloxidation and by the addition of oxygen peroxide into the hydrochloric acid solution.

  3. What's in a wait? Contrasting management science and economic perspectives on waiting for emergency care.

    PubMed

    Morton, Alec; Bevan, Gwyn

    2008-02-01

    The current paper reviews and contrasts a management science view of waiting for healthcare, which centres on queues as devices for buffering demand, with an economic view, which stresses the role of the incentive structure, in the context of English Accident and Emergency Departments. We demonstrate that the management science view provides insight into waiting time performance within a single facility but is limited in its ability to shed light on variations in performance across facilities. We argue, with reference to supporting data, that such variations may be explainable by a proper understanding of the incentive structure in A&E Departments.

  4. Do waiting times affect health outcomes? Evidence from coronary bypass.

    PubMed

    Moscelli, Giuseppe; Siciliani, Luigi; Tonei, Valentina

    2016-07-01

    Long waiting times for non-emergency services are a feature of several publicly-funded health systems. A key policy concern is that long waiting times may worsen health outcomes: when patients receive treatment, their health condition may have deteriorated and health gains reduced. This study investigates whether patients in need of coronary bypass with longer waiting times are associated with poorer health outcomes in the English National Health Service over 2000-2010. Exploiting information from the Hospital Episode Statistics (HES), we measure health outcomes with in-hospital mortality and 28-day emergency readmission following discharge. Our results, obtained combining hospital fixed effects and instrumental variable methods, find no evidence of waiting times being associated with higher in-hospital mortality and weak association between waiting times and emergency readmission following a surgery. The results inform the debate on the relative merits of different types of rationing in healthcare systems. They are to some extent supportive of waiting times as an acceptable rationing mechanism, although further research is required to explore whether long waiting times affect other aspects of individuals' life. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Bridging the timescales between thermochronological and cosmogenic nuclide data

    NASA Astrophysics Data System (ADS)

    Glotzbach, Christoph

    2015-04-01

    Reconstructing the evolution of Earth's landscape is a key to understand its future evolution and to identify the driving forces that shape Earth's surface. Cosmogenic nuclide and thermochronological methods are routinely used to quantify Earth surface processes over 102-104 yr and 106-107 yr, respectively (e.g. Lal 1991; Reiners and Ehlers 2005; von Blanckenburg 2006). A comparison of the rates of surface processes derived from these methods is, however, hampered by the large difference in their timescales. For instance, a constant erosion rate of 0.1 mm/yr yield an apatite (U-Th)/He age of ~24 Ma and a 10Be age of ~6 ka, respectively. Analytical methods that bridge this time gap are on the way, but are not yet fully established (e.g. Herman et al. 2010). A ready to use alternative are river profiles, which record the regional uplift history over 102-107 yr (e.g. Pritchard et al. 2009). Changes in uplift are retained in knickzones that propagate with a distinct velocity upstream, and therefore the time of an uplift event can be estimated. Here I present an integrative inverse modelling approach to simultaneously reconstruct river profiles, model thermochronological and cosmogenic nuclide data and to derive robust information about landscape evolution over thousands to millions of years. An efficient inversion routine is used to solve the forward problem and find the best uplift history and erosional parameters that reproduce the observed data. I test the performance of the algorithm by inverting a synthetic dataset and a dataset from the Sila massif (Italy). Results show that even complicated uplift histories can be reliably retrieved by the combined interpretation of river profiles, thermochronological and cosmogenic nuclide data. References Gallagher, K., Brown, R. & Johnson, C. (1998): Fission track analysis and its applications to geological problems. - Annu. Rev. Earth Planet., 26: 519-572. Herman, F., Rhodes, E.J., Braun, J. & Heiniger, L. (2010): Uniform

  6. International comparisons of waiting times in health care--limitations and prospects.

    PubMed

    Viberg, Nina; Forsberg, Birger C; Borowitz, Michael; Molin, Roger

    2013-09-01

    Long waiting times for health care is an important health policy issue in many countries, and many have introduced some form of national waiting time guarantees. International comparison of waiting times are critical for countries to improve policy and for patients to be able to make informed choices, especially in Europe, where patients have the right to seek care in other countries if there is undue delay. The objective of this study was to describe how countries measure waiting times and to assess whether waiting times can be compared internationally. Twenty-three OECD countries were included. Information was collected through scientific articles, official and unofficial documents and web pages. Fifteen of the 23 countries monitor and publish national waiting time statistics and have some form of waiting time guarantees. There are significant differences in how waiting times are measured: whether they measure the "ongoing" or "completed" waiting period what kind of care the patient is waiting for; the parameters used; and where in the patient journey the measurement begins. Current national waiting time statistics are of limited use for comparing health care availability among the various countries due to the differences in measurements and data collection. Different methodological issues must be taken into account when making such cross-country comparisons. Within the given context of national sovereignty of health systems it would be desirable if countries could collaborate in order to facilitate international comparisons. Such comparisons would be of benefit to all involved in the process of continuous improvement of health services. They would also benefit patients who seek cross-border alternatives for their care. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  7. Maternity waiting homes in Ethiopia--three decades experience.

    PubMed

    Gaym, Asheber; Pearson, Luwei; Soe, Khynn Win Win

    2012-07-01

    Access to comprehensive emergency obstetric care is limited in Ethiopia. Maternity waiting homes are part of the strategies utilized to improve access to hard to reach rural populations. Despite long years of existence of this service in Ethiopia, the practice has not been adequately assessed so far. Describe the current status of maternity waiting home services in Ethiopia All facilities in Ethiopia that have a maternity waiting home were identified from FMOH data as well as personal contacts with focal persons at Regional Health Bureaus in the nine regions and UNICEF regional offices. A standardized data collection tool for facility assessment was developed by the quality referral team, Health Section, UNICEF. Data collection included site visits and documentation of infrastructural related issues through a facility checklist. Service related issues were also collected from log books and other documents as well as through interview with relevant staff Focus group discussions were held with all MWHs attendants who were found admitted at the time of the review at Attat, Wolisso and Gidole hospital maternity waiting homes on major thematic areas identified by the review team regarding MWH care The practice of maternity waiting homes in Ethiopia spans more than three decades. Nine facilities located in five Regional States had maternity waiting home services. All except one were located in hospitals. Admission capacity ranged from 4 up to 44 mothers at a time. Seven of the maternity waiting homes required the clients to cater for their own food, firewood and clothing supply providing only kitchen space and few kitchen utensils. Clients came from as far as 400 kms away to obtain services. Medical care and documentation of services were not standardized Duration of stay varied from 3-90 days. Monthly admission rates varied from 0-84 mothers at different institutions. Major indications for admission were previous caesarean section 34%; previous fistula repair 12

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

    PubMed Central

    2013-01-01

    Background Early referral and management of high-risk chronic kidney disease may prevent or delay the need for dialysis. Automatic eGFR reporting has increased demand for out-patient nephrology consultations and in some cases, prolonged queues. In Canada, a national task force suggested the development of waiting time targets, which has not been done for nephrology. Methods We sought to describe waiting time for outpatient nephrology consultations in British Columbia (BC). Data collection occurred in 2 phases: 1) Baseline Description (Jan 18-28, 2010) and 2) Post Waiting Time Benchmark-Introduction (Jan 16-27, 2012). Waiting time was defined as the interval from receipt of referral letters to assessment. Using a modified Delphi process, Nephrologists and Family Physicians (FP) developed waiting time targets for commonly referred conditions through meetings and surveys. Rules were developed to weigh-in nephrologists’, FPs’, and patients’ perspectives in order to generate waiting time benchmarks. Targets consider comorbidities, eGFR, BP and albuminuria. Referred conditions were assigned a priority score between 1-4. BC nephrologists were encouraged to centrally triage referrals to see the first available nephrologist. Waiting time benchmarks were simultaneously introduced to guide patient scheduling. A post-intervention waiting time evaluation was then repeated. Results In 2010 and 2012, 43/52 (83%) and 46/57 (81%) of BC nephrologists participated. Waiting time decreased from 98(IQR44,157) to 64(IQR21,120) days from 2010 to 2012 (p = <.001), despite no change in referral eGFR, demographics, nor number of office hrs/wk. Waiting time improved most for high priority patients. Conclusions An integrated, Provincial initiative to measure wait times, develop waiting benchmarks, and engage physicians in active waiting time management associated with improved access to nephrologists in BC. Improvements in waiting time was most marked for the highest priority

  9. Radio-nuclide mixture identification using medium energy resolution detectors

    DOEpatents

    Nelson, Karl Einar

    2013-09-17

    According to one embodiment, a method for identifying radio-nuclides includes receiving spectral data, extracting a feature set from the spectral data comparable to a plurality of templates in a template library, and using a branch and bound method to determine a probable template match based on the feature set and templates in the template library. In another embodiment, a device for identifying unknown radio-nuclides includes a processor, a multi-channel analyzer, and a memory operatively coupled to the processor, the memory having computer readable code stored thereon. The computer readable code is configured, when executed by the processor, to receive spectral data, to extract a feature set from the spectral data comparable to a plurality of templates in a template library, and to use a branch and bound method to determine a probable template match based on the feature set and templates in the template library.

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

    PubMed

    Panda, A; Garg, I; Shah, M

    2015-02-01

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

  11. Notre Dame Nuclear Database: A New Chart of Nuclides

    NASA Astrophysics Data System (ADS)

    Lee, Kevin; Khouw, Timothy; Fasano, Patrick; Mumpower, Matthew; Aprahamian, Ani

    2014-09-01

    Nuclear data is critical to research fields from medicine to astrophysics. We are creating a database, the Notre Dame Nuclear Database, which can store theoretical and experimental datasets. We place emphasis on storing metadata and user interaction with the database. Users are able to search in addition to the specific nuclear datum, the author(s), the facility where the measurements were made, the institution of the facility, and device or method/technique used. We also allow users to interact with the database by providing online search, an interactive nuclide chart, and a command line interface. The nuclide chart is a more descriptive version of the periodic table that can be used to visualize nuclear properties such as half-lives and mass. We achieve this by using D3 (Data Driven Documents), HTML, and CSS3 to plot the nuclides and color them accordingly. Search capabilities can be applied dynamically to the chart by using Python to communicate with MySQL, allowing for customization. Users can save the customized chart they create to any image format. These features provide a unique approach for researchers to interface with nuclear data. We report on the current progress of this project and will present a working demo that highlights each aspect of the aforementioned features. This is the first time that all available technologies are put to use to make nuclear data more accessible than ever before in a manner that is much easier and fully detailed. This is a first and we will make it available as open source ware.

  12. Development of Advanced Nuclide Separation and Recovery Methods using Ion-Exchanhge Techniques in Nuclear Backend

    NASA Astrophysics Data System (ADS)

    Miura, Hitoshi

    The development of compact separation and recovery methods using selective ion-exchange techniques is very important for the reprocessing and high-level liquid wastes (HLLWs) treatment in the nuclear backend field. The selective nuclide separation techniques are effective for the volume reduction of wastes and the utilization of valuable nuclides, and expected for the construction of advanced nuclear fuel cycle system and the rationalization of waste treatment. In order to accomplish the selective nuclide separation, the design and synthesis of novel adsorbents are essential for the development of compact and precise separation processes. The present paper deals with the preparation of highly functional and selective hybrid microcapsules enclosing nano-adsorbents in the alginate gel polymer matrices by sol-gel methods, their characterization and the clarification of selective adsorption properties by batch and column methods. The selective separation of Cs, Pd and Re in real HLLW was further accomplished by using novel microcapsules, and an advanced nuclide separation system was proposed by the combination of selective processes using microcapsules.

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

    PubMed

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

    2018-04-01

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

  14. Interior view; Street Car Waiting House North Philadelphia Station, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Interior view; Street Car Waiting House - North Philadelphia Station, Street Car Waiting House, 2900 North Broad Street, on northwest corner of Broad Street & Glenwood Avenue, Philadelphia, Philadelphia County, PA

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

    PubMed

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

    2001-06-01

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

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

    PubMed

    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.

  17. ICoN, the Interactive Chart of Nuclides

    NASA Astrophysics Data System (ADS)

    Lee, Kevin; Mumpower, Matthew; Aprahamian, Ani

    2015-10-01

    Nuclear data is critical to research fields from medicine to astrophysics. The chart of nuclides is a more descriptive version of the periodic table that can be used to visualize nuclear properties such as half-lives and mass. We have created ICoN (simply short for Interactive Chart of Nuclides), an API which can be used to visualize theoretical and experimental datasets. This visualization is achieved by using D3 (Data Driven Documents), HTML, and CSS3 to plot the elements and color them accordingly. ICoN features many customization options that users can access that are dynamically applied to the chart without reloading the page. Users can save the customized chart they create to various formats. We have constructed these features in order to provide a unique approach for researchers to interface with nuclear data. ICoN can also be used on all electronic devices without loss of support. We report on the current progress of this project and will present a working demo that highlights each aspect of the aforementioned features. This is the first time that all available technologies are put to use to make nuclear data more accessible than ever before. This is a first and we will make it available as open source ware.

  18. Detail; Street Car Waiting House window, north wall North ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Detail; Street Car Waiting House window, north wall - North Philadelphia Station, Street Car Waiting House, 2900 North Broad Street, on northwest corner of Broad Street & Glenwood Avenue, Philadelphia, Philadelphia County, PA

  19. West view; Street Car Waiting House, east elevation North ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    West view; Street Car Waiting House, east elevation - North Philadelphia Station, Street Car Waiting House, 2900 North Broad Street, on northwest corner of Broad Street & Glenwood Avenue, Philadelphia, Philadelphia County, PA

  20. Wait Time for Counseling Affecting Perceived Stigma and Attitude toward the University

    ERIC Educational Resources Information Center

    Blau, Gary; DiMino, John; Sheridan, Natalie; Stein, Alexander; Casper, Steven; Chessler, Marcy; Beverly, Clyde

    2015-01-01

    A sample of 99 undergraduates in counseling was divided into two groups based on wait time from triage to intake, "less wait time" (up to two weeks) versus "more wait time" (at least two weeks). The less wait time group showed "higher willingness to recommend the university," "higher institutional…

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

    PubMed

    Abásolo, Ignacio; Barber, Patricia; González López-Valcárcel, Beatriz; Jiménez, Octavio

    2014-01-01

    In Spain, official information on waiting times for surgery is based on the interval between the indication for surgery and its performance. We aimed to estimate total waiting times for surgical procedures, including outpatient visits and diagnostic tests prior to surgery. In addition, we propose an alternative system to manage total waiting times that reduces variability and maximum waiting times without increasing the use of health care resources. This system is illustrated by three surgical procedures: cholecystectomy, carpal tunnel release and inguinal/femoral hernia repair. Using data from two Autonomous Communities, we adjusted, through simulation, a theoretical distribution of the total waiting time assuming independence of the waiting times of each stage of the clinical procedure. We show an alternative system in which the waiting time for the second consultation is established according to the time previously waited for the first consultation. Average total waiting times for cholecystectomy, carpal tunnel release and inguinal/femoral hernia repair were 331, 355 and 137 days, respectively (official data are 83, 68 and 73 days, respectively). Using different negative correlations between waiting times for subsequent consultations would reduce maximum waiting times by between 2% and 15% and substantially reduce heterogeneity among patients, without generating higher resource use. 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. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

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

    PubMed

    Sheard, Sally

    2018-02-19

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

  3. Outpatient Office Wait Times And Quality Of Care For Medicaid Patients.

    PubMed

    Oostrom, Tamar; Einav, Liran; Finkelstein, Amy

    2017-05-01

    The time patients spend in a doctor's waiting room prior to a scheduled appointment is an important component of the quality of the overall health care experience. We analyzed data on twenty-one million outpatient visits obtained from electronic health record systems, which allowed us to measure time spent in the waiting room beyond the scheduled appointment time. Median wait time was a little more than four minutes. Almost one-fifth of visits had waits longer than twenty minutes, and 10 percent were more than thirty minutes. Waits were shorter for early-morning appointments, for younger patients, and at larger practices. Median wait time was 4.1 minutes for privately insured patients and 4.6 minutes for Medicaid patients. After adjustment for patient and appointment characteristics, Medicaid patients were 20 percent more likely than the privately insured patients to wait longer than twenty minutes, with most of this disparity explained by differences in practices and providers they saw. Wait times for Medicaid patients relative to privately insured patients were longer in states with relatively lower Medicaid reimbursement rates. The study complements other work that suggests that Medicaid patients face some additional barriers in the receipt of care. Project HOPE—The People-to-People Health Foundation, Inc.

  4. Waiting time effect of a GM type orifice pulse tube refrigerator

    NASA Astrophysics Data System (ADS)

    Zhu, Shaowei; Kakimi, Yasuhiro; Matsubara, Yoichi

    In a general GM type orifice pulse tube refrigerator, there are two short periods during which both the high pressure valve and the low pressure valve are closed in one cycle. We call the short period `waiting time'. The pressure differences across the high pressure valve and the low pressure valve are decreased by using long waiting time. The pressure difference loss is decreased. Thus, the cooling capacity and the efficiency are increased, and the no-load temperature is decreased. The mechanism of the waiting time is discussed with numerical analysis and verified by experiments. Experiments show that there is an optimum waiting time for the no-load temperature, the cooling capacity and the efficiency, respectively. The no-load temperature of 40.3 K was achieved with a 90° waiting time. The cooling capacity of 58 W at 80 K was achieved with a 60° waiting time. The no-load temperature of 45.1 K and the cooling capacity of 45 W at 80 K were achieved with a 1° waiting time.

  5. North view; Street Car Waiting House, south (front) elevation ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    North view; Street Car Waiting House, south (front) elevation - North Philadelphia Station, Street Car Waiting House, 2900 North Broad Street, on northwest corner of Broad Street & Glenwood Avenue, Philadelphia, Philadelphia County, PA

  6. Numbers or apologies? Customer reactions to telephone waiting time fillers.

    PubMed

    Munichor, Nira; Rafaeli, Anat

    2007-03-01

    The authors examined the effect of time perception and sense of progress in telephone queues on caller reactions to 3 telephone waiting time fillers: music, apologies, and information about location in the queue. In Study 1, conducted on 123 real calls, call abandonment was lowest, and call evaluations were most positive with information about location in the queue as the time filler. In Study 2, conducted with 83 participants who experienced a simulated telephone wait experience, sense of progress in the queue rather than perceived waiting time mediated the relationship between telephone waiting time filler and caller reactions. The findings provide insight for the management and design of telephone queues, as well as theoretical insight into critical cognitive processes that underlie telephone waiting, opening up an important new research agenda. (c) 2007 APA, all rights reserved.

  7. Waiting times for hospital admissions: the impact of GP fundholding.

    PubMed

    Propper, Carol; Croxson, Bronwyn; Shearer, Arran

    2002-03-01

    Waiting times for hospital care are a significant issue in the UK National Health Service (NHS). The reforms of the health service in 1990 gave a subset of family doctors (GP fundholders) both the ability to choose the hospital where their patients were treated and the means to pay for some services. One of the key factors influencing family doctors' choice of hospital was patient waiting time. However, without cash inducements, hospitals would get no direct reward from giving shorter waiting times to a subset of patients. Using a unique dataset, we investigate whether GP fundholders were able to secure shorter waiting times for their patients, whether they were able to do so in cases where they had no financial rewards to offer hospitals, and whether the impact of fundholding spilled over into shorter waiting times for all patients.

  8. Sensitivity Analysis of Nuclide Importance to One-Group Neutron Cross Sections

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Sekimoto, Hiroshi; Nemoto, Atsushi; Yoshimura, Yoshikane

    The importance of nuclides is useful when investigating nuclide characteristics in a given neutron spectrum. However, it is derived using one-group microscopic cross sections, which may contain large errors or uncertainties. The sensitivity coefficient shows the effect of these errors or uncertainties on the importance.The equations for calculating sensitivity coefficients of importance to one-group nuclear constants are derived using the perturbation method. Numerical values are also evaluated for some important cases for fast and thermal reactor systems.Many characteristics of the sensitivity coefficients are derived from the derived equations and numerical results. The matrix of sensitivity coefficients seems diagonally dominant. However,more » it is not always satisfied in a detailed structure. The detailed structure of the matrix and the characteristics of coefficients are given.By using the obtained sensitivity coefficients, some demonstration calculations have been performed. The effects of error and uncertainty of nuclear data and of the change of one-group cross-section input caused by fuel design changes through the neutron spectrum are investigated. These calculations show that the sensitivity coefficient is useful when evaluating error or uncertainty of nuclide importance caused by the cross-section data error or uncertainty and when checking effectiveness of fuel cell or core design change for improving neutron economy.« less

  9. Optimal Server Scheduling to Maintain Constant Customer Waiting Times

    DTIC Science & Technology

    1988-12-01

    I I• I I I I I LCn CN OPTIMAL SERVER SCHEDUUNG TO MAINTAIN CONSTANT CUSTOMER WAITING TIMES THESIS Thomas J. Frey Captain UISAF AFIT/GOR/ENS/88D-7...hw bees appsewlf in ple rtan. cd = , ’ S 087 AFIT/GORMENS/8D-7 OPTIMAL SERVER SCHEDUUNG TO MAINTAIN~ CONSTANT CUSTOMER WAITING TIMES THESIS Thomas j...CONSTANT CUSTOMER WAITING TIMES THESIS Presented to the Faculty of the School of Engineering of the Air Force Institute of Technology Air University In

  10. Equity in specialist waiting times by socioeconomic groups: evidence from Spain.

    PubMed

    Abásolo, Ignacio; Negrín-Hernández, Miguel A; Pinilla, Jaime

    2014-04-01

    In countries with publicly financed health care systems, waiting time--rather than price--is the rationing mechanism for access to health care services. The normative statement underlying such a rationing device is that patients should wait according to need and irrespective of socioeconomic status or other non-need characteristics. The aim of this paper is to test empirically that waiting times for publicly funded specialist care do not depend on patients' socioeconomic status. Waiting times for specialist care can vary according to the type of medical specialty, type of consultation (review or diagnosis) and the region where patients' reside. In order to take into account such variability, we use Bayesian random parameter models to explain waiting times for specialist care in terms of need and non-need variables. We find that individuals with lower education and income levels wait significantly more time than their counterparts.

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

    PubMed

    Huan, Mei; Yang, Xiao-bao

    2014-01-01

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

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

    PubMed Central

    Huan, Mei; Yang, Xiao-bao

    2014-01-01

    The paper proposed a model for estimating waiting endurance times of electric two-wheelers at signalized intersections using survival analysis method. Waiting duration times were collected by video cameras and they were assigned as censored and uncensored data to distinguish between normal crossing and red-light running behavior. A Cox proportional hazard model was introduced, and variables revealing personal characteristics and traffic conditions were defined as covariates to describe the effects of internal and external factors. Empirical results show that riders do not want to wait too long to cross intersections. As signal waiting time increases, electric two-wheelers get impatient and violate the traffic signal. There are 12.8% of electric two-wheelers with negligible wait time. 25.0% of electric two-wheelers are generally nonrisk takers who can obey the traffic rules after waiting for 100 seconds. Half of electric two-wheelers cannot endure 49.0 seconds or longer at red-light phase. Red phase time, motor vehicle volume, and conformity behavior have important effects on riders' waiting times. Waiting endurance times would decrease with the longer red-phase time, the lower traffic volume, or the bigger number of other riders who run against the red light. The proposed model may be applicable in the design, management and control of signalized intersections in other developing cities. PMID:24895659

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

    PubMed Central

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

    2008-01-01

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

  14. Graph transformation method for calculating waiting times in Markov chains.

    PubMed

    Trygubenko, Semen A; Wales, David J

    2006-06-21

    We describe an exact approach for calculating transition probabilities and waiting times in finite-state discrete-time Markov processes. All the states and the rules for transitions between them must be known in advance. We can then calculate averages over a given ensemble of paths for both additive and multiplicative properties in a nonstochastic and noniterative fashion. In particular, we can calculate the mean first-passage time between arbitrary groups of stationary points for discrete path sampling databases, and hence extract phenomenological rate constants. We present a number of examples to demonstrate the efficiency and robustness of this approach.

  15. Interventions to reduce waiting times for elective procedures.

    PubMed

    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

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

    PubMed

    Almomani, Iman; AlSarheed, Ahlam

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

  17. Cosmogenic nuclides in the Martian surface: Constraints for sample recovery and transport

    NASA Technical Reports Server (NTRS)

    Englert, Peter A. J.

    1988-01-01

    Stable and radioactive cosmogenic nuclides and radiation damage effects such as cosmic ray tracks can provide information on the surface history of Mars. A recent overview on developments in cosmogenic nuclide research for historical studies of predominantly extraterrestrial materials was published previously. The information content of cosmogenic nuclides and radiation damage effects produced in the Martian surface is based on the different ways of interaction of the primary galactic and solar cosmic radiation (GCR, SCR) and the secondary particle cascade. Generally the kind and extent of interactions as seen in the products depend on the following factors: (1) composition, energy and intensity of the primary SCR and GCR; (2) composition, energy and intensity of the GCR-induced cascade of secondary particles; (3) the target geometry, i.e., the spatial parameters of Martian surface features with respect to the primary radiation source; (4) the target chemistry, i.e., the chemical composition of the Martian surface at the sampling location down to the minor element level or lower; and (5) duration of the exposure. These factors are not independent of each other and have a major influence on sample taking strategies and techniques.

  18. Where does the waiting list begin? A short review of the dynamics and organization of modern waiting lists.

    PubMed

    Rotstein, Dalia L; Alter, David A

    2006-06-01

    Waiting for medical care is the by-product of system rationing, where demand exceeds supply. In this short report we expand on the conventional concept of the queue, by focusing on the regulation of demand and by incorporating a funnel and spout analogy. Real-world examples are used to illustrate the infancy of funnel or demand-side reform initiatives targeting the queue, and the suggestion is made that policy needs to address the concept of 'waiting' much earlier in the treatment cycle.

  19. Forbush decreases geomagnetic and atmospheric effects cosmogenic nuclides

    NASA Technical Reports Server (NTRS)

    Flueckiger, E. O.

    1986-01-01

    An overview and synthesis is given of recent developments that have occurred in the areas of Forbush decreases, geomagnetic and atmospheric effects, and cosmogenic nuclides. Experimental evidence has been found for substantial differences in the effects of the various types of interplanetary perturbations on cosmic rays, and for a dependence of these effects on the three-dimensional configuration of the interplanetary medium. In order to fully understand and to be able to simulate the solar cosmic ray particle access to the polar regions of the earth we need accurate models of the magnetospheric magnetic field. These models must include all major magnetospheric current systems (in particular the field aligned currents), and they should represent magnetically quiet time periods as well as different levels of geomagnetic activity. In the evolution of magnetospheric magnetic field models, cosmic ray and magnetospheric physicists should work closely together since cosmic ray measurements are a powerful additional tool in the study of the perturbed magnetosphere. In the field of cosmogenic nuclides, finally, exciting new results and developments follow in rapid succession. Thanks to new techniques and new isotopes the analysis of cosmic ray history has entered into a new dimension.

  20. Advertising emergency department wait times.

    PubMed

    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.

  1. Advertising Emergency Department Wait Times

    PubMed Central

    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

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

    PubMed

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

    2014-08-01

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

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

    PubMed

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

    2014-10-01

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

  4. Waiting for Water

    ERIC Educational Resources Information Center

    Lamson-Nussbaum, Jorie

    2013-01-01

    The author waits in the hot and oppressive air while dust devils are born and die over the newly plowed field. It is a dry spring and she prays for rain. The lupine beans withered to dry threads last week and the corn that sprouted in a green haze over the north field is turning to brown paper. However, driving north, the author discovers the Rum…

  5. Organ Type and Waiting Time

    MedlinePlus

    ... but each organ type has its own individual distribution policy reflects reflect factors that are unique to each organ type: Kidney Waiting time Donor/recipient immune system compatibility Prior living donor ...

  6. Non-Poissonian Distribution of Tsunami Waiting Times

    NASA Astrophysics Data System (ADS)

    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

  7. Waiting Lists for Radiation Therapy: A Case Study

    PubMed Central

    2001-01-01

    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. PMID:11319944

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

    PubMed

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

    2013-04-01

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

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

    PubMed

    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.

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

    PubMed

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

    2018-07-01

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

  11. The exposure history of Jilin and production rates of cosmogenic nuclides

    NASA Technical Reports Server (NTRS)

    Heusser, G.

    1986-01-01

    Jilin, the largest known story meteorite, is a very suitable object for studying the systematics of cosmic ray produced nuclides in stony meteorites. Its well established two stage exposure history even permits to gain information about two different irradiation geometries (2pi and 4pi). All stable and long-lived cosmogenic nuclides measured in Jilin so far correlate well with each other. An example is shown where the Al-26 activities are plotted vs. the spallogenic Ne-21 concentration. These records of cosmic-ray interaction in Jilin can be used both to determine the history of the target and to study the nature of production rate profiles. This is unavoidably a bootstrap process, involving studying one with assumption about the other. Production rate equations are presented and discussed.

  12. Waiting in the surgery.

    PubMed

    Fry, F

    1994-07-01

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

  13. Waiting Narratives of Lung Transplant Candidates

    PubMed Central

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

    2013-01-01

    Before 2005, time accrued on the lung transplant waiting list counted towards who was next in line for a donor lung. Then in 2005 the lung allocation scoring system was implemented, which meant the higher the illness severity scores, the higher the priority on the transplant list. Little is known of the lung transplant candidates who were listed before 2005 and were caught in the transition when the lung allocation scoring system was implemented. A narrative analysis was conducted to explore the illness narratives of seven lung transplant candidates between 2006 and 2007. Arthur Kleinman's concept of illness narratives was used as a conceptual framework for this study to give voice to the illness narratives of lung transplant candidates. Results of this study illustrate that lung transplant candidates expressed a need to tell their personal story of waiting and to be heard. Recommendation from this study calls for healthcare providers to create the time to enable illness narratives of the suffering of waiting to be told. Narrative skills of listening to stories of emotional suffering would enhance how healthcare providers could attend to patients' stories and hear what is most meaningful in their lives. PMID:23476760

  14. Waiting narratives of lung transplant candidates.

    PubMed

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

    2013-01-01

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

  15. The behavior of U- and Th-series nuclides in the estuarine environment

    USGS Publications Warehouse

    Swarzenski, P.W.; Porcelli, D.; Andersson, P.S.; Smoak, J.M.

    2003-01-01

    Rivers carry the products of continental weathering, and continuously supply the oceans with a broad range of chemical constituents. This erosional signature is, however, uniquely moderated by biogeochemical processing within estuaries. Estuaries are commonly described as complex filters at land-sea margins, where significant transformations can occur due to strong physico-chemical gradients. These changes differ for different classes of elements, and can vary widely depending on the geographic location. U- and Th-series nuclides include a range of elements with vastly different characteristics and behaviors within such environments, and the isotopic systematics provide methods for investigating the transport of these nuclides and other analog species across estuaries and into the coastal ocean.

  16. Protocol to Exploit Waiting Resources for UASNs.

    PubMed

    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.

  17. Weight-ing: the experience of waiting on weight loss.

    PubMed

    Glenn, Nicole M

    2013-03-01

    Perhaps we want to be perfect, strive for health, beauty, and the admiring gaze of others. Maybe we desire the body of our youth, the "healthy" body, the body that has just the right fit. Regardless of the motivation, we might find ourselves striving, wanting, and waiting on weight loss. What is it to wait on weight loss? I explore the meaning of this experience-as-lived using van Manen's guide to phenomenological reflection and writing. Weight has become an increasing focus of contemporary culture, demonstrated, for example, by a growing weight-loss industry and global obesity "epidemic." Weight has become synonymous with health status, and weight loss with "healthier." I examine the weight wait through experiences of the common and uncommon, considering relations to time, body, space, and the other with the aim of evoking a felt, embodied, emotive understanding of the meaning of waiting on weight loss. I also discuss the implications of the findings.

  18. Waiting times in the ambulatory sector--the case of chronically ill patients.

    PubMed

    Sundmacher, Leonie; Kopetsch, Thomas

    2013-09-10

    First, the influence of determinants on the waiting times of chronically ill patients in the ambulatory sector is investigated. The determinants are subdivided into four groups: (1) need, (2) socio-economic factors, (3) health system and (4) patient time pressures. Next, the influence of waiting times on the annual number of consultations is examined to assess whether the existing variation in waiting times influences the frequency of medical examinations. The waiting times of chronically ill patients are analysed since regular ambulatory care for this patient group could both improve treatment outcomes and lower costs. Individual data from the 2010 Representative Survey conducted by the National Association of Statutory Health Insurance Physicians (KBV) together with regional data from the Federal Office of Construction and Regional Planning. This is a retrospective observational study. The dependent variables are waiting times in the ambulatory sector and the number of consultations of General Practitioners (GPs) and specialist physicians in the year 2010. The explanatory variables of interest are 'need' and 'health system' in the first model and 'length of waiting times' in the second. Negative binomial models with random effects are used to estimate the incidence rate ratios of increased waiting times and number of consultations. Subsequently, the models are stratified by urban and rural areas. In the pooled regression the factor 'privately insured' shortens the waiting time for treatment by a specialist by approximately 28% (about 3 days) in comparison with members of the statutory health insurance system. The category of insurance has no influence on the number of consultations of GPs. In addition, the regression results stratified by urban and rural areas show that in urban areas the factor 'privately insured' reduces the waiting time for specialists by approximately 35% (about 3.3 days) while in rural areas there is no evidence of statistical influence. In

  19. Detail; Street Car Waiting House, support for exterior light fixture ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Detail; Street Car Waiting House, support for exterior light fixture - North Philadelphia Station, Street Car Waiting House, 2900 North Broad Street, on northwest corner of Broad Street & Glenwood Avenue, Philadelphia, Philadelphia County, PA

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

    Code of Federal Regulations, 2010 CFR

    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... filing is the priority date for purposes of case control. Refugees or groups of refugees may be selected...

  1. [Radioactive nuclides in the marine environment--distribution and behaviour of 95Zr, 95Nb originated from fallout].

    PubMed

    Yamato, A; Miyagawa, N; Miyanaga, N

    1984-07-01

    To investigate behaviour of 95Zr, 95Nb in the marine environment, various samples have been collected and measured by means of Ge(Li) gamma-ray spectrometry and/or radiochemical analysis during a period from 1974 to 1982 at coastal area of Tokai-mura, Ibaraki prefecture. Concentration of the nuclides in seaweeds increased remarkably after atmospheric nuclear detonation by P.R. of China, and the activity ratio between the nuclides changed by time was not fit well by the transient decay equation. Concentration variation in sea water was smaller than that in sea weeds, and the minimum change in sea sediment. Increase of concentration in these environmental samples was observed in chronological order of sea water, sea weeds then sediment after detonations, suggesting that the uptake of the nuclides by these sea weeds from sea water is faster than that via root. Observed concentration factors on the nuclides by sea weeds were calculated from the observed concentrations in sea water and sea weeds. Maximum values on 95Zr and 95Nb were 2110, 2150, respectively for Ecklonia cava and Eisenia bicyclis.

  2. Challenging "Waiting for Superman"

    ERIC Educational Resources Information Center

    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…

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

    PubMed

    Stone, Anne M; Lammers, John C

    2012-01-01

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

  4. ED adds business center to wait area.

    PubMed

    2007-10-01

    Providing your patients with Internet access in the waiting area can do wonders for their attitudes and make them much more understanding of long wait times. What's more, it doesn't take a fortune to create a business center. The ED at Florida Hospital Celebration (FL) Health made a world of difference with just a couple of computers and a printer. Have your information technology staff set the computers up to preserve the privacy of your internal computer system, and block out offensive sites. Access to medical sites can help reinforce your patient education efforts.

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

    PubMed

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

    2009-08-01

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

  6. Decreasing Wait Times and Increasing Patient Satisfaction: A Lean Six Sigma Approach.

    PubMed

    Godley, Mary; Jenkins, Jeanne B

    2018-06-08

    Patient satisfaction scores in the vascular interventional radiology department were low, especially related to wait times in registration and for tests/treatments, with low scores for intentions to recommend. The purpose of our quality improvement project was to decrease wait times and improve patient satisfaction using Lean Six Sigma's define, measure, analyze, improve, and control (DMAIC) framework with a pre-/postintervention design. There was a statistically significant decrease in wait times (P < .0019) and an increase in patient satisfaction scores in 3 areas: registration wait times (from 17 to 99 percentiles), test/treatment (from 19 to 60 percentiles), and likelihood to recommend (from 6 to 97 percentiles). Lean Six Sigma was an effective framework for use in decreasing wait times and improving patient satisfaction.

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

    PubMed

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

    2010-02-01

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

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

    PubMed

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

    2015-08-01

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

  9. Ice Elevation Changes in the Ellsworth Mountains, Antarctica Using Multiple Cosmogenic Nuclides

    NASA Astrophysics Data System (ADS)

    Marrero, S.; Hein, A.; Sugden, D.; Woodward, J.; Dunning, S.; Reid, K.

    2014-12-01

    Well-dated geologic data points provide important indicators that can be used for the reconstruction of ice sheet dynamics and as constraints in ice sheet models predicting future change. Cosmogenic nuclides, which accumulate in rocks exposed at the earth's surface, can be used to directly date the exposure age of the rock surfaces that have been created through glacial erosion or deposition. The technique requires a detailed understanding of the local geomorphology as well as awareness of the post-depositional processes that may affect the interpretation of exposure ages. Initial surface exposure ages (10Be, 26Al, 21Ne, and 36Cl ) from local limestone bedrock and other glacially deposited exotic lithologies provide a history spanning from 0 to 1.1 Ma in the Patriot, Independence, and Marble Hills in the southern Ellsworth Mountains, Antarctica. Using the new surface exposure ages combined with geomorphological mapping, we will discuss the implications for the glacial history of the southern Ellsworth Mountains.

  10. No-waiting dentine self-etch concept-Merit or hype.

    PubMed

    Huang, Xue-Qing; Pucci, César R; Luo, Tao; Breschi, Lorenzo; Pashley, David H; Niu, Li-Na; Tay, Franklin R

    2017-07-01

    A recently-launched universal adhesive, G-Premio Bond, provides clinicians with the alternative to use the self-etch technique for bonding to dentine without waiting for the adhesive to interact with the bonding substrate (no-waiting self-etch; Japanese brochure), or after leaving the adhesive undisturbed for 10s (10-s self-etch; international brochure). The present study was performed to examine in vitro performance of this new universal adhesive bonded to human coronal dentine using the two alternative self-etch modes. One hundred and ten specimens were bonded using two self-etch application modes and examined with or without thermomechanical cycling (10,000 thermal cycles and 240,000 mechanical cycles) to simulate one year of intraoral functioning. The bonded specimens were sectioned for microtensile bond testing, ultrastructural and nanoleakage examination using transmission electron microscopy. Changes in the composition of mineralised dentine after adhesive application were examined using Fourier transform infrared spectroscopy. Both reduced application time and thermomechanical cycling resulted in significantly lower bond strengths, thinner hybrid layers, and significantly more extensive nanoleakage after thermomechanical cycling. Using the conventional 10-s application time improved bonding performance when compared with the no-waiting self-etch technique. Nevertheless, nanoleakage was generally extensive under all testing parameters employed for examining the adhesive. Although sufficient bond strength to dentine may be achieved using the present universal adhesive in the no-waiting self-etch mode that does not require clinicians to wait prior to polymerisation of the adhesive, this self-etch concept requires further technological refinement before it can be recommended as a clinical technique. Although the surge for cutting application time to increase user friendliness remains the most frequently sought conduit for advancement of dentine bonding

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

    ERIC Educational Resources Information Center

    Li, Winnie Sim Siew; Arshad, Mohammad Yusof

    2014-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Nabi, Jameel-Un; Böyükata, Mahmut

    2016-03-01

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

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

    PubMed

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

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

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

    PubMed Central

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

    2017-01-01

    This study aimed to clarify psychosocial influences of waiting periods on patients undergoing endoscopic submucosal dissection for cancer at an advanced medical care facility in Japan. Subjects were consenting patients hospitalized from 2009 to 2010. Qualitative and quantitative data were gathered about patients' characteristics, disease and stage, and waiting period. Qualitative content analysis was used to analyze free statements and interview data. Subjects included 154 patients with an average wait period of 46.28 days for admission. Qualitative analysis revealed the following wait period perceptions. For calmness, results indicated (1) no anxiety, (2) relief based on doctors' positive judgment, (3) whatever happens/no choice, and (4) trust in doctor. For uneasiness, perceptions included (1) the sooner, the better/eagerly waiting, (2) anxiety and concern, and (3) emotional instability. Four waiting period coping types were identified: (1) making phone inquiries, (2) busy and forgot about the medical procedure, (3) relief from anxiety, and (4) unable to function well in daily life. Patients need to be educated about cancer progression and provided an estimated wait time. They also require more information about how to manage daily life such as monitoring factors from the nursing domain including physical condition, digestive symptoms, diet, and exercise. PMID:26987103

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

    PubMed

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

    2014-02-01

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

  16. Progress on multi-nuclide AMS of JAEA-AMS-TONO

    NASA Astrophysics Data System (ADS)

    Saito-Kokubu, Yoko; Matsubara, Akihiro; Miyake, Masayasu; Nishizawa, Akimitsu; Ohwaki, Yoshio; Nishio, Tomohiro; Sanada, Katsuki; Hanaki, Tatsumi

    2015-10-01

    The JAEA-AMS-TONO (Japan Atomic Energy Agency's Accelerator Mass Spectrometer established at the Tono Geoscience Center) facility has been used for the dating of geological samples. The AMS system is versatile, based on a 5 MV tandem Pelletron-type accelerator. Since its establishment in 1997, the AMS system has been used for measurement of carbon-14 (14C) mainly for 14C dating studies in neotectonics and hydrogeology, in support of JAEA's research on geosphere stability applicable to the long-term isolation of high-level radioactive waste. Results of the measurement of 14C in soils and plants has been applied to the dating of fault activity and volcanism. Development of beryllium-10 (10Be) and aluminum-26 (26Al) AMS systems are now underway to enhance the capability of the multi-nuclide AMS in studies of dating by cosmogenic nuclides. The 10Be-AMS system has already been used for routine measurements in applied studies and improvements of the measurement technique have been made. Now we plan to fine tune the system and perform test measurements to develop the 26Al-AMS system.

  17. Work plan for improving the DARWIN2.3 depleted material balance calculation of nuclides of interest for the fuel cycle

    NASA Astrophysics Data System (ADS)

    Rizzo, Axel; Vaglio-Gaudard, Claire; Martin, Julie-Fiona; Noguère, Gilles; Eschbach, Romain

    2017-09-01

    DARWIN2.3 is the reference package used for fuel cycle applications in France. It solves the Boltzmann and Bateman equations in a coupling way, with the European JEFF-3.1.1 nuclear data library, to compute the fuel cycle values of interest. It includes both deterministic transport codes APOLLO2 (for light water reactors) and ERANOS2 (for fast reactors), and the DARWIN/PEPIN2 depletion code, each of them being developed by CEA/DEN with the support of its industrial partners. The DARWIN2.3 package has been experimentally validated for pressurized and boiling water reactors, as well as for sodium fast reactors; this experimental validation relies on the analysis of post-irradiation experiments (PIE). The DARWIN2.3 experimental validation work points out some isotopes for which the depleted concentration calculation can be improved. Some other nuclides have no available experimental validation, and their concentration calculation uncertainty is provided by the propagation of a priori nuclear data uncertainties. This paper describes the work plan of studies initiated this year to improve the accuracy of the DARWIN2.3 depleted material balance calculation concerning some nuclides of interest for the fuel cycle.

  18. Simulations of Terrestrial in-situ Cosmogenic-Nuclide Production

    NASA Technical Reports Server (NTRS)

    Reedy, R. C.; Nishiizumi, K.; Lal, D.; Arnold, J. R.; Englert, P. A. J.; Klein, J.; Middleton, R.; Jull, A. J. T.; Donahue, D. J.

    1994-01-01

    Targets of silicon and silicon dioxide were irradiated with spallation neutrons to simulate the production of long-lived radionuclides in the surface of the Earth. Gamma-ray spectroscopy was used to measure Be-7 and Na-22, and accelerator mass spectrometry was used to measure Be-10, C-14, and Al-26. The measured ratios of these nuclides are compared with calculated ratios and with ratios from other simulations and agree well with ratios inferred from terrestrial samples.

  19. The effect of early education on patient anxiety while waiting for elective cardiac catheterization.

    PubMed

    Harkness, Karen; Morrow, Lydia; Smith, Kelly; Kiczula, Michele; Arthur, Heather M

    2003-07-01

    A supply-demand mismatch with respect to cardiac catheterization (CATH) often results in patients experiencing waiting times that vary from a few weeks to several months. Long delays can impose both physical and psychological distress for patients. The purpose of this study was to examine the effect of a psychoeducational nursing intervention at the beginning of the waiting period on patient anxiety during the waiting time for elective CATH. This was a 2-group randomized controlled trial. Intervention patients received a nurse-delivered, detailed information/education session within 2 weeks of being placed on the waiting list for elective CATH. Control group patients received usual care. The mean waiting time for CATH was 13.4+/-7.2 weeks, which did not differ between groups (P=0.509). Anxiety increased in both groups over the waiting time (P=0.028). Health-related quality of life deteriorated over the waiting time in both groups (P<0.05). On a visual analogue scale, there was a significant difference (P=0.002) between the intervention (4.0+/-2.7) and control (5.2+/-3.0) groups in self-reported anxiety 2 weeks prior to CATH. The waiting period prior to elective CATH has a negative impact on patients' perceived anxiety and quality of life and a simple intervention, provided at the beginning of the waiting period, may positively affect the experience of waiting.

  20. Activity in children with ADHD during waiting situations in the classroom: a pilot study.

    PubMed

    Antrop, Inge; Buysse, Ann; Roeyers, Herbert; Van Oost, Paulette

    2005-03-01

    According to the optimal stimulation theory and the delay aversion hypothesis, children with attention deficit hyperactivity disorder (ADHD) experience difficulties when they are confronted with low levels of stimulation and delay, respectively. This study investigated the activity level of children with ADHD during waiting situations in the classroom. Three series of hypothesis were made: (1) with respect to the comparison between waiting and non-waiting intervals, (2) with respect to the effects of non-temporal stimulation, and (3) with respect to the effects of temporal stimulation on behaviour during waiting. The activity level of 14 children with ADHD and 14 control children between the ages of 6 and 11 years was observed during two non-waiting class situations and three waiting situations: without any stimulation, in the presence of nontemporal stimulation and in the presence of temporal stimulation. Both groups of children obtained higher activity scores for all behavioural dimensions during waiting compared with non-waiting situations. The results further revealed additive effects of waiting and diagnostic group on behaviour. Additional nontemporal stimulation during waiting affected the behaviour of all children for most behavioural characteristics. For noisiness, additive effects were also found for diagnostic group and either non-temporal stimulation or temporal stimulation. For restlessness, a trend for an interaction effect between diagnostic group and nontemporal stimulation was found. The findings have clear implications for school observations within an assessment protocol.

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

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Kildea, John; Hijal, Tarek

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

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

    PubMed

    Carlsen, Fredrik; Kaarboe, Oddvar Martin

    2015-11-01

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

  3. What happened to the no-wait hospital? A case study of implementation of operational plans for reduced waits.

    PubMed

    Hansson, Johan; Tolf, Sara; Øvretveit, John; Carlsson, Jan; Brommels, Mats

    2012-01-01

    Both research and practice show that waiting lists are hard to reduce. Implementing complex interventions for reduced waits is an intricate and challenging process that requires special attention for surrounding factors helping and hindering the implementation. This article reports a case study of a hospital implementation of operational plans for reduced waits, with an emphasis on the process of change. A case study research design, theoretically informed by the Pettigrew and Whipp model of strategic change, was applied. Data were gathered from individual and focus group interviews with informants from different organizational levels at different times and from documents and plans. The findings revealed arrangements both helping and hindering the implementation work. Helping factors were the hospital's contemporary savings requirements and experiences from similar change initiatives. Those hindering the actions to plan and agree the changes were unclear support functions and unclear task prioritization. One contribution of this study is to demonstrate the advantages, disadvantages, and challenges of a contextualized case study for increased understanding of factors influencing organizational change implementation. One lesson for current policy is to regard context factors that are critical for successful implementation.

  4. An Efficient Wait-Free Vector

    DOE PAGES

    Feldman, Steven; Valera-Leon, Carlos; Dechev, Damian

    2016-03-01

    The vector is a fundamental data structure, which provides constant-time access to a dynamically-resizable range of elements. Currently, there exist no wait-free vectors. The only non-blocking version supports only a subset of the sequential vector API and exhibits significant synchronization overhead caused by supporting opposing operations. Since many applications operate in phases of execution, wherein each phase only a subset of operations are used, this overhead is unnecessary for the majority of the application. To address the limitations of the non-blocking version, we present a new design that is wait-free, supports more of the operations provided by the sequential vector,more » and provides alternative implementations of key operations. These alternatives allow the developer to balance the performance and functionality of the vector as requirements change throughout execution. Compared to the known non-blocking version and the concurrent vector found in Intel’s TBB library, our design outperforms or provides comparable performance in the majority of tested scenarios. Over all tested scenarios, the presented design performs an average of 4.97 times more operations per second than the non-blocking vector and 1.54 more than the TBB vector. In a scenario designed to simulate the filling of a vector, performance improvement increases to 13.38 and 1.16 times. This work presents the first ABA-free non-blocking vector. Finally, unlike the other non-blocking approach, all operations are wait-free and bounds-checked and elements are stored contiguously in memory.« less

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

    PubMed

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

    2010-02-15

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

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

    PubMed

    Cani, Pascale

    2014-01-01

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

  7. Scaling in situ cosmogenic nuclide production rates using analytical approximations to atmospheric cosmic-ray fluxes

    NASA Astrophysics Data System (ADS)

    Lifton, Nathaniel; Sato, Tatsuhiko; Dunai, Tibor J.

    2014-01-01

    Several models have been proposed for scaling in situ cosmogenic nuclide production rates from the relatively few sites where they have been measured to other sites of interest. Two main types of models are recognized: (1) those based on data from nuclear disintegrations in photographic emulsions combined with various neutron detectors, and (2) those based largely on neutron monitor data. However, stubborn discrepancies between these model types have led to frequent confusion when calculating surface exposure ages from production rates derived from the models. To help resolve these discrepancies and identify the sources of potential biases in each model, we have developed a new scaling model based on analytical approximations to modeled fluxes of the main atmospheric cosmic-ray particles responsible for in situ cosmogenic nuclide production. Both the analytical formulations and the Monte Carlo model fluxes on which they are based agree well with measured atmospheric fluxes of neutrons, protons, and muons, indicating they can serve as a robust estimate of the atmospheric cosmic-ray flux based on first principles. We are also using updated records for quantifying temporal and spatial variability in geomagnetic and solar modulation effects on the fluxes. A key advantage of this new model (herein termed LSD) over previous Monte Carlo models of cosmogenic nuclide production is that it allows for faster estimation of scaling factors based on time-varying geomagnetic and solar inputs. Comparing scaling predictions derived from the LSD model with those of previously published models suggest potential sources of bias in the latter can be largely attributed to two factors: different energy responses of the secondary neutron detectors used in developing the models, and different geomagnetic parameterizations. Given that the LSD model generates flux spectra for each cosmic-ray particle of interest, it is also relatively straightforward to generate nuclide-specific scaling

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

    PubMed

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

    2010-08-05

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

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

    PubMed

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

    2015-08-01

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

  10. Outpatient clinic waiting time, provider communication styles and satisfaction with healthcare in India.

    PubMed

    Mehra, Payal

    2016-08-08

    Purpose - The purpose of this paper is to evaluate the impact of extended waiting time on patients' perceptions of provider communication skills and in-clinic satisfaction, in three major cities in India. Design/methodology/approach - In total, 625 patients were interviewed. The multivariate general linear model was used to determine the causality and relationship between the independent and the dependent variable. A moderation analysis was also conducted to assess waiting time role as a potential moderator in doctor-patient communication. Findings - Results show that patients with higher waiting time were less satisfied with health care quality. Male patients and patients of male providers were more affected by extended waiting time than female patients and patients of female providers. The advanced regression analysis, however, suggests weak support for waiting time and its effect on overall satisfaction with clinic quality. Waiting time did not moderate the relationship between satisfaction with dominant communication style, and overall satisfaction at the outpatient clinic. Research limitations/implications - A cross-sectional study does not easily lend itself to explaining causality with certainty. Thus, sophisticated techniques, such as structural equation modelling may also be utilized to assess the influence of extended waiting time on satisfaction with healthcare at outpatient clinics. Practical implications - Findings are relevant for providers as the onus is on them to ensure patient satisfaction. They should initiate a workable waiting time assessment model at the operational level. Originality/value - There has been a relatively lesser focus on patient waiting time in patient-provider satisfaction studies. In India, this aspect is still vastly unexplored especially in the context of outpatient clinics. Gender wise pattern of patient satisfaction and waiting time is also missing in most studies.

  11. The microdistribution of α-active nuclides in the human lung

    NASA Astrophysics Data System (ADS)

    Henshaw, D. L.; Fews, A. P.

    1984-06-01

    Elsewhere (refs. [4,5]) the authors have discussed new and elaborate techniques for alpha-particle autoradiography using the nuclear track detector CR-39. These techniques are at present being applied in a major study of the microdistribution of alpha-active nuclides in the human lung. Whole lungs with trachea are obtained at autopsy. Case histories representing a wide spectrum of lung burden are sought but that from the general population serves as a baseline from which all abnormal levels may be compared. The lungs are dissected, loaded against CR-39 and stored deep frozen for 3-20 months. Subsequent analysis of the autoradiograph reveals: (i) The microdistribution of activity. This includes for example the pattern of deposition around the tracheal bifurcation and across the tracheal wall for both the total activity and separately that due to 222Rn + daughter nuclei and, the distribution of single and multiple decays from single points over the storage period of the autoradiograph. The information enables the frequency of single and multiple hits to sensitive cells in the lung to be calculated. This is an important step in estimating the frequency of radiation induced mutations. (ii) The absolute abundance of alpha-active nuclides present at each site. This quantity is determined at particular locations in lung such as bifurcations in the major airways, in corresponding positions on the posterior aspect of the trachea and bronchus and parenchymal lung for each of the five lobes and in the lymph nodes. The information is obtained in normal lung over a wide span of age. This overall information may be used to study the deposition, retention and clearance patterns of different alpha-emitting elements with associated differences in size and physical and chemical nature. These studies in normal lung may provide new information on the mechanism at work in lung for the clearance of particulate matter. They may also be used to predict the behaviour of inhaled alpha

  12. Role of Core-collapse Supernovae in Explaining Solar System Abundances of p Nuclides

    NASA Astrophysics Data System (ADS)

    Travaglio, C.; Rauscher, T.; Heger, A.; Pignatari, M.; West, C.

    2018-02-01

    The production of the heavy stable proton-rich isotopes between 74Se and 196Hg—the p nuclides—is due to the contribution from different nucleosynthesis processes, activated in different types of stars. Whereas these processes have been subject to various studies, their relative contributions to Galactic chemical evolution (GCE) are still a matter of debate. Here we investigate for the first time the nucleosynthesis of p nuclides in GCE by including metallicity and progenitor mass-dependent yields of core-collapse supernovae (ccSNe) into a chemical evolution model. We used a grid of metallicities and progenitor masses from two different sets of stellar yields and followed the contribution of ccSNe to the Galactic abundances as a function of time. In combination with previous studies on p-nucleus production in thermonuclear supernovae (SNIa), and using the same GCE description, this allows us to compare the respective roles of SNeIa and ccSNe in the production of p-nuclei in the Galaxy. The γ process in ccSN is very efficient for a wide range of progenitor masses (13 M ⊙–25 M ⊙) at solar metallicity. Since it is a secondary process with its efficiency depending on the initial abundance of heavy elements, its contribution is strongly reduced below solar metallicity. This makes it challenging to explain the inventory of the p nuclides in the solar system by the contribution from ccSNe alone. In particular, we find that ccSNe contribute less than 10% of the solar p nuclide abundances, with only a few exceptions. Due to the uncertain contribution from other nucleosynthesis sites in ccSNe, such as neutrino winds or α-rich freeze out, we conclude that the light p-nuclides 74Se, 78Kr, 84Sr, and 92Mo may either still be completely or only partially produced in ccSNe. The γ-process accounts for up to twice the relative solar abundances for 74Se in one set of stellar models and 196Hg in the other set. The solar abundance of the heaviest p nucleus 196Hg is

  13. Apparatus and method for quantitatively evaluating total fissile and total fertile nuclide content in samples

    DOEpatents

    Caldwell, John T.; Kunz, Walter E.; Cates, Michael R.; Franks, Larry A.

    1985-01-01

    Simultaneous photon and neutron interrogation of samples for the quantitative determination of total fissile nuclide and total fertile nuclide material present is made possible by the use of an electron accelerator. Prompt and delayed neutrons produced from resulting induced fissions are counted using a single detection system and allow the resolution of the contributions from each interrogating flux leading in turn to the quantitative determination sought. Detection limits for .sup.239 Pu are estimated to be about 3 mg using prompt fission neutrons and about 6 mg using delayed neutrons.

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

    PubMed

    Sivey, Peter

    2018-03-01

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

  15. [Women's satisfaction with waiting times for further investigation in breast cancer screening].

    PubMed

    Molina-Barceló, Ana; Salas Trejo, Dolores; Miranda García, Josefa

    2011-01-01

    To determine the factors associated with satisfaction with waiting times for further investigation in breast cancer screening. 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). 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%). 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 special attention to women aged 45 to 54 years attending their initial screening. 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

  16. SouthWest view, Street Car Waiting House, north and east elevations ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    South-West view, Street Car Waiting House, north and east elevations - North Philadelphia Station, Street Car Waiting House, 2900 North Broad Street, on northwest corner of Broad Street & Glenwood Avenue, Philadelphia, Philadelphia County, PA

  17. NorthEast view; Street Car Waiting House, south (front) and west ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    North-East view; Street Car Waiting House, south (front) and west elevations - North Philadelphia Station, Street Car Waiting House, 2900 North Broad Street, on northwest corner of Broad Street & Glenwood Avenue, Philadelphia, Philadelphia County, PA

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

    PubMed Central

    2010-01-01

    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. PMID:20687952

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

    PubMed

    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.

  20. Delays in Prior Living Kidney Donors Receiving Priority on the Transplant Waiting List

    PubMed Central

    Klassen, David K.; Kucheryavaya, Anna Y.; Stewart, Darren E.

    2016-01-01

    Background and objectives Prior living donors (PLDs) receive very high priority on the Organ Procurement and Transplantation Network (OPTN) kidney waiting list. Program delays in adding PLDs to the waiting list, setting their status to active, and submitting requests for PLD priority can affect timely access to transplantation. Design, setting, participants, & measurements We used the OPTN and the Centers for Medicare and Medicaid Services data to examine timing of (1) listing relative to start of dialysis, (2) activation on the waiting list, and (3) requests for PLD priority relative to listing date. There were 210 PLDs (221 registrations) added to the OPTN kidney waiting list between January 1, 2010 and July 31, 2015. Results As of September 4, 2015, 167 of the 210 PLDs received deceased donor transplants, six received living donor transplants, two died, five were too sick to transplant, and 29 were still waiting. Median waiting time to deceased donor transplant for PLDs was 98 days. Only 40.7% of 221 PLD registrations (n=90) were listed before they began dialysis; 68.3% were in inactive status for <90 days, 17.6% were in inactive status for 90–365 days, 8.6% were in inactive status for 1–2 years, and 5.4% were in inactive status for >2 years. Median time of PLDs waiting in active status before receiving PLD priority was 2 days (range =0–1450); 67.4% of PLDs received PLD priority within 7 days after activation, but 15.4% waited 8–30 days, 8.1% waited 1–3 months, 4.1% waited 3–12 months, and 5.0% waited >1 year in active status for PLD priority. After receiving priority, most were transplanted quickly. Median time in active status with PLD priority before deceased donor transplant was 23 days. Conclusions Fewer than one half of listed PLDs were listed before starting dialysis. Most listed PLDs are immediately set to active status and receive PLD priority quickly, but a substantial number spends time in active status without PLD priority or a large

  1. A state of limbo: the politics of waiting in neo-liberal Latvia.

    PubMed

    Ozoliņa-Fitzgerald, Liene

    2016-09-01

    This article presents an ethnographic study of politics of waiting in a post-Soviet context. While activation has been explored in sociological and anthropological literature as a neo-liberal governmental technology and its application in post-socialist context has also been compellingly documented, waiting as a political artefact has only recently been receiving increased scholarly attention. Drawing on ethnographic fieldwork at a state-run unemployment office in Riga, this article shows how, alongside activation, state welfare policies also produce passivity and waiting. Engaging with the small but developing field of sociological literature on the politics of waiting, I argue that, rather than interpreting it as a clash between 'neo-liberal' and 'Soviet' regimes, we should understand the double-move of activation and imposition of waiting as a key mechanism of neo-liberal biopolitics. This article thus extends the existing theorizations of the temporal politics of neo-liberalism. © London School of Economics and Political Science 2016.

  2. Improved estimation of commuter waiting times using headway and commuter boarding information

    NASA Astrophysics Data System (ADS)

    Ramli, Muhamad Azfar; Jayaraman, Vasundhara; Kwek, Hyen Chee; Tan, Kian Heong; Lee Kee Khoon, Gary; Monterola, Christopher

    2018-07-01

    The average amount of waiting time spent by commuters is one of the key indicators of service quality for public bus operations. While actual measurements of actual waiting time is difficult to be done en masse, models of waiting time can be derived from bus headways and these models have been adopted by transport planners in monitoring and regulating service reliability of operators. However, these models are founded on several assumptions on the patterns of commuter arrival which may not be applicable for bus services that experience high demand and heavily fluctuating commuter patterns. Given the availability of granular data on commuter boarding from automated fare collection systems, we propose a new methodology to better estimate the average waiting time of commuters. The formulation is anchored and validated using a three-month dataset from ten selected bus routes in Singapore. Finally, we discuss how our new measure allows for minimization of commuter waiting time through schedule optimization.

  3. Wait Time and Effective Social Studies Instruction: What Can Research in Science Education Tell Us?

    ERIC Educational Resources Information Center

    Atwood, Virgina A.; Wilen, William W.

    1991-01-01

    Defines wait time as the length of time teachers wait for answers from students after asking a question. Maintains that increasing wait time can stimulate reflective thinking and student involvement. Reviews the research literature on wait time studies in science education. Finds that student responses improve and participation expands with…

  4. VRF ("Visual RobFit") — nuclear spectral analysis with non-linear full-spectrum nuclide shape fitting

    NASA Astrophysics Data System (ADS)

    Lasche, George; Coldwell, Robert; Metzger, Robert

    2017-09-01

    A new application (known as "VRF", or "Visual RobFit") for analysis of high-resolution gamma-ray spectra has been developed using non-linear fitting techniques to fit full-spectrum nuclide shapes. In contrast to conventional methods based on the results of an initial peak-search, the VRF analysis method forms, at each of many automated iterations, a spectrum-wide shape for each nuclide and, also at each iteration, it adjusts the activities of each nuclide, as well as user-enabled parameters of energy calibration, attenuation by up to three intervening or self-absorbing materials, peak width as a function of energy, full-energy peak efficiency, and coincidence summing until no better fit to the data can be obtained. This approach, which employs a new and significantly advanced underlying fitting engine especially adapted to nuclear spectra, allows identification of minor peaks that are masked by larger, overlapping peaks that would not otherwise be possible. The application and method are briefly described and two examples are presented.

  5. The ethics of waiting and anticipating life beyond.

    PubMed

    Milton, Constance L

    2014-01-01

    Waiting is a common everyday experience. It is particularly important to person(s) and families living with changing complex health patterns and may be especially vital to those who are anticipating the end-of-life and beyond. The author in this column offers a discussion of potential definitions, meanings, and straight thinking responsibilities for healthcare professionals, as they provide professional services with persons and families who may be arduously experiencing the phenomenon of waiting with ever-changing health situations. Implications for professional nurse practice are offered from a humanbecoming perspective.

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

    PubMed

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

    2015-11-01

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

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

    PubMed Central

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

    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 time for a home visit and the distance to the GP cooperative. Further, we investigated if other factors (traffic intensity, home visit intensity, time of day, and degree of urgency) influenced waiting times. Methods Cross-sectional study at four GP cooperatives. We used variance analysis to calculate waiting times for various categories of traffic intensity, home visit intensity, time of day, and degree of urgency. We used multiple logistic regression analysis to calculate to what degree these factors affected the ability to meet targets in urgent cases. Results The average waiting time for 5827 consultations was 30.5 min. Traffic intensity, home visit intensity, time of day and urgency of the complaint all seemed to affect waiting times significantly. A total of 88.7% of all patients were seen within 1 hour. In the case of life-threatening complaints (U1), 68.8% of the patients were seen within 15 min, and 95.6% of those with acute complaints (U2) were seen within 1 hour. For patients with life-threatening complaints (U1) the percentage of visits that met the time target of 15 minuts decreased from 86.5% (less than 2.5 km) to 16.7% (equals or more than 20 km). Discussion and conclusion Although home visits waiting times increase with increasing distance from the GP cooperative, it appears that traffic intensity, home visit intensity, and urgency also influence waiting times. For patients with life-threatening complaints waiting times increase sharply with the distance. PMID:17295925

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

    PubMed

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

    2007-02-12

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

  9. Review of "Waiting for Superman"

    ERIC Educational Resources Information Center

    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…

  10. Fukushima-derived fission nuclides monitored around Taiwan: Free tropospheric versus boundary layer transport

    NASA Astrophysics Data System (ADS)

    Huh, Chih-An; Hsu, Shih-Chieh; Lin, Chuan-Yao

    2012-02-01

    The 2011 Fukushima nuclear accident in Japan was the worst nuclear disaster following the 1986 Chernobyl accident. Fission products (nuclides) released from the Fukushima plant site since March 12, 2011 had been detected around the northern hemisphere in about two weeks and also in the southern hemisphere about one month later. We report here detailed time series of radioiodine and radiocesium isotopes monitored in a regional network around Taiwan, including one high-mountain and three ground-level sites. Our results show several pulses of emission from a sequence of accidents in the Fukushima facility, with the more volatile 131I released preferentially over 134Cs and 137Cs at the beginning. In the middle of the time series, there was a pronounced peak of radiocesium observed in northern Taiwan, with activity concentrations of 134Cs and 137Cs far exceeding that of 131I during that episode. From the first arrival time of these fission nuclides and their spatial and temporal variations at our sampling sites and elsewhere, we suggest that Fukushima-derived radioactive nuclides were transported to Taiwan and its vicinity via two pathways at different altitudes. One was transported in the free troposphere by the prevailing westerly winds around the globe; the other was transported in the planetary boundary layer by the northeast monsoon wind directly toward Taiwan.

  11. RECONCILIATION OF WAITING TIME STATISTICS OF SOLAR FLARES OBSERVED IN HARD X-RAYS

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Aschwanden, Markus J.; McTiernan, James M., E-mail: aschwanden@lmsal.co, E-mail: jimm@ssl.berkeley.ed

    2010-07-10

    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{sup -3}-10{sup 3} hr), can be reconciled with a single distribution function, N({Delta}t) {proportional_to} {lambda}{sub 0}(1 + {lambda}{sub 0{Delta}}t){sup -2}, which has a power-law slope of p {approx} 2.0 at large waiting times ({Delta}t {approx} 1-1000 hr) and flattens out at short waiting times {Delta}t {approx}waiting times is invariant for sampling with different flux thresholds, while the mean waiting time scales reciprocically with the number of detected events, {Delta}t {sub 0} {proportional_to} 1/n {sub det}. This waiting time distribution can be modeled with a nonstationary Poisson process with a flare rate {lambda} = 1/{Delta}t that varies as f({lambda}) {proportional_to} {lambda}{sup -1}exp - ({lambda}/{lambda}{sub 0}). 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.« less

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

    PubMed Central

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

    2010-01-01

    BACKGROUND: Assessment of current wait times for specialist health services in Canada is a key method that can assist government and health care providers to plan wisely for future health needs. These data are not readily available. A method to capture wait time data at the time of consultation or procedure has been developed, which should be applicable to other specialist groups and also allows for assessment of wait time trends over intervals of years. METHODS: In November 2008, gastroenterologists across Canada were asked to complete a questionnaire (online or by fax) that included personal demographics and data from one week on at least five consecutive new consultations and five consecutive procedure patients who had not previously undergone a procedure for the same indication. Wait times were collected for 18 primary indications and results were then compared with similar survey data collected in 2005. RESULTS: The longest wait times observed were for screening colonoscopy (201 days) and surveillance of previous colon cancer or polyps (272 days). The shortest wait times were for cancer-likely based on imaging or physical examination (82 days), severe or rapidly progressing dysphagia or odynophagia (83 days), documented iron-deficiency anemia (90 days) and dyspepsia with alarm symptoms (99 days). Compared with 2005 data, total wait times in 2008 were lengthened overall (127 days versus 155 days; P<0.05) and for most of the seven individual indications that permitted data comparison. CONCLUSION: Median wait times for gastroenterology services continue to exceed consensus conference recommended targets and have significantly worsened since 2005. PMID:20186352

  13. In-situ measurements of U-series nuclides by electron microprobe on zircons and monazites from Gandak river sediments

    NASA Astrophysics Data System (ADS)

    Bosia, C.; Deloule, E.; France-Lanord, C.; Chabaux, F.

    2015-12-01

    Determination of sediment transfer time during transport in the alluvial plains is a critical issue to correctly understand the relationship between climate, tectonics and Earth surface evolution. The residence time of river sediments may be constrained by analyzing the U series nuclides fractionations (e.g. [1] and [2]), which are created during water rock interactions by the ejection of the daughter nuclides of the grain (α-recoil) and the preferential mobilization of nuclides in decay damaged crystal structure. However, recent studies on sediments from the Gandak river, one of the main Ganga tributary, highlighted the difficulties to obtain reproducible data on bulk sediments, due to the nuggets distribution of U-Th enriched minor minerals in the samples (Bosia et al., unpublished data). We therefore decided to analyze the U and Th isotopic systematic at a grain-scale for Himalayan sediments from the Gandak river. This has been tested by performing in situ depth profiles of 238U-234U-230Th and 232Th on zircons and monazites (50-250 μm) by Secondary Ion Mass Spectrometry (SIMS) at the CRPG, Nancy, France. The first results point the occurrence of 238U-234U-230Th disequilibria in the outermost parts of both monazite and zircon minerals with a return to the equilibrium state in the core of the grains. The relative U and Th enrichment is however slightly different depending on considered minerals, suggesting possible adsorption processes of 230-Th. Coupled to a simple model of U and Th mobility during water-mineral interactions, these data should help to constrain the origin of 238U-234U-230Th disequilibria in these minerals. Moreover, the results of the study should be relevant to discuss the potential of this approach to constrain the residence time of zircons and monazites in the Gandak alluvial plain. [1] Chabaux et al., 2012, C. R. Geoscience, 344 (11-12): 688-703; [2] Granet et al., 2007, Earth and Planet. Sci. Lett., 261 (3-4): 389-406.

  14. 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?

    PubMed

    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

  15. An investigation of the impact of prolonged waiting times on blood donors in Ireland.

    PubMed

    McKeever, T; Sweeney, M R; Staines, A

    2006-02-01

    The aim of this study was to investigate the impact of prolonged queuing times on blood donors, by measuring their satisfaction levels, and positive and negative affects. As donation times have increased over the past number of years within the Irish Blood Transfusion Service, this is an important issue to examine in a climate where voluntary donors are becoming scarce and demands on people's time are increasing. Eighty-five blood donors were sampled from one urban and one rural blood donor clinic. The respondents conducted a questionnaire by means of face-to-face interview, while waiting in the clinic. The questionnaire contained the Positive and Negative Affect Scale (PANAS), and a waiting satisfaction scale. Both actual and perceived waiting times of the donors were noted. Waiting time was found to be negatively related to satisfaction. Inexperienced donors expressed higher levels of negative affect than experienced donors. Urban donors were significantly more satisfied than rural donors. There was a significant difference in perceived waiting time between lone donors and those queuing in a group, with those waiting alone perceiving their wait as shorter. While all respondents stated that they intended to donate again, over one-third stated that prolonged waiting times would be their most likely deterrent. However, only 15% stated that long queuing times might actually prevent them from donating in the future, and almost all respondents said that they would recommend donation to a friend, despite long queuing times. Although our results show that the respondents were not satisfied with current waiting times, it did not seem to affect their future intentions to donate. These findings provide some optimism for the future of blood donation in Ireland, as they suggest a strong sense of commitment to donation within the population sampled. Future research could explore the application of 'the service industry' approach to waiting times to blood donation clinics.

  16. Waiting time distribution in public health care: empirics and theory.

    PubMed

    Dimakou, Sofia; Dimakou, Ourania; Basso, Henrique S

    2015-12-01

    Excessive waiting times for elective surgery have been a long-standing concern in many national healthcare systems in the OECD. How do the hospital admission patterns that generate waiting lists affect different patients? What are the hospitals characteristics that determine waiting times? By developing a model of healthcare provision and analysing empirically the entire waiting time distribution we attempt to shed some light on those issues. We first build a theoretical model that describes the optimal waiting time distribution for capacity constraint hospitals. Secondly, employing duration analysis, we obtain empirical representations of that distribution across hospitals in the UK from 1997-2005. We observe important differences on the 'scale' and on the 'shape' of admission rates. Scale refers to how quickly patients are treated and shape represents trade-offs across duration-treatment profiles. By fitting the theoretical to the empirical distributions we estimate the main structural parameters of the model and are able to closely identify the main drivers of these empirical differences. We find that the level of resources allocated to elective surgery (budget and physical capacity), which determines how constrained the hospital is, explains differences in scale. Changes in benefits and costs structures of healthcare provision, which relate, respectively, to the desire to prioritise patients by duration and the reduction in costs due to delayed treatment, determine the shape, affecting short and long duration patients differently. JEL Classification I11; I18; H51.

  17. Sustainability: orthopaedic surgery wait time management strategies.

    PubMed

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

    2015-01-01

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

  18. Reward Sensitivity and Waiting Impulsivity: Shift towards Reward Valuation away from Action Control

    PubMed Central

    Mechelmans, Daisy J; Strelchuk, Daniela; Doñamayor, Nuria; Banca, Paula; Robbins, Trevor W; Baek, Kwangyeol

    2017-01-01

    Abstract Background Impulsivity and reward expectancy are commonly interrelated. Waiting impulsivity, measured using the rodent 5-Choice Serial Reaction Time task, predicts compulsive cocaine seeking and sign (or cue) tracking. Here, we assess human waiting impulsivity using a novel translational task, the 4-Choice Serial Reaction Time task, and the relationship with reward cues. Methods Healthy volunteers (n=29) performed the monetary incentive delay task as a functional MRI study where subjects observe a cue predicting reward (cue) and wait to respond for high (£5), low (£1), or no reward. Waiting impulsivity was tested with the 4-Choice Serial Reaction Time task. Results For high reward prospects (£5, no reward), greater waiting impulsivity on the 4-CSRT correlated with greater medial orbitofrontal cortex and lower supplementary motor area activity to cues. In response to high reward cues, greater waiting impulsivity was associated with greater subthalamic nucleus connectivity with orbitofrontal cortex and greater subgenual cingulate connectivity with anterior insula, but decreased connectivity with regions implicated in action selection and preparation. Conclusion These findings highlight a shift towards regions implicated in reward valuation and a shift towards compulsivity away from higher level motor preparation and action selection and response. We highlight the role of reward sensitivity and impulsivity, mechanisms potentially linking human waiting impulsivity with incentive approach and compulsivity, theories highly relevant to disorders of addiction. PMID:29020291

  19. Including Deposition Rate in Models of Cosmogenic Nuclide Accumulation in Fluvial Sediments to Improve Terrace Abandonment Ages

    NASA Astrophysics Data System (ADS)

    Norton, K. P.; Wang, N.; Van Dissen, R. J.; Little, T.

    2017-12-01

    Fluvial sediments are archives of the erosional, transport, and depositional processes occurring in the catchment. Terraces become robust markers for geomorphic analysis if their time of abandonment can be determined. Methods such as OSL can determine burial ages for fine grained sediments within the terrace fill but may not be directly related to the terrace abandonment age. Cosmogenic nuclides can be used to determine exposure ages for geologically young terraces but the surface being dated may have been subsequently eroded and the material itself may have been deposited with an inherited nuclide concentration. To deal with this problem, many researchers collect multiple samples with depth to model the depth-dependent nuclide concentration to help constrain inheritance and post-depositional erosion. It is often, however, assumed that the entire sediment pile accumulated instantaneously. In this submission, we present the results of a depth profile model that incorporates sediment accumulation rate to improve terrace age estimates. We test this model on fault-offset river terraces near Kaikoura, New Zealand. We measured depth profiles of OSL ages and cosmogenic nuclide concentrations of two late Quaternary terraces that are offset by up to 800 m across the Kekerengu Fault. OSL ages and dated tephras in the overlying loess provide minimum age constraints for both terraces while OSL ages of fine-grained sediments within the fill provide depositional ages. The predicted sedimentation rates for the terraces are as high as 0.5m/yr, consistent with geologically instantaneous deposition. Modelled abandonment ages from cosmogenic nuclides for the terraces are consistent with OSL and tephra constraints at 9.7 +/- 3.8 ka and 30.4 +/- 2.1 ka, respectively. These terrace abandonment ages yield dextral slip rates of 18.5-20.5 mm/yr and 25-28 mm/yr, respectively, consistent with the rapid slip rate on the adjacent Hope Fault.

  20. Discrimination in a universal health system: explaining socioeconomic waiting time gaps.

    PubMed

    Johar, Meliyanni; Jones, Glenn; Keane, Micheal P; Savage, Elizabeth; Stavrunova, Olena

    2013-01-01

    One of the core goals of a universal health care system is to eliminate discrimination on the basis of socioeconomic status. We test for discrimination using patient waiting times for non-emergency treatment in public hospitals. Waiting time should reflect patients' clinical need with priority given to more urgent cases. Using data from Australia, we find evidence of prioritisation of the most socioeconomically advantaged patients at all quantiles of the waiting time distribution. These patients also benefit from variation in supply endowments. These results challenge the universal health system's core principle of equitable treatment. Copyright © 2012 Elsevier B.V. All rights reserved.

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

    PubMed

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

    2017-05-01

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

  2. Cosmogenic nuclide production rates as a function of latitude and altitude calculated via a physics based model and excitation functions

    NASA Astrophysics Data System (ADS)

    Argento, D.; Reedy, R. C.; Stone, J. O.

    2012-12-01

    Cosmogenic nuclides have been used to develop a set of tools critical to the quantification of a wide range of geomorphic and climatic processes and events (Dunai 2010). Having reliable absolute measurement methods has had great impact on research constraining ice age extents as well as providing important climatic data via well constrained erosion rates, etc. Continuing to improve CN methods is critical for these sciences. While significant progress has been made in the last two decades to reduce uncertainties (Dunai 2010; Gosse & Phillips 2001), numerous aspects still need to be refined in order to achieve the analytic resolution desired by glaciologists and geomorphologists. In order to investigate the finer details of the radiation responsible for cosmogenic nuclide production, we have developed a physics based model which models the radiation cascade of primary and secondary cosmic-rays through the atmosphere. In this study, a Monte Carlo method radiation transport code, MCNPX, is used to model the galactic cosmic-ray (GCR) radiation impinging on the upper atmosphere. Beginning with a spectrum of high energy protons and alpha particles at the top of the atmosphere, the code tracks the primary and resulting secondary particles through a model of the Earth's atmosphere and into the lithosphere. Folding the neutron and proton flux results with energy dependent cross sections for nuclide production provides production rates for key cosmogenic nuclides (Argento et al. 2012, in press; Reedy 2012, in press). Our initial study for high latitude shows that nuclides scale at different rates for each nuclide (Argento 2012, in press). Furthermore, the attenuation length for each of these nuclide production rates increases with altitude, and again, they increase at different rates. This has the consequence of changing the production rate ratio as a function of altitude. The earth's geomagnetic field differentially filters low energy cosmic-rays by deflecting them away

  3. Spontaneous activity in the waiting brain: a marker of impulsive choice in attention-deficit/hyperactivity disorder?

    PubMed

    Hsu, Chia-Fen; Benikos, Nicholas; Sonuga-Barke, Edmund J S

    2015-04-01

    Spontaneous very low frequency oscillations (VLFO), seen in the resting brain, are attenuated when individuals are working on attention demanding tasks or waiting for rewards (Hsu et al., 2013). Individuals with attention-deficit/hyperactivity disorder (ADHD) display excess VLFO when working on attention tasks. They also have difficulty waiting for rewards. Here we examined the waiting brain signature in ADHD and its association with impulsive choice. DC-EEG from 21 children with ADHD and 21 controls (9-15 years) were collected under four conditions: (i) resting; (ii) choosing to wait; (iii) being "forced" to wait; and (iv) working on a reaction time task. A questionnaire measured two components of impulsive choice. Significant VLFO reductions were observed in controls within anterior brain regions in both working and waiting conditions. Individuals with ADHD showed VLFO attenuation while working but to a reduced level and none at all when waiting. A closer inspection revealed an increase of VLFO activity in temporal regions during waiting. Excess VLFO activity during waiting was associated with parents' ratings of temporal discounting and delay aversion. The results highlight the potential role for waiting-related spontaneous neural activity in the pathophysiology of impulsive decision-making of ADHD. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

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

    PubMed Central

    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 (P<0.001). All 15 of the most gossipy magazines 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. An exploration of the basis for patient complaints about the oldness of magazines in practice waiting rooms: cohort study.

    PubMed

    Arroll, Bruce; Alrutz, Stowe; Moyes, Simon

    2014-12-11

    To explore the basis for patient complaints about the oldness of most magazines in practice waiting rooms. Cohort study. Waiting room of a general practice in Auckland, New Zealand. 87 magazines stacked into three mixed piles and placed in the waiting room: this included non-gossipy magazines (Time magazine, the Economist, Australian Women's Weekly, National Geographic, BBC History) and gossipy ones (not identified for fear of litigation). Gossipy was defined as having five or more photographs of celebrities on the front cover and most gossipy as having up to 10 such images. The magazines were marked with a unique number on the back cover, placed in three piles in the waiting room, and monitored twice weekly. Disappearance of magazines less than 2 months old versus magazines 3-12 months old, the overall rate of loss of magazines, and the rate of loss of gossipy versus non-gossipy magazines. 47 of the 82 magazines with a visible date on the front cover were aged less than 2 months. 28 of these 47 (60%) magazines and 10 of the 35 (29%) older magazines disappeared (P=0.002). After 31 days, 41 of the 87 (47%, 95% confidence interval 37% to 58%) magazines had disappeared. None of the 19 non-gossipy magazines (the Economist and Time magazine) had disappeared compared with 26 of the 27 (96%) gossipy magazines (P<0.001). All 15 of the most gossipy magazines and none of the non-gossipy magazines [corrected] had disappeared by 31 days. The study was terminated at this point. General practice waiting rooms contain mainly old magazines. This phenomenon relates to the disappearance of the magazines rather than to the supply of old ones. Gossipy magazines were more likely to disappear than non-gossipy ones. On the grounds of cost we advise practices to supply old copies of non-gossipy magazines. A waiting room science curriculum is urgently needed. © Arroll et al 2014.

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

    PubMed

    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.

  7. Waiting time for radiotherapy in women with cervical cancer

    PubMed Central

    do Nascimento, Maria Isabel; Azevedo e Silva, Gulnar

    2016-01-01

    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. PMID:26786473

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

    PubMed

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

    2017-06-24

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

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

    NASA Astrophysics Data System (ADS)

    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.

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

    PubMed

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

    2014-08-01

    lowered-state anxiety (-5.1 ± 0.53 points on the State Trait Anxiety Scale) than those who received standard care. The efficacy of aromatherapy was inconclusive. Studies reporting on the impact of improved interior design of waiting areas, while positive, are minimal and heterogeneous. For children, insufficient evidence is available to corroborate the effectiveness of play opportunities, media distractions, and music for mitigating anxiety in children awaiting medical procedures. Music is a well-established means of decreasing anxiety in adult patients awaiting medical interventions. The effect of music on children's anxiety is not known. Limited studies and heterogeneity of interventions and methods in the areas of aromatherapy, interior design, digital media, and play opportunities (for children) suggest the need for future research.

  11. Erosion of mountain plateaus along Sognefjord, Norway, constrained by cosmogenic nuclides

    NASA Astrophysics Data System (ADS)

    Andersen, Jane Lund; Egholm, David L.; Knudsen, Mads F.; Linge, Henriette; Jansen, John D.

    2016-04-01

    Norway is famous for its deeply incised, steep-sided fjords, carved out by glacial erosion. The high relief of the fjords stands in contrast to the extensive areas of relatively low relief found between the fjords. The origin and development of these low-relief areas remain debated. The classical interpretation relates them to a Mesozoic peneplanation surface, uplifted to the current high elevation in the early Cenozoic (e.g. Nesje, 1994). The validity of this interpretation has, however, been repeatedly questioned in recent times (e.g. Nielsen et al. 2009, Steer et al. 2012). Recent studies point instead to a significant impact of glacial and periglacial erosion processes on the long-term development of the low-relief surfaces (Egholm et al. 2015). Here, we present a large new dataset of in-situ produced cosmogenic 10Be and 26Al in bedrock and boulders from the high, flat summit surfaces along a transect from the coast to the inner parts of Sognefjorden in Norway. Our results indicate substantial glacial modification of the sampled low-relief surfaces within the last 50 ka. Close to the coast, at an elevation of around 700 meters, the cosmogenic nuclide signal was reset around the Younger Dryas due to extensive glacial erosion. Regarding the higher surfaces further inland, our results indicate a maximum cosmogenic nuclide inheritance of 20-30 ka prior to the last deglaciation. We do not find any signs of exceptional longevity of the low-relief landscape. In contrast, our results indicate that the low-relief areas were continuously eroded by glacial and periglacial processes in the Quaternary. Nesje & Whillans. Erosion of Sognefjord, Norway. Geomorphology 9(1), 33-45, 1994. Nielsen et al. The evolution of western Scandinavian topography: a review of Neogene uplift versus the ICE (isostasy-climate-erosion) hypothesis. Journal of Geodynamics 47(2), 72-95, 2009. Steer et al. Bimodal Plio-Quaternary glacial erosion of fjords and low-relief surfaces in Scandinavia

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

    ERIC Educational Resources Information Center

    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…

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

    NASA Astrophysics Data System (ADS)

    Tam, Giuseppe

    2005-11-01

    The aim of this study was to compare the efficacy of three types of treatments in the periarthritis of the shoulder: corticosteroid injections, Low Level Laser Therapy (LLLT) or wait-and-see-policy. BACKGROUND DATA: Low level laser irradiation is a treatment method widely used in medical science. Many disorders, such as osteoarthritis and musculoskeletal conditions with pain, have been treated with LLLT. METHODS: Patients, suffering from periarthritis of the shoulder of at least 6 weeks' duration, were recruited by family doctors. We randomly allocated eligible patients to 6 weeks of treatment n. 20 (33%) with corticosteroid injection, n. 21 (35%) with LLLT and with wait-and-see policy n.19 (31%). We applied a number of 12 sessions with infrared Diode Laser Ga-As (904 nm), 60 W maximum power, peak power per pulse 27 W, pulse frequency 1280 Hz, average point region 2-8 J; dose/point = 3-4 J; total energy density 24 J/cm2. Outcome measures included general improvement, severity of the main complaint, pain, shoulder disability, and patient satisfaction. Severity of shoulder complaints, abduction and elevation of the arm, and the pressure pain threshold were assessed. The principal analysis was done on an intention treatment basis. We assessed all outcomes at 3,6, 12, 26, 52 weeks. RESULTS: We randomly assigned 60 patients. At 6 weeks, corticosteroid injections were significantly better than all other therapy options for all outcome measures. Success rates were 90% (18) compared with 52% (11) for LLLT and 35% (7) for wait-and-see policy. Long-term differences between injections and LLLT were significantly in favour of LLLT. Success rate at 52 weeks were 14 (70%) for injections, 19 (90.5%) for LLLT, and 16 (84%) for wait-and-see policy. LLLT had better results than a wait-and-see policy, but differences were not significant ( p < 0.0001). CONCLUSIONS: Patients should be properly informed about the advantages and disadvantages of the treatment options for the

  14. Impact of Appointment Waiting Time on Attendance Rates at a Clinical Cancer Genetics Service.

    PubMed

    Shaw, Tarryn; Metras, Julie; Ting, Zoe Ang Li; Courtney, Eliza; Li, Shao-Tzu; Ngeow, Joanne

    2018-05-24

    The increase in demand for clinical cancer genetics services has impacted the ability to provide services timeously. Given limited resources, this often results in extended appointment waiting times. Over the last 3 years, the Cancer Genetics Service at the National Cancer Centre Singapore has continued to experience a steady increase in demand for its service. Nevertheless, significant no-show rates have been reported. This study sought to determine whether an association exists between appointment waiting times and attendance rates. Data was gathered for all participants meeting inclusion criteria. Attendance rates and appointment waiting times were calculated. The relationship between mean waiting times for those who did and did not attend their scheduled appointments was evaluated using Welch's t test and linear regression model. The results showed a significant difference in mean appointment waiting times between patients who did and did not attend (32.66 versus 43.50 days respectively; p < 0.0001). Furthermore, patients who waited for longer than 37 days were significantly less likely to attend. No-show rates increased as the waiting time increased, at a rate of 19.60% per 20 days and 21.40% per 30 days. In conclusion, appointment waiting time is a significant predictor for patient attendance. Strategies to ensure patients receive an appointment within the necessary timeframe at the desired setting are important to ensure that individuals at increased cancer risk attend their appointments in order to manage their cancer risks effectively.

  15. Waiting time of inpatients before elective surgical procedures at a State Government Teaching Hospital in India.

    PubMed

    Ray, Shreyasi; Kirtania, Jyotirmay

    2017-01-01

    Abundant published literature exists addressing the issues of outpatient waiting lists before surgery. However, there is no published literature on inpatient waiting time before elective surgical procedures. This study aims to measure the inpatient waiting time, identify the factors that affect the inpatient waiting time, and recommend the ways of reducing the waiting time of inpatients before elective surgical procedures, at a state government teaching hospital in India. Descriptive research methods and quality control tools were used for this prospective observational study. Descriptive statistics, Shapiro-Wilk test of normality, Wilcoxon-Mann-Whitney Test, and Kruskal-Wallis test were used. Pareto charts were used to highlight the most important modifiable factors among the set of factors causing increased waiting time. We also applied the M/M/c model (Erlang - A model) of queue theory to analyze the traffic intensity and system congestion. The median waiting time of inpatients before elective surgery was 12 days (interquartile range = 11.5 days). The waiting time was influenced significantly (P < 0.05) by the patient's age, physical status, and the financial status. The surgical specialty, blood product booking and procurement, cross-specialty consultation before surgery, and Intensive Care Unit booking were the other important factors. Modifiable and nonmodifiable factors affecting the inpatient waiting time of surgical patients were identified. Control measures that can reduce the waiting time of inpatients before elective surgery were identified.

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

    PubMed

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

    2017-01-01

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

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

    PubMed Central

    Merriman, Eileen; Corwin, Paul; Ikram, Rosemary

    2002-01-01

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

  18. Using Multiple Cosmogenic Nuclides to Investigate Ice Elevation Changes in the Ellsworth Mountains, Antarctica

    NASA Astrophysics Data System (ADS)

    Marrero, Shasta; Hein, Andy; Sugden, David; Woodward, John; Dunning, Stuart; Freeman, Stewart; Shanks, Richard

    2015-04-01

    Well-dated geologic data points provide important indicators that can be used for the reconstruction of ice sheet dynamics and as constraints in ice sheet models predicting future change. Cosmogenic nuclides, which accumulate in rocks exposed at the earth's surface, can be used to directly date the exposure age of the rock surfaces that have been created through glacial erosion or deposition. The technique requires a detailed understanding of the local geomorphology as well as awareness of the post-depositional processes that may affect the interpretation of exposure ages. Surface exposure ages (10Be, 26Al, 21Ne, and 36Cl) from local limestone bedrock and other glacially deposited exotic lithologies provide a history spanning from 0 to more than 1 million years in the Patriot, Independence, and Marble Hills in the southern Ellsworth Mountains, Antarctica. Using the new surface exposure ages combined with geomorphological mapping, we will discuss the implications for the glacial history of the southern Ellsworth Mountains.

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

    PubMed

    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.

  20. An empirical analysis of the impact of choice on waiting times.

    PubMed

    Siciliani, Luigi; Martin, Steve

    2007-08-01

    Policy-makers often claim that enhancing patient choice induces more competition among hospitals and may therefore reduce waiting times. This paper tests this claim using 120 English NHS hospitals over the period 1999-2001. Several proxies for the degree of choice (or competition) are constructed including: (a) the number of hospitals within the catchment area of each hospital; (b) the number of hospitals in the catchment area of each hospital standardised by the population of the catchment area; (c) the inverse of the Herfindahl index (or 'the number of effective competitors'). Several control variables are included: the availability of doctors, junior doctors, nurses, and other personnel; the availability of acute beds; the emergency admission rate; the day-case rate; the average length of inpatient stay; an indicator of case-mix; and mortality and re-admission rates. We find that more choice is significantly associated with lower waiting times at the sample mean (five hospitals) although the quantitative effect is modest: an extra hospital in a catchment area will only reduce waiting by at most a few days (or 1-2% reduction in waiting). There is also some evidence that increases in choice can boost waiting times when the degree of choice is very high (i.e. more than 11 hospitals are included in the catchment area). Copyright 2007 John Wiley & Sons, Ltd.

  1. Fission barriers at the end of the chart of the nuclides

    DOE PAGES

    Möller, Peter; Sierk, Arnold J.; Ichikawa, Takatoshi; ...

    2015-02-12

    We present calculated fission-barrier heights for 5239 nuclides for all nuclei between the proton and neutron drip lines with 171 ≤ A ≤ 330. The barriers are calculated in the macroscopic-microscopic finite-range liquid-drop (FRLDM) with a 2002 set of macroscopic-model parameters. The saddle-point energies are determined from potential-energy surfaces based on more than five million different shapes, defined by five deformation parameters in the three-quadratic-surface shape parametrization: elongation, neck diameter, left-fragment spheroidal deformation, right-fragment spheroidal deformation, and nascent-fragment mass asymmetry. The energy of the ground state is determined by calculating the lowest-energy configuration in both the Nilsson perturbed-spheroid (ϵ) andmore » the spherical-harmonic (β) parametrizations, including axially asymmetric deformations. The lower of the two results (correcting for zero-point motion) is defined as the ground-state energy. The effect of axial asymmetry on the inner barrier peak is calculated in the (ϵ,γ) parametrization. We have earlier benchmarked our calculated barrier heights to experimentally extracted barrier parameters and found average agreement to about one MeV for known data across the nuclear chart. Here we do additional benchmarks and investigate the qualitative and, when possible, quantitative agreement and/or consistency with data on β-delayed fission, isotope generation along prompt-neutron-capture chains in nuclear-weapons tests, and superheavy-element stability. In addition these studies all indicate that the model is realistic at considerable distances in Z and N from the region of nuclei where its parameters were determined.« less

  2. Fission barriers at the end of the chart of the nuclides

    NASA Astrophysics Data System (ADS)

    Möller, Peter; Sierk, Arnold J.; Ichikawa, Takatoshi; Iwamoto, Akira; Mumpower, Matthew

    2015-02-01

    We present calculated fission-barrier heights for 5239 nuclides for all nuclei between the proton and neutron drip lines with 171 ≤A ≤330 . The barriers are calculated in the macroscopic-microscopic finite-range liquid-drop model with a 2002 set of macroscopic-model parameters. The saddle-point energies are determined from potential-energy surfaces based on more than 5 000 000 different shapes, defined by five deformation parameters in the three-quadratic-surface shape parametrization: elongation, neck diameter, left-fragment spheroidal deformation, right-fragment spheroidal deformation, and nascent-fragment mass asymmetry. The energy of the ground state is determined by calculating the lowest-energy configuration in both the Nilsson perturbed-spheroid (ɛ ) and the spherical-harmonic (β ) parametrizations, including axially asymmetric deformations. The lower of the two results (correcting for zero-point motion) is defined as the ground-state energy. The effect of axial asymmetry on the inner barrier peak is calculated in the (ɛ ,γ ) parametrization. We have earlier benchmarked our calculated barrier heights to experimentally extracted barrier parameters and found average agreement to about 1 MeV for known data across the nuclear chart. Here we do additional benchmarks and investigate the qualitative and, when possible, quantitative agreement and/or consistency with data on β -delayed fission, isotope generation along prompt-neutron-capture chains in nuclear-weapons tests, and superheavy-element stability. These studies all indicate that the model is realistic at considerable distances in Z and N from the region of nuclei where its parameters were determined.

  3. Accelerator experiments on the contribution of secondary particles to the production of cosmogenic nuclides in meteorites

    NASA Technical Reports Server (NTRS)

    Dragovitsch, P.; Englert, P.

    1985-01-01

    Through the interaction of galactic cosmic particle radiation (GCR) a wide variety of cosmogenic nuclides is produced in meteorites. They provide historical information about the cosmic radiation and the bombarded meteorites. An important way to understand the production mechanisms of cosmogenic nuclides in meteorites is to gather information about the depth and size dependence of the build-up of Galactic Rays Cosmic-secondary particles within meteorites of different sizes and chemical compositions. Simulation experiments with meteorite models offer an alternative to direct observation providing a data basis to describe the development and action of the secondary cascade induced by the GCR in meteorites.

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

    PubMed Central

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

    2013-01-01

    BACKGROUND: Periodically surveying wait times for specialist health services in Canada captures current data and enables comparisons with previous surveys to identify changes over time. METHODS: During one week in April 2012, Canadian gastroenterologists were asked to complete a questionnaire (online or by fax) recording demographics, reason for referral, and dates of referral and specialist visits for at least 10 consecutive new patients (five consultations and five procedures) who had not been seen previously for the same indication. Wait times were determined for 18 indications and compared with those from similar surveys conducted in 2008 and 2005. RESULTS: Data regarding adult patients were provided by 173 gastroenterologists for 1374 consultations, 540 procedures and 293 same-day consultations and procedures. Nationally, the median wait times were 92 days (95% CI 85 days to 100 days) from referral to consultation, 55 days (95% CI 50 days to 61 days) from consultation to procedure and 155 days (95% CI 142 days to 175 days) (total) from referral to procedure. Overall, wait times were longer in 2012 than in 2005 (P<0.05); the wait time to same-day consultation and procedure was shorter in 2012 than in 2008 (78 days versus 101 days; P<0.05), but continued to be longer than in 2005 (P<0.05). The total wait time remained longest for screening colonoscopy, increasing from 201 days in 2008 to 279 days in 2012 (P<0.05). DISCUSSION: Wait times for gastroenterology services continue to exceed recommended targets, remain unchanged since 2008 and exceed wait times reported in 2005. PMID:23472243

  5. Cross Sections for the Production of Cosmogenic Nuclides with Protons up to 400 MeV for the Interpretation of Cosmic-Ray-produced Nuclides

    NASA Astrophysics Data System (ADS)

    Schiekel, Th.; Rosel, R.; Herpers, U.; Bodemann, R.; Leya, I.; Gloris, M.; Michel, R.; Dittrich, B.; Kubik, P.; Suter, M.

    1993-07-01

    Integral excitation functions of the cosmogenic nuclides are the basic requirement for the interpretation of interactions between cosmic ray particles and extraterrestrial and terrestrial matter. Together with the knowledge of primary and secondary particle fields inside an irradiated body, model calculations can be developed to interpret abundances of cosmogenic nuclides in dependencies of the irradiation history of the irradiated body and of the cosmic particle ray itself. The quality of those model calculations depends on the quality of the available cross-section database, which is neither comprehensive nor reliable for the most important nuclides like the long-lived radionuclides (i.e., 10Be, 26Al, 36Cl, 41Ca) and the stable rare gas isotopes. For a systematic investigation in this field of science we carried out several irradiation experiments with protons in the energy region between 45 MeV and 400 MeV at the Paul Scherrer Institut (Villigen, Switzerland) and the Laboratoire Nationale Saturne (Saclay, France) using the stacked foil technique. We included 21 different target elements with Z between 6 and 79 (C, N as Si3N4, O as SiO2, Mg, Al, Si, Ca as CaC2H2O4, Ti, V, Mn as Mn/Ni alloy, Fe, Co, Ni, Cu, Sr as SrF2, Y, Zr, Nb, Rh, Ba as Ba containing glass and Au) in our experiments. The proton fluxes were monitored via the reaction 27Al(p,3p3n)22Na using the evaluated data of [1]. Residual nuclides were measured by X-, gamma-, and after a chemical separation by accelerator mass spectrometry. In order to check the quality of our experimental procedures we included some target elements in our new experiments for which consistent excitation functions have already been determined [2,3,4]. Our new data show excellent agreement with the earlier measurements. We measured cross sections for more than 120 different reactions. Here we report on the results for target elements with Z up to 28. The exsisting database of experimental excitation functions for the production

  6. Apparatus and method for quantitatively evaluating total fissile and total fertile nuclide content in samples. [Patent application

    DOEpatents

    Caldwell, J.T.; Kunz, W.E.; Cates, M.R.; Franks, L.A.

    1982-07-07

    Simultaneous photon and neutron interrogation of samples for the quantitative determination of total fissile nuclide and total fertile nuclide material present is made possible by the use of an electron accelerator. Prompt and delayed neutrons produced from resulting induced fission are counted using a single detection system and allow the resolution of the contributions from each interrogating flux leading in turn to the quantitative determination sought. Detection limits for /sup 239/Pu are estimated to be about 3 mg using prompt fission neutrons and about 6 mg using delayed neutrons.

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

    PubMed

    Liu, Jiming; Tao, Li; Xiao, Bo

    2011-01-01

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

  8. Continuous-Time Finance and the Waiting Time Distribution: Multiple Characteristic Times

    NASA Astrophysics Data System (ADS)

    Fa, Kwok Sau

    2012-09-01

    In this paper, we model the tick-by-tick dynamics of markets by using the continuous-time random walk (CTRW) model. We employ a sum of products of power law and stretched exponential functions for the waiting time probability distribution function; this function can fit well the waiting time distribution for BUND futures traded at LIFFE in 1997.

  9. Developmental Changes in Anger Expression and Attention Focus: Learning to Wait

    ERIC Educational Resources Information Center

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

    2011-01-01

    Being able to wait is an essential part of self-regulation. In the present study, the authors examined the developmental course of changes in the latency to and duration of target-waiting behaviors by following 65 boys and 55 girls from rural and semirural economically strained homes from ages 18 months to 48 months. Age-related changes in latency…

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

    PubMed

    Soussou, Randa; Aleksejūnienė, Jolanta; Harrison, Rosamund

    2017-09-14

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

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

    PubMed

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

    2012-07-01

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

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

    PubMed

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

    2013-10-01

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

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

    ERIC Educational Resources Information Center

    Kohn, Karen

    2018-01-01

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

  14. Preparation of alpha-emitting nuclides by electrodeposition

    NASA Astrophysics Data System (ADS)

    Lee, M. H.; Lee, C. W.

    2000-06-01

    A method is described for electrodepositing the alpha-emitting nuclides. To determine the optimum conditions for plating plutonium, the effects of electrolyte concentration, chelating reagent, current, pH of electrolyte and the time of plating on the electrodeposition were investigated on the base of the ammonium oxalate-ammonium sulfate electrolyte containing diethyl triamino pentaacetic acid. An optimized electrodeposition procedure for the determination of plutonium was validated by application to environmental samples. The chemical yield of the optimized method of electrodeposition step in the environmental sample was a little higher than that of Talvitie's method. The developed electrodeposition procedure in this study was applied to determine the radionuclides such as thorium, uranium and americium that the electrodeposition yields were a little higher than those of the conventional method.

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

    PubMed Central

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

    2000-01-01

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

  16. A Model to Study: Cannibalization, FMC, and Customer Waiting Time

    DTIC Science & Technology

    2002-02-01

    4825 Mark Center Drive • Alexandria, Virginia 22311-1850 CRM D0005957.A2/Final February 2002 A Model to Study: Cannibalization, FMC, and Customer ...numerical example In this section, we will derive the relationship between cannibaliza- tion rates, customer waiting time (CWT) for needed spare parts... relationships between the FMC given by equation 1, the mean customer wait time for spare parts, denoted µ, and the 5. According to [19], not every part can be

  17. Posted wait times an added advantage to multi-facility systems?

    PubMed

    2011-04-01

    Methodist Le Bonheur Healthcare in Memphis, TN, is investigating whether posting ED wait times via the internet can positively impact patient flow in the six EDs the health system operates in the Memphis region. The health system began posting wait times in August 2010, resulting in increases in ED volume ranging from 6% to 10%. The health system is monitoring ED arrivals by zip code to assess any impact on load balancing between its busy EDs. One marketing challenge is that a competitor is posting ED wait times as well, but it is posting the time it takes for a patient to be placed in a bed as opposed to the door-to-provider time that Methodist Le Bonheur is posting. The approach has the most impact on lower-acuity patients, but experts worry that in the future, payers may not be reimbursed for ED care for these patients.

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

    NASA Astrophysics Data System (ADS)

    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.

  19. Watchful waiting and factors predictive of secondary treatment of localized prostate cancer.

    PubMed

    Wu, Hongyan; Sun, Leon; Moul, Judd W; Wu, Hong Yu; McLeod, David G; Amling, Christopher; Lance, Raymond; Kusuda, Leo; Donahue, Timothy; Foley, John; Chung, Andrew; Sexton, Wade; Soderdahl, Douglas

    2004-03-01

    Watchful waiting remains an important treatment option for some patients with localized prostate cancer. We defined the demographic, clinical and outcome features of men selecting watchful waiting as an initial treatment strategy, and determined factors predictive of eventual progression to secondary treatment. Of 8390 patients diagnosed with prostate cancer from 1990 to 2001 in the Department of Defense Center for Prostate Disease Research Database, 1158 patients chose watchful waiting as initial treatment. The demographic and clinical differences between patients on watchful waiting and those choosing other initial treatments were compared using the chi-square test. Secondary treatment-free survival according to various prognostic factors was plotted using the Kaplan-Meier method and differences were tested using the log rank test. A multivariate Cox proportional hazards regression analysis was performed to determine which factors were independent predictors of secondary treatment. Compared to other patients, those selecting watchful waiting were older, had lower prostate specific antigen (PSA) at diagnosis, and were more likely to have lower stage (cT1) and lower grade (Gleason sum 7 or less) cancers. Age, PSA and clinical stage were all significant and independent predictors of secondary treatment. The relative risk of secondary treatment can be expressed as EXP (-0.034 x age at diagnosis + 0.284 x LOG (diagnostic PSA) + 0.271 x clinical stage T2 + 0.264 x clinical stage T3). Men who elect watchful waiting as initial management for prostate cancer are older with lower Gleason sums and serum PSA. In these men, age at diagnosis, serum PSA and clinical stage are the most significant predictors of requiring or selecting secondary treatment.

  20. Waiting time as a competitive device: an example from general medical practice.

    PubMed

    Iversen, Tor; Lurås, Hilde

    2002-09-01

    From a theoretical model we predict that only physicians with quality characteristics perceived as inferior by patients are willing to embark on waiting time reductions. Because of variation in these quality characteristics among physicians, market equilibrium is likely to show a range of waiting times for physician services. This hypothesis is supported by results from a study of Norwegian general practitioners. Since the waiting time offered by a physician influences the number of patient-initiated consultations, a policy implication of our study is that the distinction between patient-initiated and physician-initiated consultations may be less clear-cut than often assumed in the literature.

  1. Developmental changes in anger expression and attention focus: Learning to wait

    PubMed Central

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

    2011-01-01

    Being able to wait is an essential part of self-regulation. The present study examined the developmental course of changes in the latency to and duration of target waiting behaviors by following 65 boys and 55 girls from rural and semi-rural economically strained homes from ages 18 to 48 months. Age-related changes in latency to and duration of children’s anger expressions and attention focus (e.g., self-initiated distraction) during an eight minute wait for a gift were found. On average, at 18 and 24 months of age, children were quick to react angrily and slower to shift attention away from the desired object than they were at later ages. Over time, children were quicker to distract themselves. By 36 months, distractions occurred before children expressed anger, and anger expressions were briefer. At 48 months, children typically made a quick bid to mother about demands of waiting before distracting themselves; on average, they did not appear angry until the latter half of the wait. Unexpectedly, children bid to their mothers as much at age 48 months as they had at 18 months; however bids became less angry as children got older. Developmental changes in distraction and bidding predicted age-related changes in the latency to anger. Findings are discussed in terms of the neurocognitive control of attention around age 30 months, the limitations of children’s self-regulatory efforts at age 48 months, and the importance of fostering children’s ability to forestall, as well as modulate, anger. PMID:21639619

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

    ERIC Educational Resources Information Center

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

    2002-01-01

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

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

    DTIC Science & Technology

    2016-12-01

    managed by an RIP. SECREPs are typically critical repair assemblies that require consistently high fill- rates to satisfy maintenance customers ...fill-rate is potentially misreporting performance and areas where short customer wait times could potentially suffice for inventory management . A...supply. Inventory forecasting and management should focus on parts with CWTs that do not satisfy the maintenance customer and 100% fill-rates should

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

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Joseph, Ackeem; Herrera, David; Hijal, Tarek

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

  5. 13. 'WAITING AT THE DRAWBRIDGE.' THE COAL SCHOONER LUCY MAY ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    13. 'WAITING AT THE DRAWBRIDGE.' THE COAL SCHOONER LUCY MAY WAITING AT THE DRAW, JUNE 19, 1896. Photocopy of photograph (original glass plate negative #T89 in the collection of the Annisquam Historical Society, Annisquam, Massachusetts). Photographer: Martha Harvey (1862-1949). (The handwritten legend along the top edge of the photograph is scratched in the emulsion of the original glass plate negative. Consequently it reads in reverse when printed.) - Annisquam Bridge, Spanning Lobster Cove between Washington & River Streets, Gloucester, Essex County, MA

  6. Wait times in the emergency department for patients with mental illness

    PubMed Central

    Atzema, Clare L.; Schull, Michael J.; Kurdyak, Paul; Menezes, Natasja M.; Wilton, Andrew S.; Vermuelen, Marian J.; Austin, Peter C.

    2012-01-01

    Background: It has been suggested that patients with mental illness wait longer for care than other patients in the emergency department. We determined wait times for patients with and without mental health diagnoses during crowded and noncrowded periods in the emergency department. Methods: We conducted a population-based retrospective cohort analysis of adults seen in 155 emergency departments in Ontario between April 2007 and March 2009. We compared wait times and triage scores for patients with mental illness to those for all other patients who presented to the emergency department during the study period. Results: The patients with mental illness (n = 51 381) received higher priority triage scores than other patients, regardless of crowding. The time to assessment by a physician was longer overall for patients with mental illness than for other patients (median 82, interquartile range [IQR] 41–147 min v. median 75 [IQR 36–140] min; p < 0.001). The median time from the decision to admit the patient to hospital to ward transfer was markedly shorter for patients with mental illness than for other patients (median 74 [IQR 15–215] min v. median 152 [IQR 45–605] min; p < 0.001). After adjustment for other variables, patients with mental illness waited 10 minutes longer to see a physician compared with other patients during noncrowded periods (95% confidence interval [CI] 8 to 11), but they waited significantly less time than other patients as crowding increased (mild crowding: −14 [95% CI −12 to −15] min; moderate crowding: −38 [95% CI −35 to −42] min; severe crowding: −48 [95% CI −39 to −56] min; p < 0.001). Interpretation: Patients with mental illness were triaged appropriately in Ontario’s emergency departments. These patients waited less time than other patients to see a physician under crowded conditions and only slightly longer under noncrowded conditions. PMID:23148052

  7. 24 CFR 982.207 - Waiting list: Local preferences in admission to program.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false Waiting list: Local preferences in... Admission to Tenant-Based Program § 982.207 Waiting list: Local preferences in admission to program. (a) Establishment of PHA local preferences. (1) The PHA may establish a system of local preferences for selection of...

  8. 24 CFR 882.513 - Public notice to low-income families; waiting list.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...-income families; waiting list. (a) Public notice to low-income Families. (1) If the PHA does not have a... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Public notice to low-income families; waiting list. 882.513 Section 882.513 Housing and Urban Development Regulations Relating to...

  9. 24 CFR 882.513 - Public notice to low-income families; waiting list.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...-income families; waiting list. (a) Public notice to low-income Families. (1) If the PHA does not have a... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false Public notice to low-income families; waiting list. 882.513 Section 882.513 Housing and Urban Development REGULATIONS RELATING TO...

  10. 24 CFR 882.513 - Public notice to low-income families; waiting list.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...-income families; waiting list. (a) Public notice to low-income Families. (1) If the PHA does not have a... 24 Housing and Urban Development 4 2013-04-01 2013-04-01 false Public notice to low-income families; waiting list. 882.513 Section 882.513 Housing and Urban Development REGULATIONS RELATING TO...

  11. 24 CFR 882.513 - Public notice to low-income families; waiting list.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...-income families; waiting list. (a) Public notice to low-income Families. (1) If the PHA does not have a... 24 Housing and Urban Development 4 2014-04-01 2014-04-01 false Public notice to low-income families; waiting list. 882.513 Section 882.513 Housing and Urban Development REGULATIONS RELATING TO...

  12. 24 CFR 882.513 - Public notice to low-income families; waiting list.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...-income families; waiting list. (a) Public notice to low-income Families. (1) If the PHA does not have a... 24 Housing and Urban Development 4 2012-04-01 2012-04-01 false Public notice to low-income families; waiting list. 882.513 Section 882.513 Housing and Urban Development REGULATIONS RELATING TO...

  13. Outpatient Waiting Time in Health Services and Teaching Hospitals: A Case Study in Iran

    PubMed Central

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

    2014-01-01

    Background: 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. Methods: 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: 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. Conclusion: 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. PMID:24373277

  14. Consultation sequencing of a hospital with multiple service points using genetic programming

    NASA Astrophysics Data System (ADS)

    Morikawa, Katsumi; Takahashi, Katsuhiko; Nagasawa, Keisuke

    2018-07-01

    A hospital with one consultation room operated by a physician and several examination rooms is investigated. Scheduled patients and walk-ins arrive at the hospital, each patient goes to the consultation room first, and some of them visit other service points before consulting the physician again. The objective function consists of the sum of three weighted average waiting times. The problem of sequencing patients for consultation is focused. To alleviate the stress of waiting, the consultation sequence is displayed. A dispatching rule is used to decide the sequence, and best rules are explored by genetic programming (GP). The simulation experiments indicate that the rules produced by GP can be reduced to simple permutations of queues, and the best permutation depends on the weight used in the objective function. This implies that a balanced allocation of waiting times can be achieved by ordering the priority among three queues.

  15. Surface Exposure Geochronology Using Cosmogenic Nuclides: Applications in Antarctic Glacial Geology

    DTIC Science & Technology

    1994-02-01

    Department of Marine Chemistry and Geochemistry Dist Special Dean of Graduate Studies I I I SURFACE EXPOSURE GEOCHRONOLOGY USING COSMOGENIC NUCLIDES... studies of Sirius Group tills. Comparison of measured 10Be concentrations in Sirius Group deposits with those predicted with a model of the effects of...that this deposit does not, 1 as previous studies suggested, represent a single ice advance in response to lowered sea level at the last glacial

  16. Long-term Glacial History of the West Antarctic Ice Sheet from Cosmogenic Nuclides in a Subglacial Bedrock Core

    NASA Astrophysics Data System (ADS)

    Spector, P. E.; Stone, J.; Hillebrand, T.; Gombiner, J. H.

    2017-12-01

    To investigate the response of the West Antarctic Ice Sheet (WAIS) to climatic conditions warmer than present, we are analyzing cosmogenic nuclides in a bedrock core from beneath 150 m of ice at a site near the Pirrit Hills. Our aim is to determine whether the WAIS has thinned in the past, exposing bedrock at this site, and if so, when. This will help to determine the vulnerability of the ice sheet to future warming, and identify climatic thresholds capable of inducing WAIS collapse. We selected a site where the ice-sheet surface lies at 1300 m, approximately halfway from the ice-sheet divide to the grounding line. We expect ice thickness at the site to reflect WAIS dynamics, rather than local meteorology or topography. Ice flow speeds are moderate and ice above the core site is thin enough to remain cold-based, limiting the possibility of subglacial erosion which would compromise the cosmogenic nuclide record. We targeted a subglacial ridge adjacent to an exposed granite nunatak. This lithology provides minerals suitable for analysis of multiple cosmogenic nuclides with different half-lives. Although we aimed to collect two cores from different depths to compare exposure histories, hydrofracture of the basal ice prevented us from reaching the bed at the first drill site. The second hole produced 5.5 m of discontinuous ice core above 8 m of bedrock core. Initial analyses of quartz from the bedrock show low levels of Be-10. Further analyses of Be-10, Al-26, Cl-36 and Ne-21 from the full length of the core will be required to determine whether this is because the surface has never been exposed, or because the cosmogenic nuclide profile has been truncated by glacial erosion. We will present comprehensive cosmogenic nuclide data, and discuss implications for WAIS deglaciation history, at the meeting. Supported by US National Science Foundation awards ANT-1142162 and PLR-1341728.

  17. Patient satisfaction with wait times at an emergency ophthalmology on-call service.

    PubMed

    Chan, Brian J; Barbosa, Joshua; Moinul, Prima; Sivachandran, Nirojini; Donaldson, Laura; Zhao, Lily; Mullen, Sarah J; McLaughlin, Christopher R; Chaudhary, Varun

    2018-04-01

    To assess patient satisfaction with emergency ophthalmology care and determine the effect provision of anticipated appointment wait time has on scores. Single-centre, randomized control trial. Fifty patients triaged at the Hamilton Regional Eye Institute (HREI) from November 2015 to July 2016. Fifty patients triaged for next-day appointments at the HREI were randomly assigned to receive standard-of-care preappointment information or standard-of-care information in addition to an estimated appointment wait time. Patient satisfaction with care was assessed postvisit using the modified Judgements of Hospital Quality Questionnaire (JHQQ). In determining how informing patients of typical wait times influenced satisfaction, the Mann-Whitney U test was performed. As secondary study outcomes, we sought to determine patient satisfaction with the intervention material using the Fisher exact test and the effect that wait time, age, sex, education, mobility, and number of health care providers seen had on satisfaction scores using logistic regression analysis. The median JHQQ response was "very good" (4/5) and between "very good" and "excellent" (4.5/5) in the intervention and control arms, respectively. There was no difference in patient satisfaction between the cohorts (Mann-Whitney U = 297.00, p = 0.964). Logistic regression analysis demonstrated that wait times influenced patient satisfaction (OR = 0.919, 95% CI 0.864-0.978, p = 0.008). Of the intervention arm patients, 92.0% (N = 23) found the preappointment information useful, whereas only 12.5% (N = 3) of the control cohort patients noted the same (p < 0.001). Provision of anticipated wait time information to patients in an emergency on-call ophthalmology clinic did not influence satisfaction with care as captured by the JHQQ. Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

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

    PubMed

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

    2015-01-01

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

  19. Effectiveness of Multimedia for Transplant Preparation for Kidney Transplant Waiting List Patients.

    PubMed

    Charoenthanakit, C; Junchotikul, P; Sittiudomsuk, R; Saiyud, A; Pratumphai, P

    2016-04-01

    A multimedia program could effectively advise patients about preparing for transplantation while on the waiting list for a kidney transplant. This study aimed to compare knowledge about transplant preparation for patients on a kidney transplant waiting list before and after participating in a multimedia program, and to evaluate patient satisfaction with the multimedia program. Research design was quasiexperimental with the use of 1 group. Subjects were 186 patients on the kidney transplant waiting list after HLA matching in Ramathibodi Hospital. The questionnaires were developed by the researchers. The statistical tools used were basic statistics, percentage, average, standard deviation, and the difference of score between before and after participation in the multimedia program (t test). The evaluation knowledge for transplant preparation for kidney transplant waiting list patients after participating in the multimedia program averaged 85.40%, and there was an increased improvement of score by an average 3.27 out of a possible full score of 20 (P < .05). The result of patient satisfaction for the multimedia program had good average, 4.58. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Impact of waiting time on the quality of life of patients awaiting coronary artery bypass grafting.

    PubMed

    Sampalis, J; Boukas, S; Liberman, M; Reid, T; Dupuis, G

    2001-08-21

    A lack of resources has created waiting lists for many elective surgical procedures within Canada's universal health care system. Coronary artery bypass grafting (CABG) for the treatment of atherosclerotic ischemic heart disease is one of these affected surgical procedures. We studied the impact of waiting times on the quality of life of patients awaiting CABG. A prospective cohort of 266 patients from 3 hospitals in Montreal was used. Patients who gave informed consent were followed from the time they were registered for CABG until 6 months after surgery; recruitment began in November 1993, and the last follow-up was completed in July 1995. Patient groups were classified according to the duration of the wait for CABG (< or = 97 days or > 97 days). We measured the following outcomes: quality of life (using the Medical Outcomes Study 36-item Short Form [SF-36]), incidence of chest pain (using the New York Heart Association angina classification), frequency of symptoms (using the Cardiac Symptom Inventory) and rates of complications and death before and after surgery. There were no differences in quality of life at baseline between the 2 groups. Immediately before surgery, compared with patients who waited 97 days or less, those who waited longer had significantly reduced physical functioning (change from baseline SF-36 score 0 v. -4 respectively, p = 0.001), vitality (change from baseline score -0.1 v. -1.3, p = 0.01), social functioning (change from baseline score 0.4 v. -0.4, p = 0.03) and general health (change from baseline score 1.1 v. -1.7, p = 0.001). At 6 months after surgery, compared with patients who waited 97 days or less for CABG, those who waited longer had reduced physical functioning (change from baseline SF-36 score 4.0 v. -0.1 respectively, p = 0.001), physical role (change from baseline score 0.8 v. 0.0, p = 0.001), vitality (change from baseline score 2.2 v. 0.9, p = 0.001), mental health (change from baseline score 1.2 v. 0.0, p = 0.001) and

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

    PubMed

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

    2016-08-01

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

  2. Characteristics of Older Adults on Waiting Lists for Meals on Wheels: Identifying Areas for Intervention

    PubMed Central

    Thomas, Kali S.; Smego, Raul; Akobundu, Ucheoma; Dosa, David

    2016-01-01

    The purpose of this study was to characterize the population of seniors on Meals on Wheels’ (MOW) waiting lists and identify their rate of depression, anxiety, falls, and fear of falling. Data come from surveys of 626 seniors on waiting lists across the country and the 2013 National Health and Aging Trends Study (NHATS). Results suggest that seniors on waiting lists for MOW were more likely to be widowed, less educated, older, Black, Hispanic, and receive Medicaid than the population of community-dwelling older adults. In addition, 31% of seniors on MOW waiting lists were depressed, compared with 12% of seniors in the national population (p < .001), and 28% exhibited signs and symptoms of anxiety, compared with 10% of the national population of seniors (p < .001). Seniors on waiting lists were significantly more likely to have fallen in the last month and be fearful of falling than the national population of seniors (p < .001). Individuals on MOW waiting lists are a vulnerable and high-risk group. By seeking to better understand clients’ needs, appropriate services can be tailored to promote independent living and improve older adults’ well-being. PMID:26597791

  3. Waiting for Radiology Test Results: Patient Expectations and Emotional Disutility.

    PubMed

    Woolen, Sean; Kazerooni, Ella A; Wall, Amber; Parent, Kelly; Cahalan, Shannon; Alameddine, Mitchell; Davenport, Matthew S

    2018-02-01

    To measure patient willingness to wait and emotional disutility of waiting for outpatient imaging test results. A prospective HIPAA-compliant multicenter outpatient quality improvement survey was administered by a trained interviewer to 218 outpatients from November 1, 2016, to February 1, 2017. The survey was vetted by patient- and family-centered care advocates with experience in survey design and underwent precognitive testing for readability. Six clinical scenarios were tested. Descriptive statistics were calculated. The response (93% [202 of 218]) and completion (93% [188 of 202]) rates were excellent. Anxiety (28% [57 of 202]), depression (26% [53 of 202]), and cancer (23% [46 of 202]) histories were common. Median stated expectations for imaging test results receipt were 3 days after a screening examination (interquartile range [IQR] 5 days); 2 days after chest x-ray for chest pain (IQR 3) or MRI or CT for back pain (IQR 2); and 1 day after chest x-ray for pneumonia (IQR 2), MRI or CT for brain tumor (IQR 2), or CT for cancer treatment (IQR 3). If imaging results are not received, the median time patients stated they would wait to call their provider was 1 to 5 days (varied by indication). Waiting for imaging results exerts an emotional change in 45% (91 of 202) of individuals, with the majority (85% [77 of 91]) experiencing anxiety (minimal 28%, mild 45%, moderate 22%, severe 4%, extreme 1%). Patients expect outpatient imaging results within 1 to 3 days and will call providers by 1 to 5 days. Waiting for test results commonly induces anxiety. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  4. Nuclide Depletion Capabilities in the Shift Monte Carlo Code

    DOE PAGES

    Davidson, Gregory G.; Pandya, Tara M.; Johnson, Seth R.; ...

    2017-12-21

    A new depletion capability has been developed in the Exnihilo radiation transport code suite. This capability enables massively parallel domain-decomposed coupling between the Shift continuous-energy Monte Carlo solver and the nuclide depletion solvers in ORIGEN to perform high-performance Monte Carlo depletion calculations. This paper describes this new depletion capability and discusses its various features, including a multi-level parallel decomposition, high-order transport-depletion coupling, and energy-integrated power renormalization. Several test problems are presented to validate the new capability against other Monte Carlo depletion codes, and the parallel performance of the new capability is analyzed.

  5. How Long Are Cancer Patients Waiting for Oncological Therapy in Poland?

    PubMed

    Osowiecka, Karolina; Rucinska, Monika; Nowakowski, Jacek J; Nawrocki, Sergiusz

    2018-03-23

    The five-year relative survival rate in Poland is approximately 10% lower compared with the average for Europe. One of the factors that may contribute to the inferior treatment results in Poland could be the long time between cancer suspicion and the beginning of treatment. The aim of the study was to determine the real waiting time for cancer diagnosis and treatment in Poland. The study was carried out in six cancer centers on a group of 1373 patients, using a questionnaire to interview patients. The median waiting time was estimated as follows: (A) from suspicion (the date of the first visit, with symptoms, to a doctor or a preventive or screening test) until histopathological diagnosis; (B) from suspicion until initial treatment; and (C) from diagnosis until initial treatment. The median times from suspicion to treatment, from suspicion to diagnosis, and from diagnosis to treatment, were 10.6, 5.6, and 5.0 weeks, respectively. Using multivariate analysis, the strongest influence was estimated, in a case of tumor localization, to be the method of initial treatment and facilities. The waiting time for cancer treatment in Poland is too long. The highest influence on waiting time was determined, in the case of tumors, as the type of cancer and factors related to the health care system.

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

    PubMed

    Beukeboom, Camiel J; Langeveld, Dion; Tanja-Dijkstra, Karin

    2012-04-01

    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. In this between-patients experimental design, patients were exposed to one of the following: real plants, posters of plants, or no nature (control). These conditions were alternately applied to two waiting rooms. The location of this study was two waiting rooms at the Radiology Department of a Dutch hospital. The subjects comprised 457 patients (60% female and 40% male) who were mostly scheduled for echocardiogram, dual-energy x-ray absorptiometry, magnetic resonance imaging, computed tomography scans, or nuclear research. Patients exposed to real plants, as well as patients exposed to posters of plants, report lower levels of experienced stress compared to the control condition. Further analyses show that these small but significant effects of exposure to nature are partially mediated by the perceived attractiveness of the waiting room. Natural elements in hospital environments have the potential to reduce patients' feelings of stress. By increasing the attractiveness of the waiting room by adding either real plants or posters of plants, hospitals can create a pleasant atmosphere that positively influences patients' well-being.

  7. The effect of in-office waiting time on physician visit frequency among working-age adults.

    PubMed

    Tak, Hyo Jung; Hougham, Gavin W; Ruhnke, Atsuko; Ruhnke, Gregory W

    2014-10-01

    Disparities in unmet health care demand resulting from socioeconomic, racial, and financial factors have received a great deal of attention in the United States. However, out-of-pocket costs alone do not fully reflect the total opportunity cost that patients must consider as they seek medical attention. While there is an extensive literature on the price elasticity of demand for health care, empirical evidence regarding the effect of waiting time on utilization is sparse. Using the nationally representative 2003 Community Tracking Study Household Survey, the most recent iteration containing respondents' physician office visit frequency and estimated in-office waiting time in the United States (N = 23,484), we investigated the association between waiting time and calculated time cost with the number of physician visits among a sample of working-age adults. To avoid the bias that literature suggests would result from excluding respondents with zero physician visits, we imputed waiting time for the essential inclusion of such individuals. On average, respondents visited physician offices 3.55 times, during which time they waited 28.7 min. The estimates from a negative binomial model indicated that a doubling of waiting time was associated with a 7.7 percent decrease (p-value < 0.001) in physician visit frequency. For women and unemployed respondents, who visited physicians more frequently, the decrease was even larger, suggesting a stronger response to greater waiting times. We believe this finding reflects the discretionary nature of incremental visits in these groups, and a consequent lower perceived marginal benefit of additional visits. The results suggest that in-office waiting time may have a substantial influence on patients' propensity to seek medical attention. Although there is a belief that expansions in health insurance coverage increase health care utilization by reducing financial barriers to access, our results suggest that unintended consequences

  8. Tonsillectomy Versus Watchful Waiting for Recurrent Throat Infection: A Systematic Review.

    PubMed

    Morad, Anna; Sathe, Nila A; Francis, David O; McPheeters, Melissa L; Chinnadurai, Sivakumar

    2017-02-01

    The effectiveness of tonsillectomy or adenotonsillectomy ("tonsillectomy") for recurrent throat infection compared with watchful waiting is uncertain. To compare sleep, cognitive, behavioral, and health outcomes of tonsillectomy versus watchful waiting in children with recurrent throat infections. MEDLINE, Embase, and the Cochrane Library. Two investigators independently screened studies against predetermined criteria. One investigator extracted data with review by a second. Investigators independently assessed risk of bias and strength of evidence (SOE) and confidence in the estimate of effects. Seven studies including children with ≥3 infections in the previous 1 to 3 years addressed this question. In studies reporting baseline data, number of infections/sore throats decreased from baseline in both groups, with greater decreases in sore throat days, clinician contacts, diagnosed group A streptococcal infections, and school absences in tonsillectomized children in the short term (<12 months). Quality of life was not markedly different between groups at any time point. Few studies fully categorized infection/sore throat severity; attrition was high. Throat infections, utilization, and school absences improved in the first postsurgical year in tonsillectomized children versus children not receiving surgery. Benefits did not persist over time; longer-term outcomes are limited. SOE is moderate for reduction in short-term throat infections and insufficient for longer-term reduction. SOE is low for no difference in longer-term streptococcal infection reduction. SOE is low for utilization and missed school reduction in the short term, low for no difference in longer-term missed school, and low for no differences in quality of life. Copyright © 2017 by the American Academy of Pediatrics.

  9. Trends in Wait-list Mortality in Children Listed for Heart Transplantation in the United States

    PubMed Central

    Singh, Tajinder P.; Almond, Christopher S.; Piercey, Gary; Gauvreau, Kimberlee

    2014-01-01

    We sought to evaluate trends in overall and race-specific pediatric heart transplant (HT) wait-list mortality in the United States (US) during the last 20 years. We identified all children <18 years old listed for primary HT in the US during 1989–2009 (N=8096, 62% white, 19% black, 13% Hispanic, 6% other) using the Organ Procurement and Transplant Network database. Wait-list mortality was assessed in 4 successive eras (1989–1994, 1995–1999, 2000–2004, and 2005–2009). Overall wait-list mortality declined in successive eras (26%, 23%, 18% and 13%, respectively). The decline across eras remained significant in adjusted analysis (hazard ratio [HR] 0.70 in successive eras, 95% confidence interval [CI] 0.67, 0.74) and was 67% lower for children listed during 2005–2009 vs. those listed during 1989–1994 (HR 0.33, CI 0.28, 0.39). In models stratified by race, wait-list mortality decreased in all racial groups in successive eras. In models stratified by era, minority children were not at higher risk of wait-list mortality in the most recent era. We conclude that the risk of wait-list mortality among US children listed for HT has decreased by two-thirds during the last 20 years. Racial gaps in wait-list mortality present variably in the past are not present in the current era. PMID:21883920

  10. Decreasing Psychiatric Admission Wait Time in the Emergency Department by Facilitating Psychiatric Discharges.

    PubMed

    Stover, Pamela R; Harpin, Scott

    2015-12-01

    Limited capacity in a psychiatric unit contributes to long emergency department (ED) admission wait times. Regulatory and accrediting agencies urge hospitals nationally to improve patient flow for better access to care for all types of patients. The purpose of the current study was to decrease psychiatric admission wait time from 10.5 to 8 hours and increase the proportion of patients discharged by 11 a.m. from 20% to 50%. The current study compared pre- and post-intervention data. Plan-Do-Study-Act cycles aimed to improve discharge processes and timeliness through initiation of new practices. Admission wait time improved to an average of 5.1 hours (t = 3.87, p = 0.006). The proportion of discharges occurring by 11 a.m. increased to 46% (odds ratio = 3.42, p < 0.0001). Improving discharge planning processes and timeliness in a psychiatric unit significantly decreased admission wait time from the ED, improving access to psychiatric care. Copyright 2015, SLACK Incorporated.

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

    PubMed

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

    2015-04-05

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

  12. Soft-Rotator Coupled Channels Global Optical Potential for A=24-122 Mass Region Nuclides up to 200-MeV Incident Nucleon Energies

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Soukhovitski, Efrem Sh.; Chiba, Satoshi; Lee, Jeong-Yeon

    2005-05-24

    A coupled-channels optical model with a coupling scheme based on nuclear wave functions of the soft-rotator model was applied to analyze experimental nucleon-nucleus interaction data for even-even nuclides with mass number A=24-122. We found that all the available data (total cross sections, angular distributions of elastically and inelastically scattered nucleons, and reaction cross sections) for these nuclides can be described to a good accuracy using an optical potential having smooth dependencies of potential values, radii, and diffuseness on the mass number. The individual properties of the target nuclides are accounted for by individuality of the nuclear Hamiltonian parameters, adjusted tomore » reproduce the low-lying collective level structure, Fermi energies, and deformation parameters.« less

  13. Public involvement in the priority setting activities of a wait time management initiative: a qualitative case study.

    PubMed

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

    2007-11-16

    As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement. This study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1) over 25 documents (e.g. strategic planning reports, public updates), and (2) 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates). Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. The Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system) and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality) for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system) resulting from the Ontario Wait Times Strategy. We described and evaluated a wait time management initiative (the Ontario Wait Time Strategy) with special attention to public

  14. Public involvement in the priority setting activities of a wait time management initiative: a qualitative case study

    PubMed Central

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

    2007-01-01

    Background As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement. Methods This study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1) over 25 documents (e.g. strategic planning reports, public updates), and (2) 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates). Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. Results The Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system) and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality) for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system) resulting from the Ontario Wait Times Strategy. Conclusion We described and evaluated a wait time management initiative (the Ontario Wait Time Strategy

  15. The impact of waiting for intervention on costs and effectiveness: the case of transcatheter aortic valve replacement.

    PubMed

    Ribera, Aida; Slof, John; Ferreira-González, Ignacio; Serra, Vicente; García-Del Blanco, Bruno; Cascant, Purificació; Andrea, Rut; Falces, Carlos; Gutiérrez, Enrique; Del Valle-Fernández, Raquel; Morís-de laTassa, César; Mota, Pedro; Oteo, Juan Francisco; Tornos, Pilar; García-Dorado, David

    2017-11-23

    The economic crisis in Europe might have limited access to some innovative technologies implying an increase of waiting time. The purpose of the study is to evaluate the impact of waiting time on the costs and benefits of transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic stenosis. This is a cost-utility analysis from the perspective of the Spanish National Health Service. Results of two prospective hospital registries (158 and 273 consecutive patients) were incorporated into a probabilistic Markov model to compare quality adjusted life years (QALYs) and costs for TAVR after waiting for 3-12 months, relative to immediate TAVR. We simulated a cohort of 1000 patients, male, and 80 years old; other patient profiles were assessed in sensitivity analyses. As waiting time increased, costs decreased at the expense of lower survival and loss of QALYs, leading to incremental cost-effectiveness ratios for eliminating waiting lists of about 12,500 € per QALY. In subgroup analyses prioritization of patients for whom higher benefit was expected led to a smaller loss of QALYs. Concerning budget impact, long waiting lists reduced spending considerably and permanently. A shorter waiting time is likely to be cost-effective (considering commonly accepted willingness-to-pay thresholds in Europe) relative to 3 months or longer waiting periods. If waiting lists are nevertheless seen as unavoidable due to severe but temporary budgetary restrictions, prioritizing patients for whom higher benefit is expected appears to be a way of postponing spending without utterly sacrificing patients' survival and quality of life.

  16. A Cross-Sectional Survey of Population-Wide Wait Times for Patients Seeking Medical vs. Cosmetic Dermatologic Care.

    PubMed

    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 < 0.05). Cosmetic care was associated with the shortest wait times (3.0 weeks; Interquartile Range (IQR) = 0.4-3.4), followed by Urgent care (9.0 weeks; IQR = 2.1-12.9), then Non-Urgent Care (12.7 weeks; IQR = 4.4-16.4). Wait times for practices offering only Urgent care were not different from practices offering both Urgent and Cosmetic care (10.3 vs. 7.0 weeks). Longer wait times and greater variation for Urgent and Non-Urgent dermatologic care and shorter wait times and less variation for Cosmetic care. Wait times were significantly longer in regions with lower dermatologist density. Provision of Cosmetic services did not increase wait times for Urgent care. These findings suggest an overall dermatology workforce shortage and a need for a more streamlined referral system for dermatologic care.

  17. Willingness to Pay for a Maternity Waiting Home Stay in Zambia.

    PubMed

    Vian, Taryn; White, Emily E; Biemba, Godfrey; Mataka, Kaluba; Scott, Nancy

    2017-03-01

    Complications of pregnancy and childbirth can pose serious risks to the health of women, especially in resource-poor settings. Zambia has been implementing a program to improve access to emergency obstetric and neonatal care, including expansion of maternity waiting homes-residential facilities located near a qualified medical facility where a pregnant woman can wait to give birth. Yet it is unclear how much support communities and women would be willing to provide to help fund the homes and increase sustainability. We conducted a mixed-methods study to estimate willingness to pay for maternity waiting home services based on a survey of 167 women, men, and community elders. We also collected qualitative data from 16 focus group discussions to help interpret our findings in context. The maximum willingness to pay was 5.0 Zambian kwacha or $0.92 US dollars per night of stay. Focus group discussions showed that willingness to pay is dependent on higher quality of services such as food service and suggested that the pricing policy (by stay or by night) could influence affordability and use. While Zambians seem to value and be willing to contribute a modest amount for maternity waiting home services, planners must still address potential barriers that may prevent women from staying at the shelters. These include cash availability and affordability for the poorest households. © 2016 by the American College of Nurse-Midwives.

  18. Willingness to Pay for a Maternity Waiting Home Stay in Zambia

    PubMed Central

    White, Emily E.; Biemba, Godfrey; Mataka, Kaluba; Scott, Nancy

    2016-01-01

    Introduction Complications of pregnancy and childbirth can pose serious risks to the health of women, especially in resource‐poor settings. Zambia has been implementing a program to improve access to emergency obstetric and neonatal care, including expansion of maternity waiting homes‐residential facilities located near a qualified medical facility where a pregnant woman can wait to give birth. Yet it is unclear how much support communities and women would be willing to provide to help fund the homes and increase sustainability. Methods We conducted a mixed‐methods study to estimate willingness to pay for maternity waiting home services based on a survey of 167 women, men, and community elders. We also collected qualitative data from 16 focus group discussions to help interpret our findings in context. Results The maximum willingness to pay was 5.0 Zambian kwacha or $0.92 US dollars per night of stay. Focus group discussions showed that willingness to pay is dependent on higher quality of services such as food service and suggested that the pricing policy (by stay or by night) could influence affordability and use. Discussion While Zambians seem to value and be willing to contribute a modest amount for maternity waiting home services, planners must still address potential barriers that may prevent women from staying at the shelters. These include cash availability and affordability for the poorest households. PMID:28419708

  19. Family experience of waiting for living donor liver transplantation: from parental donor perspective.

    PubMed

    Chou, Chu-Yi; Chen, Yu-Chih; Chen, Chao-Long; Chen, Jo-Lin; Mu, Pei-Fan

    2009-06-01

    The aim of this study was to investigate from the perspectives of the donor parents of children with biliary atresia, the essence of family experiences during the period when waiting for a living donor liver transplant. Living donor liver transplantation is a new hope for children and families when the child suffers from biliary atresia. It is obvious, during the waiting period, for a family with a child undergoing living donor liver transplantation, that the process has a serious impact and there is a need for them to be well-prepared. A descriptive phenomenological design was used in this study. Nine donor parents from a medical centre in Taiwan participated in this study. The inclusion criteria were that the parent had a child with biliary atresia, that the child had received living donor liver transplantation over the last year and a half and that the parent was the living donor for child's liver transplantation. An open in-depth interview technique encouraged the parents to reflect on their experiences as the process raised their feelings to a conscious level. The data were analysed using the Colaizzi's approach. This study explores the essence of families undergoing the waiting period for living donor liver transplantation surgery from the point of view of the donating parents. Five themes emerged: (1) surgery as hope of rebirth, (2) negotiating the decision to have surgery, (3) the selection of the donor to achieve family welfare, (4) preparing and planning for the surgery and (5) worry over the impact of the surgery. The results demonstrate that the parents' experiences included a variety of domains: hope of rebirth, mental negotiation while deciding on surgery and choice of donor, coping with the preparation for surgery and the possible impact on the family of the surgery. The findings indicated that nursing professionals should provide family-centred care to assist the family with the steps needed to move toward surgery.

  20. The association between waiting for psychological therapy and therapy outcomes as measured by the CORE-OM.

    PubMed

    Beck, Alison; Burdett, Mark; Lewis, Helen

    2015-06-01

    To investigate the impact of waiting for psychological therapy on client well-being as measured by the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) global distress (GD) score. Global distress scores were retrieved for all clients referred for psychological therapy in a secondary care mental health service between November 2006 and May 2013 and who had completed a CORE-OM at assessment and first session. GD scores for a subgroup of 103 clients who had completed a CORE-OM during the last therapy session were also reviewed. The study sample experienced a median wait of 41.14 weeks between assessment and first session. The relationship between wait time from referral acceptance to assessment, and assessment GD score was not significant. During the period between assessment and first session no significant difference in GD score was observed. Nevertheless 29.1% of the sample experienced reliable change; 16.0% of clients reliably improved and 13.1% reliably deteriorated whilst waiting for therapy. Demographic factors were not found to have a significant effect on the change in GD score between assessment and first session. Waiting time was associated with post-therapy outcomes but not to a degree which was meaningful. The majority of individuals (54.4%), regardless of whether they improved or deteriorated whilst waiting for therapy, showed reliable improvement at end of therapy as measured by the CORE-OM. The majority of GD scores remained stable while waiting for therapy; however, 29.1% of secondary care clients experienced either reliable improvement or deterioration. Irrespective of whether they improved, deteriorated or remained unchanged whilst waiting for therapy, most individuals who had a complete end of therapy assessment showed reliable improvements following therapy. There was no significant difference in GD score between assessment and first session recordings. A proportion of clients (29.1%) showed reliable change, either improvement or

  1. Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care

    PubMed Central

    Wiegersma, Marian; Panman, Chantal M C R; Kollen, Boudewijn J; Berger, Marjolein Y; Lisman-Van Leeuwen, Yvonne

    2014-01-01

    Objective To compare the effects of pelvic floor muscle training and watchful waiting on pelvic floor symptoms in a primary care population of women aged 55 years and over with symptomatic mild pelvic organ prolapse. Design Randomised controlled trial. Setting Dutch primary care. Participants Women aged 55 years or over with symptomatic mild prolapse (leading edge above the hymen) were identified by screening. Exclusion criteria were current prolapse treatment or treatment in the previous year, malignancy of pelvic organs, current treatment for another gynaecological disorder, severe/terminal illness, impaired mobility, cognitive impairment, and insufficient command of the Dutch language. Interventions Pelvic floor muscle training versus watchful waiting. Main outcome measures The primary outcome was change in bladder, bowel, and pelvic floor symptoms measured with the Pelvic Floor Distress Inventory-20 (PFDI-20), three months after the start of treatment. Secondary outcomes were changes in condition specific and general quality of life, sexual function, degree of prolapse, pelvic floor muscle function, and patients’ perceived change in symptoms. Results Of the 287 women who were randomised to pelvic floor muscle training (n=145) or watchful waiting (n=142), 250 (87%) completed follow-up. Participants in the intervention group improved by (on average) 9.1 (95% confidence interval 2.8 to 15.4) points more on the PFDI-20 than did participants in the watchful waiting group (P=0.005). Of women in the pelvic floor muscle training group, 57% (82/145) reported an improvement in overall symptoms from the start of the study compared with 13% (18/142) in the watchful waiting group (P<0.001). Other secondary outcomes showed no significant difference between the groups. Conclusions Although pelvic floor muscle training led to a significantly greater improvement in PFDI-20 score, the difference between the groups was below the presumed level of clinical relevance (15 points

  2. Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care.

    PubMed

    Wiegersma, Marian; Panman, Chantal M C R; Kollen, Boudewijn J; Berger, Marjolein Y; Lisman-Van Leeuwen, Yvonne; Dekker, Janny H

    2014-12-22

    To compare the effects of pelvic floor muscle training and watchful waiting on pelvic floor symptoms in a primary care population of women aged 55 years and over with symptomatic mild pelvic organ prolapse. Randomised controlled trial. Dutch primary care. Women aged 55 years or over with symptomatic mild prolapse (leading edge above the hymen) were identified by screening. Exclusion criteria were current prolapse treatment or treatment in the previous year, malignancy of pelvic organs, current treatment for another gynaecological disorder, severe/terminal illness, impaired mobility, cognitive impairment, and insufficient command of the Dutch language. Pelvic floor muscle training versus watchful waiting. The primary outcome was change in bladder, bowel, and pelvic floor symptoms measured with the Pelvic Floor Distress Inventory-20 (PFDI-20), three months after the start of treatment. Secondary outcomes were changes in condition specific and general quality of life, sexual function, degree of prolapse, pelvic floor muscle function, and patients' perceived change in symptoms. Of the 287 women who were randomised to pelvic floor muscle training (n=145) or watchful waiting (n=142), 250 (87%) completed follow-up. Participants in the intervention group improved by (on average) 9.1 (95% confidence interval 2.8 to 15.4) points more on the PFDI-20 than did participants in the watchful waiting group (P=0.005). Of women in the pelvic floor muscle training group, 57% (82/145) reported an improvement in overall symptoms from the start of the study compared with 13% (18/142) in the watchful waiting group (P<0.001). Other secondary outcomes showed no significant difference between the groups. Although pelvic floor muscle training led to a significantly greater improvement in PFDI-20 score, the difference between the groups was below the presumed level of clinical relevance (15 points). Nevertheless, 57% of the participants in the intervention group reported an improvement of

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

    PubMed

    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.

  4. The Chondrite Neagari: Petrography, Mineralogy, Chemical Compositions, and Cosmogenic Nuclides

    NASA Astrophysics Data System (ADS)

    Okada, A.; Komura, K.; Nagao, K.; Nishiizumi, K.; Miyamoto, Y.; Sakamoto, K.; Ebihara, M.; Shima, M.

    1995-09-01

    The Neagari meteorite fell on Feb. 18, 1995 at Neagari-machi, Nomi-gun, Ishikawa-ken, Japan (geographical coordinate: 36 degrees 26.9'N, 136 degrees 27.9'E). It was broken into several pieces when it hit a car upon falling. The largest piece weighing about 325 g and a small piece weighing 39 g were brought to the Kanazawa University for the measurements of gamma-rays emitted by cosmogenic nuclides only 2.7 days after the fall. Thereafter, the measurement was repeated several times. Other small pieces were used for petrographic, mineralogical and chemical studies. Noble gas mass spectrometry and AMS were also conducted. The Neagari meteorite shows a distinct, recrystallized structure under the microscopic observation of the thin section. Chondrules, 0.6 to 1.0 mm in diameter, are all present as relicts, buried in the well-recrystallized matrix. The chondrule-matrix boundaries are scarcely discernible in the granulated matrix. Olivine (Fa: 25.3 +/- 0.6 mole%) and orthopyroxene (Fs: 20.6 +/- 0.6 mole%) are the most abundant minerals both in matrix and in the chondrule relicts. Diopside is present as individual grains in the granular matrix. Interstitial feldspar crystal (Or(sub)6.3Ab (sub)88.0 An(sub)5.8) are common in the matrix and chondrule relicts, and often enclose minute pyroxene grains. Main opaque minerals are kamacite, taenite, troilite and chromite, and the metal phase is more abundant than the sulfide phase in the section. Both Fa and Fs values indicate that the Neagari meteorite is an L chondrite. The well-crystallized structure of the matrix, poorly defined outline of relict chondrules in the matrix, the prevalence of clear and well-developed plagioclase grains in the matrix and chondrule relicts and the absence of glass and monoclinic low-Ca pyroxene indicate the petrologic type to be 6. By the non-destructive gamma-ray measurement of the meteorite, eleven cosmogenic nuclides (^44mSc, ^52Mn, ^48V, ^51Cr, ^7Be, ^56Co, ^46Sc, ^57Co, ^54Mn, ^22Na, and ^26Al

  5. Impact of insurance status on heart transplant wait-list mortality for patients with left ventricular assist devices.

    PubMed

    Emani, Sitaramesh; Tumin, Dmitry; Foraker, Randi E; Hayes, Don; Smith, Sakima A

    2017-02-01

    To test the hypotheses that receipt of Medicaid or Medicare (versus private insurance or self-pay) and low socioeconomic status (SES) leads to increased mortality and lower chances of transplantation among heart transplant (HTx) candidates with bridge to transplant left ventricular assist devices (BTT LVADs). Survival while awaiting HTx has improved with the use of BTT LVADs. However, it is unknown whether benefits extend uniformly across patient groups based on insurance status. Data from the United Network of Organ Sharing (UNOS) registry between 2006 and 2015 were examined for first-time HTx candidates ≥18 and <65 years who had LVAD support while wait-listed. Multivariable survival analysis was conducted on competing outcomes of mortality and time to transplant stratified by insurance source at the time of listing. Additional covariates included demographic information and SES. A total of 4626 patients met inclusion criteria, with 3353 being used for multivariable analysis. A majority of patients (68%) underwent HTx during the study period. BTT LVAD wait-list mortality was found to be greater among Medicaid beneficiaries vs. private insurance (SHR 1.57, P<.05) and did not diminish with the inclusion of neighborhood SES. Transplantation as an outcome demonstrated no difference by insurance status. Medicaid insurance status is associated with worse survival on the HTx wait-list among patients with BTT LVADs, although access to transplant was not different among insurance groups. The disparity is not reflective of SES in general and therefore points to other barriers inherent to Medicaid beneficiaries. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. A Tribute to Waiting Room Moms Everywhere

    ERIC Educational Resources Information Center

    Ansfield, Mara

    2008-01-01

    Waiting rooms are oases for mothers of children with special needs. They congregate in these small holding areas, sitting on musty couches, while their children receive the latest therapeutic interventions. Sometimes they sit quietly, sneaking glances at each other while pretending to read year-old "People" magazines. Sometimes they crawl under a…

  7. A Cross-Sectional Survey of Population-Wide Wait Times for Patients Seeking Medical vs. Cosmetic Dermatologic Care

    PubMed Central

    Yadav, Geeta; Goldberg, Hanna R.; Barense, Morgan D.; Bell, Chaim M.

    2016-01-01

    Background Though previous work has examined some aspects of the dermatology workforce shortage and access to dermatologic care, little research has addressed the effect of rising interest in cosmetic procedures on access to medical dermatologic care. Our objective was to determine the wait times for Urgent and Non-Urgent medical dermatologic care and Cosmetic dermatology services at a population level and to examine whether wait times for medical care are affected by offering cosmetic services. Methods A population-wide survey of dermatology practices using simulated calls asking for the earliest appointment for a Non-Urgent, Urgent and Cosmetic service. Results Response rates were greater than 89% for all types of care. Wait times across all types of care were significantly different from each other (all P < 0.05). Cosmetic care was associated with the shortest wait times (3.0 weeks; Interquartile Range (IQR) = 0.4–3.4), followed by Urgent care (9.0 weeks; IQR = 2.1–12.9), then Non-Urgent Care (12.7 weeks; IQR = 4.4–16.4). Wait times for practices offering only Urgent care were not different from practices offering both Urgent and Cosmetic care (10.3 vs. 7.0 weeks). Interpretation Longer wait times and greater variation for Urgent and Non-Urgent dermatologic care and shorter wait times and less variation for Cosmetic care. Wait times were significantly longer in regions with lower dermatologist density. Provision of Cosmetic services did not increase wait times for Urgent care. These findings suggest an overall dermatology workforce shortage and a need for a more streamlined referral system for dermatologic care. PMID:27632206

  8. 19. WILEY CITY LINE STONE TROLLEY WAITING STATION ON ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    19. WILEY CITY LINE - STONE TROLLEY WAITING STATION ON CONGDON ORCHARD PROPERTY - Yakima Valley Transportation Company Interurban Railroad, Connecting towns of Yakima, Selah & Wiley City, Yakima, Yakima County, WA

  9. Impact of Tumor Localization and Method of Preoperative Biopsy on Sentinel Lymph Node Mapping After Periareolar Nuclide Injection.

    PubMed

    Krammer, Julia; Dutschke, Anja; Kaiser, Clemens G; Schnitzer, Andreas; Gerhardt, Axel; Radosa, Julia C; Brade, Joachim; Schoenberg, Stefan O; Wasser, Klaus

    2016-01-01

    To evaluate whether tumor localization and method of preoperative biopsy affect sentinel lymph node (SLN) detection after periareolar nuclide injection in breast cancer patients. 767 breast cancer patients were retrospectively included. For lymphscintigraphy periareolar nuclide injection was performed and the SLN was located by gamma camera. Patient and tumor characteristics were correlated to the success rate of SLN mapping. SLN marking failed in 9/61 (14.7%) patients with prior vacuum-assisted biopsy and 80/706 (11.3%) patients with prior core needle biopsy. Individually evaluated, biopsy method (p = 0.4) and tumor localization (p = 0.9) did not significantly affect the SLN detection rate. Patients with a vacuum-assisted biopsy of a tumor in the upper outer quadrant had a higher odds ratio of failing in SLN mapping (OR 3.8, p = 0.09) compared to core needle biopsy in the same localization (OR 0.9, p = 0.5). Tumor localization and preoperative biopsy method do not significantly impact SLN mapping with periareolar nuclide injection. However, the failure risk tends to rise if vacuum-assisted biopsy of a tumor in the upper outer quadrant is performed.

  10. Atmospheric dust contribution to budget of U-series nuclides in weathering profiles. The Mount Cameroon volcano

    NASA Astrophysics Data System (ADS)

    Pelt, E.; Chabaux, F. J.; Innocent, C.; Ghaleb, B.

    2009-12-01

    Analysis of U-series nuclides in weathering profiles is developed today for constraining time scale of soil and weathering profile formation (e.g., Chabaux et al., 2008). These studies require the understanding of U-series nuclides sources and fractionation in weathering systems. For most of these studies the impact of aeolian inputs on U-series nuclides in soils is usually neglected. Here, we propose to discuss such an assumption, i.e., to evaluate the impact of dust deposition on U-series nuclides in soils, by working on present and paleo-soils collected on the Mount Cameroon volcano. Recent Sr, Nd, Pb isotopic analyses performed on these samples have indeed documented significant inputs of Saharan dusts in these soils (Dia et al., 2006). We have therefore analyzed 238U-234U-230Th nuclides in the same samples. Comparison of U-Th isotopic data with Sr-Nd-Pb isotopic data indicates a significant impact of the dust input on the U and Th budget of the soils, around 10% for both U and Th. Using Sr-Nd-Pb isotopic data of Saharan dusts given by Dia et al. (2006) we estimate U-Th concentrations and U-Th isotope ratios of dusts compatible with U-Th data obtained on Saharan dusts collected in Barbados (Rydell H.S. and Prospero J.M., 1972). However, the variations of U/Th ratios along the weathering profiles cannot be explained by a simple mixing scenario between material from basalt and from the defined atmospheric dust pool. A secondary uranium migration associated with chemical weathering has affected the weathering profiles. Mass balance calculation suggests that U in soils from Mount Cameroon is affected at the same order of magnitude by both chemical migration and dust accretion. Nevertheless, the Mount Cameroon is a limit case were large dust inputs from continental crust of Sahara contaminate basaltic terrain from Mount Cameroon volcano. Therefore, this study suggests that in other contexts were dust inputs are lower, or the bedrocks more concentrated in U and Th

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

    PubMed

    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.

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

    PubMed

    Atik, Fernando Antibas; Couto, Carolina Fatima; Tirado, Freddy Ponce; Moraes, Camila Scatolin; Chaves, Renato Bueno; Vieira, Nubia W; Reis, João Gabbardo

    2014-01-01

    Evaluate the addition of long-distance heart procurement on a heart transplant program and the status of heart transplant recipients waiting list. 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). 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). 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.

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

    PubMed Central

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

    2016-01-01

    Background: Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department (ED) is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in 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 number waiting 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. PMID:26793727

  14. ENDF/B-IV fission-product files: summary of major nuclide data

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    England, T.R.; Schenter, R.E.

    1975-09-01

    The major fission-product parameters [sigma/sub th/, RI, tau/sub 1/2/, E- bar/sub $beta$/, E-bar/sub $gamma$/, E-bar/sub $alpha$/, decay and (n,$gamma$) branching, Q, and AWR] abstracted from ENDF/B-IV files for 824 nuclides are summarized. These data are most often requested by users concerned with reactor design, reactor safety, dose, and other sundry studies. The few known file errors are corrected to date. Tabular data are listed by increasing mass number. (auth)

  15. Tonsillectomy Versus Watchful Waiting for Recurrent Throat Infection: A Systematic Review

    PubMed Central

    Morad, Anna; Sathe, Nila A.; Francis, David O.; McPheeters, Melissa L.

    2017-01-01

    CONTEXT: The effectiveness of tonsillectomy or adenotonsillectomy (“tonsillectomy”) for recurrent throat infection compared with watchful waiting is uncertain. OBJECTIVE: To compare sleep, cognitive, behavioral, and health outcomes of tonsillectomy versus watchful waiting in children with recurrent throat infections. DATA SOURCES: MEDLINE, Embase, and the Cochrane Library. STUDY SELECTION: Two investigators independently screened studies against predetermined criteria. DATA EXTRACTION: One investigator extracted data with review by a second. Investigators independently assessed risk of bias and strength of evidence (SOE) and confidence in the estimate of effects. RESULTS: Seven studies including children with ≥3 infections in the previous 1 to 3 years addressed this question. In studies reporting baseline data, number of infections/sore throats decreased from baseline in both groups, with greater decreases in sore throat days, clinician contacts, diagnosed group A streptococcal infections, and school absences in tonsillectomized children in the short term (<12 months). Quality of life was not markedly different between groups at any time point. LIMITATIONS: Few studies fully categorized infection/sore throat severity; attrition was high. CONCLUSIONS: Throat infections, utilization, and school absences improved in the first postsurgical year in tonsillectomized children versus children not receiving surgery. Benefits did not persist over time; longer-term outcomes are limited. SOE is moderate for reduction in short-term throat infections and insufficient for longer-term reduction. SOE is low for no difference in longer-term streptococcal infection reduction. SOE is low for utilization and missed school reduction in the short term, low for no difference in longer-term missed school, and low for no differences in quality of life. PMID:28096515

  16. Improving Patients Experience in Peadiatric Emergency Waiting Room.

    PubMed

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

    2016-01-01

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

  17. Uncertainties in the production of p nuclides in thermonuclear supernovae determined by Monte Carlo variations

    NASA Astrophysics Data System (ADS)

    Nishimura, N.; Rauscher, T.; Hirschi, R.; Murphy, A. St J.; Cescutti, G.; Travaglio, C.

    2018-03-01

    Thermonuclear supernovae originating from the explosion of a white dwarf accreting mass from a companion star have been suggested as a site for the production of p nuclides. Such nuclei are produced during the explosion, in layers enriched with seed nuclei coming from prior strong s processing. These seeds are transformed into proton-richer isotopes mainly by photodisintegration reactions. Several thousand trajectories from a 2D explosion model were used in a Monte Carlo approach. Temperature-dependent uncertainties were assigned individually to thousands of rates varied simultaneously in post-processing in an extended nuclear reaction network. The uncertainties in the final nuclear abundances originating from uncertainties in the astrophysical reaction rates were determined. In addition to the 35 classical p nuclides, abundance uncertainties were also determined for the radioactive nuclides 92Nb, 97, 98Tc, 146Sm, and for the abundance ratios Y(92Mo)/Y(94Mo), Y(92Nb)/Y(92Mo), Y(97Tc)/Y(98Ru), Y(98Tc)/Y(98Ru), and Y(146Sm)/Y(144Sm), important for Galactic Chemical Evolution studies. Uncertainties found were generally lower than a factor of 2, although most nucleosynthesis flows mainly involve predicted rates with larger uncertainties. The main contribution to the total uncertainties comes from a group of trajectories with high peak density originating from the interior of the exploding white dwarf. The distinction between low-density and high-density trajectories allows more general conclusions to be drawn, also applicable to other simulations of white dwarf explosions.

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

    PubMed

    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 (< 35, 35-49, > 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. 7. LOWER STATION, FIRST FLOOR, WAITING ROOM, LOOKING EAST. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    7. LOWER STATION, FIRST FLOOR, WAITING ROOM, LOOKING EAST. - Monongahela Incline Plane, Connecting North side of Grandview Avenue at Wyoming Street with West Carson Street near Smithfield Street, Pittsburgh, Allegheny County, PA

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

    NASA Astrophysics Data System (ADS)

    Pyragas, Viktoras; Pyragas, Kestutis

    2018-02-01

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

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

    PubMed

    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.

  2. Application of Queueing Theory to the Analysis of Changes in Outpatients' Waiting Times in Hospitals Introducing EMR

    PubMed Central

    Cho, Kyoung Won; Kim, Seong Min; Chae, Young Moon

    2017-01-01

    Objectives This research used queueing theory to analyze changes in outpatients' waiting times before and after the introduction of Electronic Medical Record (EMR) systems. Methods We focused on the exact drawing of two fundamental parameters for queueing analysis, arrival rate (λ) and service rate (µ), from digital data to apply queueing theory to the analysis of outpatients' waiting times. We used outpatients' reception times and consultation finish times to calculate the arrival and service rates, respectively. Results Using queueing theory, we could calculate waiting time excluding distorted values from the digital data and distortion factors, such as arrival before the hospital open time, which occurs frequently in the initial stage of a queueing system. We analyzed changes in outpatients' waiting times before and after the introduction of EMR using the methodology proposed in this paper, and found that the outpatients' waiting time decreases after the introduction of EMR. More specifically, the outpatients' waiting times in the target public hospitals have decreased by rates in the range between 44% and 78%. Conclusions It is possible to analyze waiting times while minimizing input errors and limitations influencing consultation procedures if we use digital data and apply the queueing theory. Our results verify that the introduction of EMR contributes to the improvement of patient services by decreasing outpatients' waiting time, or by increasing efficiency. It is also expected that our methodology or its expansion could contribute to the improvement of hospital service by assisting the identification and resolution of bottlenecks in the outpatient consultation process. PMID:28261529

  3. Application of Queueing Theory to the Analysis of Changes in Outpatients' Waiting Times in Hospitals Introducing EMR.

    PubMed

    Cho, Kyoung Won; Kim, Seong Min; Chae, Young Moon; Song, Yong Uk

    2017-01-01

    This research used queueing theory to analyze changes in outpatients' waiting times before and after the introduction of Electronic Medical Record (EMR) systems. We focused on the exact drawing of two fundamental parameters for queueing analysis, arrival rate (λ) and service rate (µ), from digital data to apply queueing theory to the analysis of outpatients' waiting times. We used outpatients' reception times and consultation finish times to calculate the arrival and service rates, respectively. Using queueing theory, we could calculate waiting time excluding distorted values from the digital data and distortion factors, such as arrival before the hospital open time, which occurs frequently in the initial stage of a queueing system. We analyzed changes in outpatients' waiting times before and after the introduction of EMR using the methodology proposed in this paper, and found that the outpatients' waiting time decreases after the introduction of EMR. More specifically, the outpatients' waiting times in the target public hospitals have decreased by rates in the range between 44% and 78%. It is possible to analyze waiting times while minimizing input errors and limitations influencing consultation procedures if we use digital data and apply the queueing theory. Our results verify that the introduction of EMR contributes to the improvement of patient services by decreasing outpatients' waiting time, or by increasing efficiency. It is also expected that our methodology or its expansion could contribute to the improvement of hospital service by assisting the identification and resolution of bottlenecks in the outpatient consultation process.

  4. Info card for surgery waiting room improves satisfaction.

    PubMed

    2015-11-01

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

  5. Differential Effects of Wait-Time on Textually Explicit and Implicit Responding: Interactional Explanation.

    ERIC Educational Resources Information Center

    Pond, Marlene R.; Newman, Isadore

    The effects of wait-time, the pause following a teacher question and the pause after a student response, on the length and number of student responses were analyzed at different cognitive levels. Data were obtained from 95 students in grade 4 and from 5 teachers using a wait-time of 5 seconds. Four oral discussion sessions by teachers and students…

  6. Transformation of a Pediatric Primary Care Waiting Room: Creating a Bridge to Community Resources.

    PubMed

    Henize, Adrienne W; Beck, Andrew F; Klein, Melissa D; Morehous, John; Kahn, Robert S

    2018-06-01

    Introduction Children and families living in poverty frequently encounter social risks that significantly affect their health and well-being. Physicians' near universal access to at-risk children and their parents presents opportunities to address social risks, but time constraints frequently interfere. We sought to redesign our waiting room to create a clinic-to-community bridge and evaluate the impact of that redesign on family-centered outcomes. Methods We conducted a pre-post study of a waiting room redesign at a large, academic pediatric primary care center. Design experts sought input about an optimal waiting room from families, community partners and medical providers. Family caregivers were surveyed before and after redesign regarding perceived availability of help with social needs and access to community resources, and hospitality and feelings of stress. Pre-post differences were assessed using the Chi square or Wilcoxon rank sum test. Results The key redesign concepts that emerged included linkages to community organizations, a welcoming environment, and positive distractions for children. A total of 313 caregiver surveys were completed (pre-160; post-153). Compared to pre-redesign, caregivers surveyed post-redesign were significantly more likely to perceive the waiting room as a place to obtain help connecting to community resources and find information about clinical and educational resources (both p < 0.05). Families were also significantly more likely to report the waiting room as more welcoming and relaxing, with sufficient privacy and space (all p < 0.05). Discussion Waiting rooms, typically a place of wasted time and space, can be redesigned to enhance families' engagement and connection to community resources.

  7. Improving access in gastroenterology: The single point of entry model for referrals

    PubMed Central

    Novak, Kerri L; Van Zanten, Sander Veldhuyzen; Pendharkar, Sachin R

    2013-01-01

    In 2005, a group of academic gastroenterologists in Calgary (Alberta) adopted a centralized referral intake system known as central triage. This system provided a single point of entry model (SEM) for referrals rather than the traditional system of individual practitioners managing their own referrals and queues. The goal of central triage was to improve wait times and referral management. In 2008, a similar system was developed in Edmonton at the University of Alberta Hospital (Edmonton, Alberta). SEMs have subsequently been adopted by numerous subspecialties throughout Alberta. There are many benefits of SEMs including improved access and reduced wait times. Understanding and measuring complex patient flow systems is key to improving access, and centralized intake systems provide an opportunity to better understand total demand and system bottlenecks. This knowledge is particularly important for specialties such as gastroenterology (GI), in which demand exceeds supply. While it is anticipated that SEMs will reduce wait times for GI care in Canada, the lack of sufficient resources to meet the demand for GI care necessitates additional strategies. PMID:24040629

  8. Improving access in gastroenterology: the single point of entry model for referrals.

    PubMed

    Novak, Kerri; Veldhuyzen Van Zanten, Sander; Pendharkar, Sachin R

    2013-11-01

    In 2005, a group of academic gastroenterologists in Calgary (Alberta) adopted a centralized referral intake system known as central triage. This system provided a single point of entry model (SEM) for referrals rather than the traditional system of individual practitioners managing their own referrals and queues. The goal of central triage was to improve wait times and referral management. In 2008, a similar system was developed in Edmonton at the University of Alberta Hospital (Edmonton, Alberta). SEMs have subsequently been adopted by numerous subspecialties throughout Alberta. There are many benefits of SEMs including improved access and reduced wait times. Understanding and measuring complex patient flow systems is key to improving access, and centralized intake systems provide an opportunity to better understand total demand and system bottlenecks. This knowledge is particularly important for specialties such as gastroenterology (GI), in which demand exceeds supply. While it is anticipated that SEMs will reduce wait times for GI care in Canada, the lack of sufficient resources to meet the demand for GI care necessitates additional strategies.

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

    PubMed

    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.

  10. Strategic attention deployment for delay of gratification in working and waiting situations.

    PubMed

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

    2002-03-01

    Two studies examined whether the detrimental effects of attention to rewards on delay of gratification in waiting situations holds-or reverses-in working situations. In Study 1, preschoolers waited or worked for desired delayed rewards. Delay times increased when children worked in the presence of rewards but, as predicted, this increase was due to the distraction provided by the work itself. not because attention to rewards motivated children to sustain work. Analysis of spontaneous attention deployment showed that attending to rewards reduces delay time regardless of the working or waiting nature of the task. Fixing attention on rewards was a particularly detrimental strategy regardless of the type of task. Study 2 showed that when the work is not engaging, however, attention to rewards can motivate instrumental work and facilitate delay of gratification as long as attention deployment does not become fixed on the rewards.

  11. The Waite Campus: Industry, Research and Educational Collaboration.

    ERIC Educational Resources Information Center

    PEB Exchange, 1997

    1997-01-01

    The Waite Campus at the University of Adelaide, South Australia, houses industrial, research, and educational organizations. One advantage of this co-location is sharing the cost of facilities and equipment. The facilities described include Plant Research Center, Wine Science Laboratory, refectory, library, conference facilities, teleteaching,…

  12. Studies on cosmogenic nuclides in meteorites with regard to an application as potential depth indicators

    NASA Technical Reports Server (NTRS)

    Sarafin, R.; Herpers, U.; Englert, P.; Wieler, R.; Signer, P.; Bonani, G.; Hofmann, H. J.; Morenzoni, E.; Nessi, M.; Suter, M.

    1986-01-01

    Measurements of stable and radioactive spallation products in meteorites allow to investigate their histories, especially with respect to the exposure to galactic cosmic ray particles and the pre-atmospheric size of the object. While the concentrations of spallation products lead to the determination of exposure and terrestrial ages, production rate ratios are characteristic for the location of the sample in the meteorite. So, one of the aims of this investigation on meteorites is to obtain depth indicators from suitable pairs of cosmogenic nuclides. Because of the different depth profiles for nuclide productions it is necessary to determine the concentrations of a larger number of spallation products in aliquots of a single small sample. Such same sample measurements of Be-10 and light noble gases were performed on 15 ordinary chondrites (7 H- and 8 L-chondrites. Be-10 was determined by accelerator mass spectrometry and the noble gases were measured by static mass spectrometry. The results are summarized and discussed.

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

    PubMed

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

    2014-08-01

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

  14. PREMOR: a point reactor exposure model computer code for survey analysis of power plant performance

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Vondy, D.R.

    1979-10-01

    The PREMOR computer code was written to exploit a simple, two-group point nuclear reactor power plant model for survey analysis. Up to thirteen actinides, fourteen fission products, and one lumped absorber nuclide density are followed over a reactor history. Successive feed batches are accounted for with provision for from one to twenty batches resident. The effect of exposure of each of the batches to the same neutron flux is determined.

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

    ERIC Educational Resources Information Center

    Johnson, Nicole; Parker, Amy T.

    2013-01-01

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

  16. Comparing Time-Dependent Geomagnetic and Atmospheric Effects on Cosmogenic Nuclide Production Rate Scaling

    NASA Astrophysics Data System (ADS)

    Lifton, N. A.

    2014-12-01

    A recently published cosmogenic nuclide production rate scaling model based on analytical fits to Monte Carlo simulations of atmospheric cosmic ray flux spectra (both of which agree well with measured spectra) (Lifton et al., 2014, Earth Planet. Sci. Lett. 386, 149-160: termed the LSD model) provides two main advantages over previous scaling models: identification and quantification of potential sources of bias in the earlier models, and the ability to generate nuclide-specific scaling factors easily for a wide range of input parameters. The new model also provides a flexible framework for exploring the implications of advances in model inputs. In this work, the scaling implications of two recent time-dependent spherical harmonic geomagnetic models spanning the Holocene will be explored. Korte and Constable (2011, Phys. Earth Planet. Int. 188, 247-259) and Korte et al. (2011, Earth Planet. Sci. Lett. 312, 497-505) recently updated earlier spherical harmonic paleomagnetic models used by Lifton et al. (2014) with paleomagnetic measurements from sediment cores in addition to archeomagnetic and volcanic data. These updated models offer improved accuracy over the previous versions, in part to due to increased temporal and spatial data coverage. With the new models as input, trajectory-traced estimates of effective vertical cutoff rigidity (RC- the standard method for ordering cosmic ray data) yield significantly different time-integrated scaling predictions when compared to the earlier models. These results will be compared to scaling predictions using another recent time-dependent spherical harmonic model of the Holocene geomagnetic field by Pavón-Carrasco et al. (2014, Earth Planet. Sci. Lett. 388, 98-109), based solely on archeomagnetic and volcanic paleomagnetic data, but extending to 14 ka. In addition, the potential effects of time-dependent atmospheric models on LSD scaling predictions will be presented. Given the typical dominance of altitudinal over

  17. Reducing Patient Waiting Times for Radiation Therapy and Improving the Treatment Planning Process: a Discrete-event Simulation Model (Radiation Treatment Planning).

    PubMed

    Babashov, V; Aivas, I; Begen, M A; Cao, J Q; Rodrigues, G; D'Souza, D; Lock, M; Zaric, G S

    2017-06-01

    We analysed the radiotherapy planning process at the London Regional Cancer Program to determine the bottlenecks and to quantify the effect of specific resource levels with the goal of reducing waiting times. We developed a discrete-event simulation model of a patient's journey from the point of referral to a radiation oncologist to the start of radiotherapy, considering the sequential steps and resources of the treatment planning process. We measured the effect of several resource changes on the ready-to-treat to treatment (RTTT) waiting time and on the percentage treated within a 14 calendar day target. Increasing the number of dosimetrists by one reduced the mean RTTT by 6.55%, leading to 84.92% of patients being treated within the 14 calendar day target. Adding one more oncologist decreased the mean RTTT from 10.83 to 10.55 days, whereas a 15% increase in arriving patients increased the waiting time by 22.53%. The model was relatively robust to the changes in quantity of other resources. Our model identified sensitive and non-sensitive system parameters. A similar approach could be applied by other cancer programmes, using their respective data and individualised adjustments, which may be beneficial in making the most effective use of limited resources. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  18. Timing of Expansions of the Quelccaya Ice Cap, Peru, and Implications for Cosmogenic Nuclide Production Rate Calibration

    NASA Astrophysics Data System (ADS)

    Lowell, T. V.; Kelly, M. A.; Applegate, P. J.; Smith, C. A.; Phillips, F. M.; Hudson, A. M.

    2010-12-01

    We calibrate the production rate of the cosmogenic nuclide beryllium-10 (10Be) at a low-latitude, high-elevation site, using nuclide concentrations measured in moraine boulders and an independent chronology determined with bracketing radiocarbon dates. The measurement of terrestrial cosmogenic nuclide (TCN) concentrations in earth surface materials has been an important development for understanding a host of earth surface processes. Uncertainty in cosmogenic nuclide production rates has hampered application of this method. Here, we contribute to the estimation of 10Be production rates by reporting both preliminary 10Be concentrations and independent radiocarbon dates from a low latitude, high elevation site. Our study site in the southeastern Peruvian Andes (~13.9°S, 70.9°W, 4850 m asl) is centered on a moraine set, known as the Huancané II moraines, that represents a ~4 km expansion of Quelccaya Ice Cap during late glacial time. At this location, organic material situated both stratigraphically below and above moraines in two adjacent valleys provide material for radiocarbon dating. Based on geomorphic arguments, we correlate results from the two valleys. The timing of ice cap margin advance is bracketed by 13 radiocarbon ages on organic material within the outermost Huancané II moraines that range from 13.6 to 12.5 ka. Two stratigraphic sections upvalley from the moraines yield 6 radiocarbon ages from 11.3 to 12.4 ka, indicating the time of retreat . We computed the probability density function that lies between these two sets of dates, and assign an age of 12.4 ka (+/-???) for the formation of the Huancané II moraines. Calculating beryllium-10 exposure dates from the measured concentrations yield exposure dates that significantly underestimate the independently determined age of the moraine (~8-30%), if existing production rate estimates are used. We suggest that the radiocarbon age for the moraines can be used as a robust independent calibration for 10Be

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

    PubMed

    Xie, Bin; Youash, Sabrina

    2011-06-14

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

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

    MedlinePlus

    ... on Vital and Health Statistics Annual Reports Health Survey Research Methods Conference Reports from the National Medical Care ... SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care ... with previous research, longer wait time for treatment was associated with ...

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

    PubMed

    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.

  2. Impact of wait times on the effectiveness of transcatheter aortic valve replacement in severe aortic valve disease: a discrete event simulation model.

    PubMed

    Wijeysundera, Harindra C; Wong, William W L; Bennell, Maria C; Fremes, Stephen E; Radhakrishnan, Sam; Peterson, Mark; Ko, Dennis T

    2014-10-01

    There is increasing demand for transcatheter aortic valve replacement (TAVR) as the primary treatment option for patients with severe aortic stenosis who are high-risk surgical candidates or inoperable. We used mathematical simulation models to estimate the hypothetical effectiveness of TAVR with increasing wait times. We applied discrete event modelling, using data from the Placement of Aortic Transcatheter Valves (PARTNER) trials. We compared TAVR with medical therapy in the inoperable cohort, and compared TAVR to conventional aortic valve surgery in the high-risk cohort. One-year mortality and wait-time deaths were calculated in different scenarios by varying TAVR wait times from 10 days to 180 days, while maintaining a constant wait time for surgery at a mean of 15.6 days. In the inoperable cohort, the 1-year mortality for medical therapy was 50%. When the TAVR wait time was 10 days, the TAVR wait-time mortality was 1.9% with a 1-year mortality of 31.5%. TAVR wait-time deaths increased to 28.9% with a 180-day wait, with a 1-year mortality of 41.4%. In the high-risk cohort, the wait-time deaths and 1-year mortality for the surgical patients were 2.5% and 27%, respectively. The TAVR wait-time deaths increased from 2.2% with a 10-day wait to 22.4% with a 180-day wait, and a corresponding increase in 1-year mortality from 24.5% to 32.6%. Mortality with TAVR exceeded surgery when TAVR wait times exceeded 60 days. Modest increases in TAVR wait times have a substantial effect on the effectiveness of TAVR in inoperable patients and high-risk surgical candidates. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  3. Reading and Television Viewing Habits of American Adults during Time Spent in Waiting Rooms.

    ERIC Educational Resources Information Center

    Spirn, Sharon L.

    In order to determine the reading and television viewing habits of American adults during time spent in waiting rooms, a study observed 100 adults waiting outside the Emergency Treatment Room of John F. Kennedy Hospital in Edison, New Jersey, over a four-week period. Results revealed that more of these adults chose to watch television as an…

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

    NASA Astrophysics Data System (ADS)

    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.

  5. IS WAITING THE HARDEST PART? A CRITICAL STUDY OF THE EXPERIENCE OF WOMEN AWAITING BREAST BIOPSY RESULTS.

    PubMed

    Hodgkinson, T; Govender, C; Rayne, S

    2017-06-01

    Most previous research efforts have focused on the psychological effects of receiving a cancer diagnosis rather than the period of waiting for definitive Results. Early detection of cancer is directly linked to successful treatment regimes, yet these procedures evoke significant anxiety in patients. The long wait for medical test Results in state health institutions, with one of the possible outcomes being a cancer diagnosis, means that the days of waiting can induce emotional distress before the diagnosis has even been given. Eight research collaborators were invited to, in their own voice, shed light on their individual experiences while waiting for their biopsy Results to gain an understanding of the experiences of each collaborator by letting her tell her story and to explore the possibility of shared experience between collaborators. Research collaborators at a local, government hospital kept a journal for the two-week waiting period for their biopsy Results. Shortly before receiving their Results, they took part in a short semi-structured interview to inquire about their waiting. The theoretical framework used for data interpretation is critical theory focusing on the structures within society and healthcare systems that impact on the experience of waiting. The undercurrent of critical commentary about the roles of the gender, economic, political and cultural factors that contribute to the screening experience for women in South Africa helps to shed light on the complex forces at play within the procedures. The Results indicate that for some women waiting provokes significant psychological stress which manifests in multiple psychological processes including the psychological bracing phenomenon, denial, suppression and negation of their emotional experience all perpetuated by the structures of power within the health care system. More understanding of the psychological experience of awaiting a cancer diagnosis is required and there is an important place for

  6. 4. EASTBOUND VIEW. NORTH TRACK WAITING STATION ON LEFT. STATION ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. EASTBOUND VIEW. NORTH TRACK WAITING STATION ON LEFT. STATION ON RIGHT. NOTE TUNNEL IN BACKGROUND. - Baltimore & Ohio Railroad, Harpers Ferry Station, Potomac Street, Harpers Ferry, Jefferson County, WV

  7. The influence of insurance status on waiting times in German acute care hospitals: an empirical analysis of new data

    PubMed Central

    2009-01-01

    Background There is an ongoing debate in Germany about the assumption that patients with private health insurance (PHI) benefit from better access to medical care, including shorter waiting times (Lüngen et al. 2008), compared to patients with statutory health insurance (SHI). Problem Existing analyses of the determinants for waiting times in Germany are a) based on patient self-reports and b) do not cover the inpatient sector. This paper aims to fill both gaps by (i) generating new primary data and (ii) analyzing waiting times in German hospitals. Methods We requested individual appointments from 485 hospitals within an experimental study design, allowing us to analyze the impact of PHI versus SHI on waiting times (Asplin et al. 2005). Results In German acute care hospitals patients with PHI have significantly shorter waiting times than patients with SHI. Conclusion Discrimination in waiting times by insurance status does occur in the German acute hospital sector. Since there is very little transparency in treatment quality in Germany, we do not know whether discrimination in waiting times leads to discrimination in the quality of treatment. This is an important issue for future research. PMID:20025744

  8. Practical solutions for reducing container ships' waiting times at ports using simulation model

    NASA Astrophysics Data System (ADS)

    Sheikholeslami, Abdorreza; Ilati, Gholamreza; Yeganeh, Yones Eftekhari

    2013-12-01

    The main challenge for container ports is the planning required for berthing container ships while docked in port. Growth of containerization is creating problems for ports and container terminals as they reach their capacity limits of various resources which increasingly leads to traffic and port congestion. Good planning and management of container terminal operations reduces waiting time for liner ships. Reducing the waiting time improves the terminal's productivity and decreases the port difficulties. Two important keys to reducing waiting time with berth allocation are determining suitable access channel depths and increasing the number of berths which in this paper are studied and analyzed as practical solutions. Simulation based analysis is the only way to understand how various resources interact with each other and how they are affected in the berthing time of ships. We used the Enterprise Dynamics software to produce simulation models due to the complexity and nature of the problems. We further present case study for berth allocation simulation of the biggest container terminal in Iran and the optimum access channel depth and the number of berths are obtained from simulation results. The results show a significant reduction in the waiting time for container ships and can be useful for major functions in operations and development of container ship terminals.

  9. Mid-Pleistocene cosmogenic minimum-age limits for pre-Wisconsinan glacial surfaces in southwestern Minnesota and southern Baffin Island: A multiple nuclide approach

    USGS Publications Warehouse

    Bierman, P.R.; Marsella, K.A.; Patterson, Chris; Davis, P.T.; Caffee, M.

    1999-01-01

    Paired 10Be and 26Al analyses (n = 14) indicate that pre-Wisconsinan, glaciated bedrock surfaces near the northern (Baffin Island) and southern (Minnesota) paleo-margins of the Laurentide Ice Sheet have long and complex histories of cosmic-ray exposure, including significant periods of partial or complete shielding from cosmic rays. Using the ratio, 26Al/10Be, we calculate that striated outcrops of Sioux Quartzite in southwestern Minnesota (southern margin) were last overrun by ice at least 500,000 years ago. Weathered bedrock tors on the once-glaciated uplands of Baffin Island (northern margin) are eroding no faster than 1.1 m Myr-1, the equivalent of at least 450,000 years of surface and near-surface exposure. Our data demonstrate that exposure ages and erosion rates calculated from single nuclides can underestimate surface stability dramatically because any intermittent burial, and the resultant lowering of nuclide production rates and nuclide abundances, will remain undetected.

  10. 28 CFR 345.33 - Waiting list hiring exceptions.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... position classification files. (b) Prior FPI work assignment. An inmate with prior FPI work experience during the inmate's current commitment and with no break in custody will ordinarily be placed within the... waiting lists, so there is no break in active duty with FPI. Such actions are also in order where the work...

  11. 28 CFR 345.33 - Waiting list hiring exceptions.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... position classification files. (b) Prior FPI work assignment. An inmate with prior FPI work experience during the inmate's current commitment and with no break in custody will ordinarily be placed within the... waiting lists, so there is no break in active duty with FPI. Such actions are also in order where the work...

  12. 28 CFR 345.33 - Waiting list hiring exceptions.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... position classification files. (b) Prior FPI work assignment. An inmate with prior FPI work experience during the inmate's current commitment and with no break in custody will ordinarily be placed within the... waiting lists, so there is no break in active duty with FPI. Such actions are also in order where the work...

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

    PubMed

    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.

  14. Processing communications events in parallel active messaging interface by awakening thread from wait state

    DOEpatents

    Archer, Charles J; Blocksome, Michael A; Ratterman, Joseph D; Smith, Brian E

    2013-10-22

    Processing data communications events in a parallel active messaging interface (`PAMI`) of a parallel computer that includes compute nodes that execute a parallel application, with the PAMI including data communications endpoints, and the endpoints are coupled for data communications through the PAMI and through other data communications resources, including determining by an advance function that there are no actionable data communications events pending for its context, placing by the advance function its thread of execution into a wait state, waiting for a subsequent data communications event for the context; responsive to occurrence of a subsequent data communications event for the context, awakening by the thread from the wait state; and processing by the advance function the subsequent data communications event now pending for the context.

  15. 36. Waiting area at main entry to building 500, Awing, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    36. Waiting area at main entry to building 500, A-wing, looking southeast - Offutt Air Force Base, Strategic Air Command Headquarters & Command Center, Headquarters Building, 901 SAC Boulevard, Bellevue, Sarpy County, NE

  16. Detailed deposition density maps constructed by large-scale soil sampling for gamma-ray emitting radioactive nuclides from the Fukushima Dai-ichi Nuclear Power Plant accident.

    PubMed

    Saito, Kimiaki; Tanihata, Isao; Fujiwara, Mamoru; Saito, Takashi; Shimoura, Susumu; Otsuka, Takaharu; Onda, Yuichi; Hoshi, Masaharu; Ikeuchi, Yoshihiro; Takahashi, Fumiaki; Kinouchi, Nobuyuki; Saegusa, Jun; Seki, Akiyuki; Takemiya, Hiroshi; Shibata, Tokushi

    2015-01-01

    Soil deposition density maps of gamma-ray emitting radioactive nuclides from the Fukushima Dai-ichi Nuclear Power Plant (NPP) accident were constructed on the basis of results from large-scale soil sampling. In total 10,915 soil samples were collected at 2168 locations. Gamma rays emitted from the samples were measured by Ge detectors and analyzed using a reliable unified method. The determined radioactivity was corrected to that of June 14, 2011 by considering the intrinsic decay constant of each nuclide. Finally the deposition maps were created for (134)Cs, (137)Cs, (131)I, (129m)Te and (110m)Ag. The radioactivity ratio of (134)Cs-(137)Cs was almost constant at 0.91 regardless of the locations of soil sampling. The radioactivity ratios of (131)I and (129m)Te-(137)Cs were relatively high in the regions south of the Fukushima NPP site. Effective doses for 50 y after the accident were evaluated for external and inhalation exposures due to the observed radioactive nuclides. The radiation doses from radioactive cesium were found to be much higher than those from the other radioactive nuclides. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

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

    PubMed

    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.

  18. Minimizing patient waiting time in emergency department of public hospital using simulation optimization approach

    NASA Astrophysics Data System (ADS)

    Ibrahim, Ireen Munira; Liong, Choong-Yeun; Bakar, Sakhinah Abu; Ahmad, Norazura; Najmuddin, Ahmad Farid

    2017-04-01

    Emergency department (ED) is the main unit of a hospital that provides emergency treatment. Operating 24 hours a day with limited number of resources invites more problems to the current chaotic situation in some hospitals in Malaysia. Delays in getting treatments that caused patients to wait for a long period of time are among the frequent complaints against government hospitals. Therefore, the ED management needs a model that can be used to examine and understand resource capacity which can assist the hospital managers to reduce patients waiting time. Simulation model was developed based on 24 hours data collection. The model developed using Arena simulation replicates the actual ED's operations of a public hospital in Selangor, Malaysia. The OptQuest optimization in Arena is used to find the possible combinations of a number of resources that can minimize patients waiting time while increasing the number of patients served. The simulation model was modified for improvement based on results from OptQuest. The improvement model significantly improves ED's efficiency with an average of 32% reduction in average patients waiting times and 25% increase in the total number of patients served.

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

    PubMed

    Sobolev, Boris G; Kuramoto, Lisa; Levy, Adrian R; Hayden, Robert

    2006-08-24

    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. 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. 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 < 0.005). After adjustment, the odds of death before surgery were 64% higher in patients on longer lists, odds ratio [OR] = 1.64 (95% confidence interval [CI] 1.02-2.63). The observed death rate was higher in category "more than 1 month" than in category "1 month or less", 0.79 (95%CI 0.54-1.04) vs. 0.58 (95% CI 0.42-0.74) per 1000 patient-weeks, the adjusted OR = 1.60 (95%CI 1.01-2.53). Longer wait times (log-rank test = 266.4, P < 0.001) and higher death rates contributed to a higher cumulative incidence for death on the wait list with a clearance time of more than 1 month. 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

  20. Concordance between partners in desired waiting time to birth for newlyweds in India

    PubMed Central

    Singh, Abhishek; Becker, Stan

    2014-01-01

    Examining waiting time to birth among newlywed couples is likely to provide insights into the desire for spacing births among newlywed husbands and wives. Data from the Indian National Family Health Survey of 2005-06 is used to examine the desired waiting time (DWT) to birth among newlywed couples. The dependent variable is spousal concordance on desired times. Overall 65 % of couples have concordant DWTs. Among discordant couples, wives were more likely to want to wait longer than their husbands. Couples from richer wealth quintiles were more likely than couples from poorest quintile to have a concordant DWTs. Muslims were less likely than Hindus to have concordant desires. There is a need for spacing methods among newlyweds. This may have implications for the Indian Family Planning Programme which to date has largely focused on sterilization. Programmes need to include newlywed husbands to promote use of spacing methods. PMID:21933466

  1. Public health care and private insurance demand: the waiting time as a link.

    PubMed

    Jofre-Bonet, M

    2000-01-01

    This paper analyzes the effect of waiting times in the Spanish public health system on the demand for private health insurance. Expected utility maximization determines whether or not individuals buy a private health insurance. The decision depends not only on consumer's covariates such as income, socio-demographic characteristics and health status, but also on the quality of the treatment by the public provider. We interpret waiting time as a qualitative attribute of the health care provision. The empirical analysis uses the Spanish Health Survey of 1993. We cope with the absence of income data by using the Spanish Family Budget Survey of 1990-91 as a complementary data set, following the Arellano-Meghir method [4]. Results indicate that a reduction in the waiting time lowers the probability of buying private health insurance. This suggests the existence of a crowd-out in the health care provision market.

  2. 17. UPPER STATION, FIRST FLOOR, WAITING ROOM, LOOKING WEST, NORTHWEST. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    17. UPPER STATION, FIRST FLOOR, WAITING ROOM, LOOKING WEST, NORTHWEST. - Monongahela Incline Plane, Connecting North side of Grandview Avenue at Wyoming Street with West Carson Street near Smithfield Street, Pittsburgh, Allegheny County, PA

  3. Water Triple-Point Comparisons: Plateau Averaging or Peak Value?

    NASA Astrophysics Data System (ADS)

    Steur, P. P. M.; Dematteis, R.

    2014-04-01

    With a certain regularity, national metrology institutes conduct comparisons of water triple-point (WTP) cells. The WTP is the most important fixed point for the International Temperature Scale of 1990 (ITS-90). In such comparisons, it is common practice to simply average all the single measured temperature points obtained on a single ice mantle. This practice is quite reasonable whenever the measurements show no time dependence in the results. Ever since the first Supplementary Information for the International Temperature Scale of 1990, published by the Bureau International des Poids et Mesures in Sèvres, it was strongly suggested to wait at least 1 day before taking measurements (now up to 10 days), in order for a newly created ice mantle to stabilize. This stabilization is accompanied by a change in temperature with time. A recent improvement in the sensitivity of resistance measurement enabled the Istituto Nazionale di Ricerca Metrologica to detect more clearly the (possible) change in temperature with time of the WTP on a single ice mantle, as for old borosilicate cells. A limited investigation was performed where the temperature of two cells was monitored day-by-day, from the moment of mantle creation, where it was found that with (old) borosilicate cells it may be counterproductive to wait the usual week before starting measurements. The results are presented and discussed, and it is suggested to adapt the standard procedure for comparisons of WTP cells allowing for a different data treatment with (old) borosilicate cells, because taking the temperature dependence into account will surely reduce the reported differences between cells.

  4. Impact of co-located general practitioner (GP) clinics and patient choice on duration of wait in the emergency department.

    PubMed

    Sharma, Anurag; Inder, Brett

    2011-08-01

    To empirically model the determinants of duration of wait of emergency (triage category 2) patients in an emergency department (ED) focusing on two questions: (i) What is the effect of enhancing the degree of choice for non-urgent (triage category 5) patients on duration of wait for emergency (category 2) patients in EDs; and (ii) What is the effect of co-located GP clinics on duration of wait for emergency patients in EDs? The answers to these questions will help in understanding the effectiveness of demand management strategies, which are identified as one of the solutions to ED crowding. The duration of wait for each patient (difference between arrival time and time first seen by treating doctor) was modelled as a function of input factors (degree of choice, patient characteristics, weekend admission, metro/regional hospital, concentration of emergency (category 2) patients in hospital service area), throughput factors (availability of doctors and nurses) and output factor (hospital bed capacity). The unit of analysis was a patient episode and the model was estimated using a survival regression technique. The degree of choice for non-urgent (category 5) patients has a non-linear effect: more choice for non-urgent patients is associated with longer waits for emergency patients at lower values and shorter waits at higher values of degree of choice. Thus more choice of EDs for non-urgent patients is related to a longer wait for emergency (category 2) patients in EDs. The waiting time for emergency patients in hospital campuses with co-located GP clinics was 19% lower (1.5 min less) on average than for those waiting in campuses without co-located GP clinics. These findings suggest that diverting non-urgent (category 5) patients to an alternative model of care (co-located GP clinics) is a more effective demand management strategy and will reduce ED crowding.

  5. Effect of self-triage on waiting times at a walk-in sexual health clinic.

    PubMed

    Hitchings, Samantha; Barter, Janet

    2009-10-01

    Lengthy waiting times can be a major problem in walk-in sexual health clinics. They are stressful for both patients and staff and may lead to clients with significant health issues leaving the department before being seen by a clinician. A self-triage system may help reduce waiting times and duplication of work, improve patient pathways and decrease wasted visits. This paper describes implementation of a self-triage system in two busy sexual and reproductive health clinics. Patients were asked to complete a self-assessment form on registration to determine the reason for attendance. This then enabled patients to be directed to the most appropriate specialist or clinical service. The benefits of this approach were determined by measuring patient waiting times, reduction in unnecessary specialist review together with patient acceptability as tested by a patient satisfaction survey. The ease of comprehension of the triage form was also assessed by an independent readers' panel. A total of 193 patients were recruited over a 4-month period from November 2004 to February 2005. Patients from the November and December clinics were assigned to the 'traditional treatment' arm, with patients at subsequent clinics being assigned to the 'self-triage' system. Waiting times were collected by the receptionist and clinic staff. Ninety six patients followed the traditional route, 97 the new self-triage system. Sixty-nine (35.8%) patients completed the satisfaction survey. The self-triage system significantly reduced waiting time from 40 (22, 60) to 23 (10, 40) minutes [results expressed as median (interquartile range)]. There was a non-significant reduction in the proportion of patients seeing two clinicians from 21% to 13% (p = 0.17). Satisfaction levels were not significantly altered (95% compared to 97% satisfied, p = 0.64). The readers' panel found the triage form both easy to understand and to complete. Self-triage can effectively reduce clinic waiting times and allow better

  6. The behavior of U- and Th-series nuclides in groundwater

    USGS Publications Warehouse

    Porcelli, D.; Swarzenski, P.W.

    2003-01-01

    Groundwater has long been an active area of research driven by its importance both as a societal resource and as a component in the global hydrological cycle. Key issues in groundwater research include inferring rates of transport of chemical constituents, determining the ages of groundwater, and tracing water masses using chemical fingerprints. While information on the trace elements pertinent to these topics can be obtained from aquifer tests using experimentally introduced tracers, and from laboratory experiments on aquifer materials, these studies are necessarily limited in time and space. Regional studies of aquifers can focus on greater scales and time periods, but must contend with greater complexities and variations. In this regard, the isotopic systematics of the naturally occurring radionuclides in the U- and Th- decay series have been invaluable in investigating aquifer behavior of U, Th, and Ra. These nuclides are present in all groundwaters and are each represented by several isotopes with very different half-lives, so that processes occurring over a range of time-scales can be studied (Table 1⇓). Within the host aquifer minerals, the radionuclides in each decay series are generally expected to be in secular equilibrium and so have equal activities (see Bourdon et al. 2003). In contrast, these nuclides exhibit strong relative fractionations within the surrounding groundwaters that reflect contrasting behavior during release into the water and during interaction with the surrounding host aquifer rocks. Radionuclide data can be used, within the framework of models of the processes involved, to obtain quantitative assessments of radionuclide release from aquifer rocks and groundwater migration rates. The isotopic variations that are generated also have the potential for providing fingerprints for groundwaters from specific aquifer environments, and have even been explored as a means for calculating groundwater ages.

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

    PubMed

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

    2018-05-22

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

  8. RADIOACTIVE NUCLIDES PRODUCED BY COSMIC RAYS IN SPUTNIK 4

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Shedlovsky, J.P.; Kaye, J.H.

    1963-09-01

    The Sputnik 4 satellite re-entered the earth's atmosphere on September 5, 1962, after 843 days in orbit. From a portion of the recovered iron mass, a number of radioactive nuclides were measured after wet chemical separations. These activities are compared with those found in the Aroos iron meteorite. The ratio of saturation activities Sputnik 4/ Aroos increases, with increasing A, from 0.20 for Ar/sup 37/ to 0.68 for Fe/sup 55/. It appears that this increase is caused by low-energy solar-flare particles. The Co sup 56+57+58/ ratio is 0.098, which reflects the different nickel contents of the two objects. The samplemore » contains 40 dpm/kg Co/sup 60/, which is of noncosmogenic origin. (auth)« less

  9. Waiting list randomized controlled trial within a case-finding design: methodological considerations.

    PubMed

    Ronaldson, Sarah; Adamson, Joy; Dyson, Lisa; Torgerson, David

    2014-10-01

    Randomized controlled trials (RCTs) are widely used in health care research to provide high-quality evidence of effectiveness of an intervention. However, sometimes a study does not require an RCT in order to answer its primary objective; a case-finding design may be more appropriate. The aim of this paper was to introduce a new study design that nests a waiting list RCT within a case-finding study. An example of the new study design is the DOC Study, which primarily aims to determine the diagnostic accuracy of lung function tests for chronic obstructive pulmonary disease. It also investigates the impact of lung function tests on smoking behaviour through use of a waiting list design. The first step of the study design is to obtain participants' consent. Individuals are then randomized to one of two groups; either the 'intervention now' group or the 'intervention later' group, that is, participants are placed on a waiting list. All participants receive the same intervention; the only difference between the groups is the timing of the intervention. The design addresses patient preference issues and recruitment issues that can arise in other trial designs. Potential limitations include differential attrition between study groups and potential demoralization for the 'intervention later' group. The 'waiting list case-finding trial' design is a valuable method that could be applied to case-finding studies; the design enables the case-finding component of a study to be maintained while simultaneously exploring additional hypotheses through conducting a trial. © 2014 John Wiley & Sons, Ltd.

  10. WAITING TIMES OF QUASI-HOMOLOGOUS CORONAL MASS EJECTIONS FROM SUPER ACTIVE REGIONS

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Wang Yuming; Liu Lijuan; Shen Chenglong

    Why and how do some active regions (ARs) frequently produce coronal mass ejections (CMEs)? These are key questions for deepening our understanding of the mechanisms and processes of energy accumulation and sudden release in ARs and for improving our space weather prediction capability. Although some case studies have been performed, these questions are still far from fully answered. These issues are now being addressed statistically through an investigation of the waiting times of quasi-homologous CMEs from super ARs in solar cycle 23. It is found that the waiting times of quasi-homologous CMEs have a two-component distribution with a separation atmore » about 18 hr. The first component is a Gaussian-like distribution with a peak at about 7 hr, which indicates a tight physical connection between these quasi-homologous CMEs. The likelihood of two or more occurrences of CMEs faster than 1200 km s{sup -1} from the same AR within 18 hr is about 20%. Furthermore, the correlation analysis among CME waiting times, CME speeds, and CME occurrence rates reveals that these quantities are independent of each other, suggesting that the perturbation by preceding CMEs rather than free energy input is the direct cause of quasi-homologous CMEs. The peak waiting time of 7 hr probably characterizes the timescale of the growth of the instabilities triggered by preceding CMEs. This study uncovers some clues from a statistical perspective for us to understand quasi-homologous CMEs as well as CME-rich ARs.« less

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

    PubMed

    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.

  12. Has the increase in private health insurance uptake affected the Victorian public hospital surgical waiting list?

    PubMed

    Hanning, Brian

    2002-01-01

    It was anticipated that increase uptake of Private Health Insurance (PHI) would reduce demand on public sector surgical waiting lists. The best measure of changed demand is the comparison of the actual cases added to that projected given previous trends in PHI uptake. Detailed Victorian data is available up to 2000-1. The total waiting list has varied little, reflecting significant decreases in both in patients added to and removed. There was a marked increase in private sector elective surgery cases coinciding with the fall in additions to the public sector waiting list and in public sector elective surgical cases. The June 2001 Victorian surgical waiting list would have been 69,599 not 41,838 if the PHI uptake rate had continued to fall in line with pre-1999 trends, and that of June 2002 about 100,000 compared to 40,458 in March 2002. Limited data from other states suggests the Victorian trends are representative of all Australia.

  13. Methods of increasing the performance of radionuclide generators used in nuclear medicine: daughter nuclide build-up optimisation, elution-purification-concentration integration, and effective control of radionuclidic purity.

    PubMed

    Le, Van So; Do, Zoe Phuc-Hien; Le, Minh Khoi; Le, Vicki; Le, Natalie Nha-Truc

    2014-06-10

    Methods of increasing the performance of radionuclide generators used in nuclear medicine radiotherapy and SPECT/PET imaging were developed and detailed for 99Mo/99mTc and 68Ge/68Ga radionuclide generators as the cases. Optimisation methods of the daughter nuclide build-up versus stand-by time and/or specific activity using mean progress functions were developed for increasing the performance of radionuclide generators. As a result of this optimisation, the separation of the daughter nuclide from its parent one should be performed at a defined optimal time to avoid the deterioration in specific activity of the daughter nuclide and wasting stand-by time of the generator, while the daughter nuclide yield is maintained to a reasonably high extent. A new characteristic parameter of the formation-decay kinetics of parent/daughter nuclide system was found and effectively used in the practice of the generator production and utilisation. A method of "early elution schedule" was also developed for increasing the daughter nuclide production yield and specific radioactivity, thus saving the cost of the generator and improving the quality of the daughter radionuclide solution. These newly developed optimisation methods in combination with an integrated elution-purification-concentration system of radionuclide generators recently developed is the most suitable way to operate the generator effectively on the basis of economic use and improvement of purposely suitable quality and specific activity of the produced daughter radionuclides. All these features benefit the economic use of the generator, the improved quality of labelling/scan, and the lowered cost of nuclear medicine procedure. Besides, a new method of quality control protocol set-up for post-delivery test of radionuclidic purity has been developed based on the relationship between gamma ray spectrometric detection limit, required limit of impure radionuclide activity and its measurement certainty with respect to

  14. Monitoring trends in waiting periods in Canada for elective surgery: validation of a method using administrative data.

    PubMed

    Shortt, Samuel E D; Shaw, Ralph A; Elliott, David; Mackillop, William J

    2004-06-01

    Provincial governments require timely, economical methods to monitor surgical waiting periods. Although use of prospective procedure-specific registers would be the ideal method, a less elaborate system has been proposed that is based on physician billing data. This study assessed the validity of using the date of the last service billed prior to surgery as a proxy for the beginning of the post-referral, pre-surgical waiting period. We examined charts for 31,824 elective surgical encounters between 1992 and 1996 at an Ontario teaching hospital. The date of the last service before surgery (the last billing date) was compared with the date of the consultant's letter indicating a decision to book surgery (i.e., to begin waiting). Several surgical specialties (but excluding cardiac, orthopedic and gynecologic) had a close correlation between the dates of the last pre-surgery visit and those of the actual decision to place the patient on the waiting list. Similar results were found for 12 of 15 individually studied procedures, including some orthopedic and gynecological procedures. Used judiciously, billing data is a timely, inexpensive and generally accurate method by which provincial governments could monitor trends in waiting times for appropriately selected surgical procedures.

  15. Two facets of patience in young children: Waiting with and without an explicit reward.

    PubMed

    Barragan-Jason, Gladys; Atance, Cristina; Kopp, Leia; Hopfensitz, Astrid

    2018-07-01

    Patience, or the ability to tolerate delay, is typically studied using delay of gratification (DoG) tasks. However, among other factors (e.g., type of reward), the use of a reward to test patience is affected by an individual's motivation to obtain the reward (e.g., degree of preference for the small vs. large reward). In addition, DoG tasks do not assess the extent to which an individual can wait in the absence of an explicit reward-or what we term "patience as a virtue." Accordingly, the current study used a new measure of patience-the "pure waiting paradigm"-in which 3- to 5-year-old children waited 3 min with nothing to do and with no explicit reward. We then examined the relation between performance on this task (as assessed by children's spontaneous patient behaviors) and performance on two DoG tasks (candy and video rewards). Significant correlations were found between DoG performance and patient behaviors in the pure waiting paradigm, especially when controlling for motivation. These results and methodology show for the first time a direct link between patience as a virtue and DoG performance and also provide new insights about the study of patience in children. Copyright © 2018 Elsevier Inc. All rights reserved.

  16. The "waiting period" of sensory and motor axons in early chick hindlimb: its role in axon pathfinding and neuronal maturation.

    PubMed

    Wang, G; Scott, S A

    2000-07-15

    During embryonic development motor axons in the chick hindlimb grow out slightly before sensory axons and wait in the plexus region at the base of the limb for approximately 24 hr before invading the limb itself (Tosney and Landmesser, 1985a). We have investigated the role of this waiting period by asking, Is the arrest of growth cones in the plexus region a general property of both sensory and motor axons? Why do axons wait? Does eliminating the waiting period affect the further development of motor and sensory neurons? Here we show that sensory axons, like motor axons, pause in the plexus region and that neither sensory nor motor axons require cues from the other population to wait in or exit from the plexus region. By transplanting older or younger donor limbs to host embryos, we show that host axons innervate donor limbs on a schedule consistent with the age of the grafted limbs. Thus, axons wait in the plexus region for maturational changes to occur in the limb rather than in the neurons themselves. Both sensory and motor axons innervate their appropriate peripheral targets when the waiting period is eliminated by grafting older donor limbs. Therefore, axons do not require a prolonged period in the plexus region to sort out and project appropriately. Eliminating the waiting period does, however, accelerate the onset of naturally occurring cell death, but it does not enhance the development of central projections or the biochemical maturation of sensory neurons.

  17. Precision Mass Measurements of Cd-131129 and Their Impact on Stellar Nucleosynthesis via the Rapid Neutron Capture Process

    NASA Astrophysics Data System (ADS)

    Atanasov, D.; Ascher, P.; Blaum, K.; Cakirli, R. B.; Cocolios, T. E.; George, S.; Goriely, S.; Herfurth, F.; Janka, H.-T.; Just, O.; Kowalska, M.; Kreim, S.; Kisler, D.; Litvinov, Yu. A.; Lunney, D.; Manea, V.; Neidherr, D.; Rosenbusch, M.; Schweikhard, L.; Welker, A.; Wienholtz, F.; Wolf, R. N.; Zuber, K.

    2015-12-01

    Masses adjacent to the classical waiting-point nuclide 130Cd have been measured by using the Penning-trap spectrometer ISOLTRAP at ISOLDE/CERN. We find a significant deviation of over 400 keV from earlier values evaluated by using nuclear beta-decay data. The new measurements show the reduction of the N =82 shell gap below the doubly magic 132Sn. The nucleosynthesis associated with the ejected wind from type-II supernovae as well as from compact object binary mergers is studied, by using state-of-the-art hydrodynamic simulations. We find a consistent and direct impact of the newly measured masses on the calculated abundances in the A =128 - 132 region and a reduction of the uncertainties from the precision mass input data.

  18. 17. View of masonry gatehouse, safety gates and pedestrian waiting ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    17. View of masonry gatehouse, safety gates and pedestrian waiting shelter with ripped copper roofing and missing columns. (Nov. 30, 1988) - University Heights Bridge, Spanning Harlem River at 207th Street & West Harlem Road, New York County, NY

  19. 40. STEEL, INGOTS, ON INGOT BUGGIES, WAIT TO BE STRIPPED. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    40. STEEL, INGOTS, ON INGOT BUGGIES, WAIT TO BE STRIPPED. STRIPPER CRANE CAN BE SEEN AT THE END OF THE RAILROAD TRACKS, AT CENTER. - Corrigan, McKinney Steel Company, 3100 East Forty-fifth Street, Cleveland, Cuyahoga County, OH

  20. Reducing waiting time and raising outpatient satisfaction in a Chinese public tertiary general hospital-an interrupted time series study.

    PubMed

    Sun, Jing; Lin, Qian; Zhao, Pengyu; Zhang, Qiongyao; Xu, Kai; Chen, Huiying; Hu, Cecile Jia; Stuntz, Mark; Li, Hong; Liu, Yuanli

    2017-08-22

    It is globally agreed that a well-designed health system deliver timely and convenient access to health services for all patients. Many interventions aiming to reduce waiting times have been implemented in Chinese public tertiary hospitals to improve patients' satisfaction. However, few were well-documented, and the effects were rarely measured with robust methods. We conducted a longitudinal study of the length of waiting times in a public tertiary hospital in Southern China which developed comprehensive data collection systems. Around an average of 60,000 outpatients and 70,000 prescribed outpatients per month were targeted for the study during Oct 2014-February 2017. We analyzed longitudinal time series data using a segmented linear regression model to assess changes in levels and trends of waiting times before and after the introduction of waiting time reduction interventions. Pearson correlation analysis was conducted to indicate the strength of association between waiting times and patient satisfactions. The statistical significance level was set at 0.05. The monthly average length of waiting time decreased 3.49 min (P = 0.003) for consultations and 8.70 min (P = 0.02) for filling prescriptions in the corresponding month when respective interventions were introduced. The trend shifted from baseline slight increasing to afterwards significant decreasing for filling prescriptions (P =0.003). There was a significant negative correlation between waiting time of filling prescriptions and outpatient satisfaction towards pharmacy services (r = -0.71, P = 0.004). The interventions aimed at reducing waiting time and raising patient satisfaction in Fujian Provincial Hospital are effective. A long-lasting reduction effect on waiting time for filling prescriptions was observed because of carefully designed continuous efforts, rather than a one-time campaign, and with appropriate incentives implemented by a taskforce authorized by the hospital managers. This

  1. Algorithm for prioritization of patients on the waiting list for liver transplantation.

    PubMed

    Gambato, M; Senzolo, M; Canova, D; Germani, G; Tomat, S; Masier, A; Russo, F P; Perissinotto, E; Zanus, G; Cillo, U; Burra, P

    2007-01-01

    Prioritization of patients on the waiting list (WL) for OLT is still a critical issue. Numerous models have been developed to predict mortality before and after OLT. The aim of the study was to prospectively evaluate cirrhotics with and without hepatocellular carcinoma (HCC) undergoing orthotopic liver transplantation (OLT) severity of liver disease on the WL and at transplant, mortality on the WL and after OLT, and their correlations. An algorithm based on seven patient variables (MELD, CTP, UNOS, HCC, BMI, waiting time, age) was created by software dedicated to prioritize patients on the waiting list. We evaluated 118 patients including 75 men and 43 women of age range 19 to 66 years, who underwent OLT from July 2004 to June 2006. Mean CTP and MELD at listing were 8.44 (range 6-12) and 13 (range 2-24), respectively. Overall mortality on the WL at 24 months was 13%, which was significantly higher among patients with MELD > 25 compared to patients with MELD 0 to 15 (P < .0001) or MELD 16 to 25 (P = .0007) at listing. Mean MELD at OLT was 15 (range 7-36), which was significantly lower in patients with than without HCC (MELD 12 vs 16; P = .0003). Six hundred-day patient survival was significantly lower among patients with MELD > 25 compared to patients with MELD < 25 at OLT (P = .017), whereas no difference in survival was observed between patients with and without HCC. The sickest patients are characterized by high mortality both on the waiting list and after liver transplantation. Patients with HCC are transplanted in better condition compared to patients without HCC with the same survival.

  2. ESTIMATION OF EFFECTIVE DOSE FROM EXTERNAL EXPOSURE DUE TO SHORT-LIVED NUCLIDES IN THE PREFECTURES SURROUNDING FUKUSHIMA.

    PubMed

    Miyatake, Hirokazu; Yoshizawa, Nobuaki; Suzuki, Gen

    2018-05-11

    The Fukushima Daiichi Nuclear Power Plant (FDNPP) accident resulted in a release of radionuclides into the environment. Since the accident, measurements of radiation in the environment such as air dose rate and deposition density of radionuclides have been performed by various organizations and universities. In particular, Japan Atomic Energy Agency (JAEA) has been performing observations of air dose rate using a car-borne survey system continuously over widespread areas. Based on the data measured by JAEA, we estimated effective dose from external exposure in the prefectures surrounding Fukushima. Since car-borne survey started a few months after the accident, the main contribution to measured data comes from 137Cs and 134Cs whose half-lives are relatively long. Using air dose rate of 137Cs and 134Cs and the ratio of deposition density of short-lived nuclides to that of 137Cs and 134Cs, we also estimated contributions to the effective dose from other short-lived nuclides.

  3. Associations Between Waiting Times, Service Times, and Patient Satisfaction in an Endocrinology Outpatient Department: A Time Study and Questionnaire Survey

    PubMed Central

    Xie, Zhenzhen; Or, Calvin

    2017-01-01

    The issue of long patient waits has attracted increasing public attention due to the negative effects of waiting on patients’ satisfaction with health care. The present study examined the associations between actual waiting time, perceived acceptability of waiting time, actual service time, perceived acceptability of service time, actual visit duration, and the level of patient satisfaction with care. We conducted a cross-sectional time study and questionnaire survey of endocrinology outpatients visiting a major teaching hospital in China. Our results show that actual waiting time was negatively associated with patient satisfaction regarding several aspects of the care they received. Also, patients who were less satisfied with the sociocultural atmosphere and the identity-oriented approach to their care tended to perceive the amounts of time they spent waiting and receiving care as less acceptable. It is not always possible to prevent dissatisfaction with waiting, or to actually reduce waiting times by increasing resources such as increased staffing. However, several improvements in care services can be considered. Our suggestions include providing clearer, more transparent information to keep patients informed about the health care services that they may receive, and the health care professionals who are responsible for those services. We also suggest that care providers are encouraged to continue to show empathy and respect for patients, that patients are provided with private areas where they can talk with health professionals and no one can overhear, and that hospital staff treat the family members or friends who accompany patients in a courteous and friendly way. PMID:29161947

  4. Associations Between Waiting Times, Service Times, and Patient Satisfaction in an Endocrinology Outpatient Department: A Time Study and Questionnaire Survey.

    PubMed

    Xie, Zhenzhen; Or, Calvin

    2017-01-01

    The issue of long patient waits has attracted increasing public attention due to the negative effects of waiting on patients' satisfaction with health care. The present study examined the associations between actual waiting time, perceived acceptability of waiting time, actual service time, perceived acceptability of service time, actual visit duration, and the level of patient satisfaction with care. We conducted a cross-sectional time study and questionnaire survey of endocrinology outpatients visiting a major teaching hospital in China. Our results show that actual waiting time was negatively associated with patient satisfaction regarding several aspects of the care they received. Also, patients who were less satisfied with the sociocultural atmosphere and the identity-oriented approach to their care tended to perceive the amounts of time they spent waiting and receiving care as less acceptable. It is not always possible to prevent dissatisfaction with waiting, or to actually reduce waiting times by increasing resources such as increased staffing. However, several improvements in care services can be considered. Our suggestions include providing clearer, more transparent information to keep patients informed about the health care services that they may receive, and the health care professionals who are responsible for those services. We also suggest that care providers are encouraged to continue to show empathy and respect for patients, that patients are provided with private areas where they can talk with health professionals and no one can overhear, and that hospital staff treat the family members or friends who accompany patients in a courteous and friendly way.

  5. Wait time management strategies for total joint replacement surgery: sustainability and unintended consequences.

    PubMed

    Pomey, Marie-Pascale; Clavel, Nathalie; Amar, Claudia; Sabogale-Olarte, Juan Carlos; Sanmartin, Claudia; De Coster, Carolyn; Noseworthy, Tom

    2017-09-07

    In Canada, long waiting times for core specialized services have consistently been identified as a key barrier to access. Governments and organizations have responded with strategies for better access management, notably for total joint replacement (TJR) of the hip and knee. While wait time management strategies (WTMS) are promising, the factors which influence their sustainable implementation at the organizational level are understudied. Consequently, this study examined organizational and systemic factors that made it possible to sustain waiting times for TJR within federally established limits and for at least 18 months or more. The research design is a multiple case study of WTMS implementation. Five cases were selected across five Canadian provinces. Three success levels were pre-defined: 1) the WTMS maintained compliance with requirements for more than 18 months; 2) the WTMS met requirements for 18 months but could not sustain the level thereafter; 3) the WTMS never met requirements. For each case, we collected documents and interviewed key informants. We analyzed systemic and organizational factors, with particular attention to governance and leadership, culture, resources, methods, and tools. We found that successful organizations had specific characteristics: 1) management of the whole care continuum, 2) strong clinical leadership; 3) dedicated committees to coordinate and sustain strategy; 4) a culture based on trust and innovation. All strategies led to relatively similar unintended consequences. The main negative consequence was an initial increase in waiting times for TJR and the main positive consequence was operational enhancement of other areas of specialization based on the TJR model. This study highlights important differences in factors which help to achieve and sustain waiting times. To be sustainable, a WTMS needs to generate greater synergies between contextual-level strategy (provincial or regional) and organizational objectives and

  6. Cholelithiasis in patients on the kidney transplant waiting list

    PubMed Central

    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

  7. Lung cancer care trajectory at a Canadian centre: an evaluation of how wait times affect clinical outcomes.

    PubMed

    Kasymjanova, G; Small, D; Cohen, V; Jagoe, R T; Batist, G; Sateren, W; Ernst, P; Pepe, C; Sakr, L; Agulnik, J

    2017-10-01

    Lung cancer continues to be one of the most common cancers in Canada, with approximately 28,400 new cases diagnosed each year. Although timely care can contribute substantially to quality of life for patients, it remains unclear whether it also improves patient outcomes. In this work, we used a set of quality indicators that aim to describe the quality of care in lung cancer patients. We assessed adherence with existing guidelines for timeliness of lung cancer care and concordance with existing standards of treatment, and we examined the association between timeliness of care and lung cancer survival. Patients with lung cancer diagnosed between 2010 and 2015 were identified from the Pulmonary Division Lung Cancer Registry at our centre. We demonstrated that the interdisciplinary pulmonary oncology service successfully treated most of its patients within the recommended wait times. However, there is still work to be done to decrease variation in wait time. Our results demonstrate a significant association between wait time and survival, supporting the need for clinicians to optimize the patient care trajectory. It would be helpful for Canadian clinicians treating patients with lung cancer to have wait time guidelines for all treatment modalities, together with standard definitions for all time intervals. Any reductions in wait times should be balanced against the need for thorough investigation before initiating treatment. We believe that our unique model of care leads to an acceleration of diagnostic steps. Avoiding any delay associated with referral to a medical oncologist for treatment could be an acceptable strategy with respect to reducing wait time.

  8. Randomized control trial: Online parent program and waiting period for unmarried parents in Title IV-D court.

    PubMed

    Rudd, Brittany N; Holtzworth-Munroe, Amy; Reyome, Jason G; Applegate, Amy G; D'Onofrio, Brian M

    2015-10-01

    Despite a lack of research on parent education programs for unmarried parents, many judicial officers mandate participation. We recruited an understudied sample likely at high risk for negative outcomes-182 court cases involving unmarried parents on government assistance in which paternity was contested and then established via genetic testing ordered by the court. This 2 × 2 randomized controlled trial evaluated the impact on initial litigation outcomes of two factors: (a) participation in an online parent education program or not and (b) having a waiting period between the establishment of paternity and the court hearing concerning child-related issues or not. Using an intent-to-treat framework, we found that among cases not assigned to the program, there was no difference in the rate of full agreement on child-related issues (e.g., child support, custody, parenting time) when comparing cases assigned to a waiting period and cases not assigned to a waiting period. In contrast, for cases assigned to the program, cases also assigned a waiting period were less likely to reach a full agreement than cases that had their hearing on the same day. In addition, cases in the "program and waiting period" condition were less likely to return to court for their hearing than cases in the "no program and waiting period" condition. In exploratory analyses of the subsample of cases in which both parents were present at the court hearing, the pattern of results remained the same, although the findings were no longer statistically significant. (c) 2015 APA, all rights reserved).

  9. Do cosmogenic nuclides (10Be, 14C , 21Ne, 26Al) track late Quaternary climate changes on the Altiplano?

    NASA Astrophysics Data System (ADS)

    Hippe, K.; Kober, F.; Zeilinger, G.; Ivy-Ochs, S.; Kubik, P.; Maden, C.; Wieler, R.

    2010-12-01

    The high Altiplano plateau is the most prominent element of the Central Andes, separating the Andean Cordilleras between 15° to 22° S. It represents a tectonically quiet, intramontane basin with arid to semi-arid climate, low relief and internal drainage. Throughout the late Quaternary regional climate on the Altiplano repeatedly changed between wet and dry conditions [1]. The influence of climate on the plateau evolution during the Pleistocene/Holocene is unclear, however, as data on erosion processes and rates on the Altiplano are sparse. Here, we present a multiple-nuclide study investigating surface denudation at the eastern Altiplano of Bolivia (16°-17° S) on millennial and longer timescales. The aim is a better understanding of the complex feedback between climate, tectonics and geomorphology on the topographic evolution of the Andes. Catchment-wide denudation (CWD) rates are provided for a 150 km NW-SE transect along the Altiplano edge based on the analyses of cosmogenic 10Be, 26Al, 21Ne and in-situ 14C in river-borne sediment. Single nuclide CWD rates obtained for 10Be, 26Al and 21Ne are similar for all three nuclides and on the order of 3-37 mm/ka. Thus, the calculated denudation rates provide an averaged denudation history dating back at least to the middle Pleistocene. Denudation rates correlate positively with the mean basin hillslope, which is mainly controlled by basin lithology. For most catchments both, the 26Al/10Be ratios and the 21Ne/10Be ratios indicate a complex erosion/exposure history with probably several periods of sediment storage and burial/shielding totalling ~0.5 - 1.2 Ma. Local geomorphology featuring low slopes and low relief, small terraces and local floodplains also suggests that sediment transport might have been periodically ineffective. Concentrations of in-situ produced short-lived 14C are significantly lower than expected from the concentrations of the long-lived and stable cosmogenic nuclides. This would indicate a 30

  10. Improving equitable access to imaging under universal-access medicine: the ontario wait time information program and its impact on hospital policy and process.

    PubMed

    Kielar, Ania Z; El-Maraghi, Robert H; Schweitzer, Mark E

    2010-08-01

    In Canada, equal access to health care is the goal, but this is associated with wait times. Wait times should be fair rather than uniform, taking into account the urgency of the problem as well as the time an individual has already waited. In November 2004, the Ontario government began addressing this issue. One of the first steps was to institute benchmarks reflecting "acceptable" wait times for CT and MRI. A public Web site was developed indicating wait times at each Local Health Integration Network. Since starting the Wait Time Information Program, there has been a sustained reduction in wait times for Ontarians requiring CT and MRI. The average wait time for a CT scan went from 81 days in September 2005 to 47 days in September 2009. For MRI, the resulting wait time was reduced from 120 to 105 days. Increased patient scans have been achieved by purchasing new CT and MRI scanners, expanding hours of operation, and improving patient throughput using strategies learned from the Lean initiative, based on Toyota's manufacturing philosophy for car production. Institution-specific changes in booking procedures have been implemented. Concurrently, government guidelines have been developed to ensure accountability for monies received. The Ontario Wait Time Information Program is an innovative first step in improving fair and equitable access to publicly funded imaging services. There have been reductions in wait times for both CT and MRI. As various new processes are implemented, further review will be necessary for each step to determine their individual efficacy. Copyright 2010 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  11. Monitoring trends in waiting periods in Canada for elective surgery: validation of a method using administrative data

    PubMed Central

    Shortt, Samuel E.D.; Shaw, Ralph A.; Elliott, David; Mackillop, William J.

    2004-01-01

    Background Provincial governments require timely, economical methods to monitor surgical waiting periods. Although use of prospective procedure-specific registers would be the ideal method, a less elaborate system has been proposed that is based on physician billing data. This study assessed the validity of using the date of the last service billed prior to surgery as a proxy for the beginning of the post-referral, pre-surgical waiting period. Method We examined charts for 31 824 elective surgical encounters between 1992 and 1996 at an Ontario teaching hospital. The date of the last service before surgery (the last billing date) was compared with the date of the consultant's letter indicating a decision to book surgery (i.e., to begin waiting). Results Several surgical specialties (but excluding cardiac, orthopedic and gynecologic) had a close correlation between the dates of the last pre-surgery visit and those of the actual decision to place the patient on the waiting list. Similar results were found for 12 of 15 individually studied procedures, including some orthopedic and gynecological procedures. Conclusion Used judiciously, billing data is a timely, inexpensive and generally accurate method by which provincial governments could monitor trends in waiting times for appropriately selected surgical procedures. PMID:15264378

  12. Experience of being a low priority patient during waiting time at an emergency department

    PubMed Central

    Dahlen, Ingrid; Westin, Lars; Adolfsson, Annsofie

    2012-01-01

    Background Work in the emergency department is characterized by fast and efficient medical efforts to save lives, but can also involve a long waiting time for patients. Patients are given a priority rating upon their arrival in the clinic based on the seriousness of their problem, and nursing care for lower priority patients is given a lower prioritization. Regardless of their medical prioritization, all patients have a right to expect good nursing care while they are waiting. The purpose of this study was to illustrate the experience of the low prioritized patient during their waiting time in the emergency department. Methods A phenomenological hermeneutic research method was used to analyze an interview transcript. Data collection consisted of narrative interviews. The interviewees were 14 patients who had waited more than three hours for surgical, orthopedic, or other medical care. Results The findings resulted in four different themes, ie, being dependent on care, being exposed, being vulnerable, and being secure. Lower priority patients are not paid as much attention by nursing staff. Patients reported feeling powerless, insulted, and humiliated when their care was delayed without their understanding what was happening to them. Not understanding results in exposure that violates self-esteem. Conclusion The goal of the health care provider must be to minimize and prevent suffering, prevent feelings of vulnerability, and to create conditions for optimal patient well being. PMID:22334799

  13. Lévy walks with variable waiting time: A ballistic case

    NASA Astrophysics Data System (ADS)

    Kamińska, A.; Srokowski, T.

    2018-06-01

    The Lévy walk process for a lower interval of an excursion times distribution (α <1 ) is discussed. The particle rests between the jumps, and the waiting time is position-dependent. Two cases are considered: a rising and diminishing waiting time rate ν (x ) , which require different approximations of the master equation. The process comprises two phases of the motion: particles at rest and in flight. The density distributions for them are derived, as a solution of corresponding fractional equations. For strongly falling ν (x ) , the resting particles density assumes the α -stable form (truncated at fronts), and the process resolves itself to the Lévy flights. The diffusion is enhanced for this case but no longer ballistic, in contrast to the case for the rising ν (x ) . The analytical results are compared with Monte Carlo trajectory simulations. The results qualitatively agree with observed properties of human and animal movements.

  14. Gender and socioeconomic status as determinants of waiting time for inpatient surgery in a system with implicit queue management.

    PubMed

    Arnesen, Kjell E; Erikssen, Jan; Stavem, Knut

    2002-12-01

    In a system with implicit queue management, to examine gender and socioeconomic status as determinants of waiting time for inpatient surgery, after adjusting for other potential predictors. A cohort of 452 subjects was examined in outpatient clinics of a general hospital and referred to inpatient surgery. They were followed until scheduled hospital admission (n=396) or until the requested procedure no longer was relevant (n=56). We compared waiting time between groups from referral date until hospital admission, using Kaplan-Meier estimates of waiting times and log rank test. A Cox proportional hazards model was used for assessing the risk ratio (RR) of hospital admission for scheduled surgery. Gender and socioeconomic status could not explain variations in waiting time. However, patients with suspected/verified neoplastic disease or a risk of serious deterioration without treatment had markedly shorter waiting times than the reference groups, with adjusted RR (95% confidence intervals (95%CI)) of time to receiving in-patient surgery of 2.3 (1.7-3.0) and 2.0 (1.3-3.0), respectively. Being on sick leave was associated with shorter waiting time, adjusted RR of 1.7 (1.2-2.5). Referrals from within the hospital or other hospitals had also shorter waiting times than referrals from primary health care physicians, adjusted RR=1.4 (1.1-1.8). There was no evidence of bias against women or people in lower socioeconomic classes in this implicit queue management system. However, patients' access to inpatient surgery was associated with malignancy, prognosis, sick leave status, physician experience, referral pattern and the major diagnosis category.

  15. Influence of Waiting Time on the Levitation Force Between a Permanent Magnet and a Superconductor

    NASA Astrophysics Data System (ADS)

    Zhang, Xing-Yi; Zhou, You-He; Zhou, Jun

    This paper describes the experimental results of the levitation force of single-grained YBaCuO bulk superconductors preparing by the top-seeded melt-growth method with different waiting time tw below an NdFeB permanent magnet. It was found that waiting time has large effects on the zero-field-cooled (ZFC) and field-cooled (FC) levitation force, and the levitation force shows aging characteristics at the liquid nitrogen temperature.

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

    PubMed Central

    Naidoo, Logandran

    2016-01-01

    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. PMID:27543283

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

    PubMed

    Naidoo, Logandran; Mahomed, Ozayr H

    2016-07-26

    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. 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. The study was conducted at the Catherine Booth Hospital (CBH) - a rural district hospital in KwaZulu-Natal, South Africa. 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. 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). The application of Lean principles, tools and techniques provides hospital managers with an evidence-based management approach to resolving problems and improving quality indicators.

  18. 4. PACK TRAIN WAITING TO BE UNLOADED AT FOOT OF ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. PACK TRAIN WAITING TO BE UNLOADED AT FOOT OF YAKI TRAIL. APPROXIMATELY TWO-AND-ONE-HALF TONS OF STEEL ON ANIMALS SHOWN. NOTE COIL OF 1-1/2' WIND CABLE IN FOREGROUND. - Kaibab Trail Suspension Bridge, Spanning Colorado River, Grand Canyon, Coconino County, AZ

  19. 14. Detail, northeast facade, arched main window of waiting room; ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    14. Detail, northeast facade, arched main window of waiting room; note quality of stonework and mortar joint tooling beneath window, representing a ca. 1937 alteration; view to southwest, 90mm lens. - Southern Pacific Depot, 559 El Camino Real, San Carlos, San Mateo County, CA

  20. The Impact of One-Dose Package of Medicines on Patient Waiting Time in Dispensing Pharmacy: Application of a Discrete Event Simulation Model.

    PubMed

    Furushima, Daisuke; Yamada, Hiroshi; Kido, Michiko; Ohno, Yuko

    2018-01-01

    Improvement in patient waiting time in dispensing pharmacies is an important element for patient and pharmacists. The One-Dose Package (ODP) of medicines was implemented in Japan to support medicine adherence among elderly patients; however, it also contributed to increase in patient waiting times. Given the projected increase in ODP patients in the near future owing to rapid population aging, development of improved strategies is a key imperative. We conducted a cross-sectional survey at a single dispensing pharmacy to clarify the impact of ODP on patient waiting time. Further, we propose an improvement strategy developed with use of a discrete event simulation (DES) model. A total of 673 patients received pharmacy services during the study period. A two-fold difference in mean waiting time was observed between ODP and non-ODP patients (22.6 and 11.2 min, respectively). The DES model was constructed with input parameters estimated from observed data. Introduction of fully automated ODP (A-ODP) system was projected to reduce the waiting time for ODP patient by 0.5 times (from 23.1 to 11.5 min). Furthermore, assuming that 40% of non-ODP patients would transfer to ODP, the waiting time was predicted to increase to 56.8 min; however, introduction of the A-ODP system decreased the waiting time to 20.4 min. Our findings indicate that ODP is one of the elements that increases the waiting time and that it might become longer in the future. Introduction of the A-ODP system may be an effective strategy to improve waiting time.

  1. Waiting for a kidney transplant: the experience of patients with end-stage renal disease in South Korea.

    PubMed

    Chong, Hye Jin; Kim, Hyun Kyung; Kim, Sung Reul; Lee, Sik

    2016-04-01

    To explore the experiences of Korean patients with end-stage renal disease awaiting kidney transplantation. The need for kidney transplantation has increased worldwide, while the number of kidney donors has not increased commensurately. This mismatch is a serious issue in South Korea. Prolonged waits for transplantation may cause physical and psychosocial issues and lead to poor outcomes. Nevertheless, the experience of waiting for kidney transplantation in South Korea has never been explored in depth. A qualitative descriptive design was used. The participants were eight patients diagnosed with end-stage renal disease on the waiting list for kidney transplantation in South Korea. Data were collected through individual in-depth interviews. All conversations during interviews were recorded and transcribed verbatim. Transcribed data were analysed using conventional content analysis. The experience of waiting for kidney transplantation consisted of six categories: (1) the light at the end of the tunnel, (2) being on call without any promise, (3) a tough tug of war between excitement and frustration, (4) doubts in the complexity, (5) A companion on the hard journey and (6) getting ready for D-day. Kidney transplantation candidates experience psychosocial difficulties and concerns while waiting for long periods of time without any assurance of resolution. Systematic education and psychosocial support from health care professionals and family members help patients get through what they describe as a difficult journey. Comprehensive management programs for kidney transplantation candidates are needed. Health care professionals need to recognise the psychosocial concerns of patients awaiting kidney transplantation. Clinicians should provide patients with information and support throughout the waiting period. © 2016 John Wiley & Sons Ltd.

  2. Cosmogenic nuclide dating of Sahelanthropus tchadensis and Australopithecus bahrelghazali: Mio-Pliocene hominids from Chad

    PubMed Central

    Lebatard, Anne-Elisabeth; Bourlès, Didier L.; Duringer, Philippe; Jolivet, Marc; Braucher, Régis; Carcaillet, Julien; Schuster, Mathieu; Arnaud, Nicolas; Monié, Patrick; Lihoreau, Fabrice; Likius, Andossa; Mackaye, Hassan Taisso; Vignaud, Patrick; Brunet, Michel

    2008-01-01

    Ages were determined at two hominid localities from the Chad Basin in the Djurab Desert (Northern Chad). In the Koro Toro fossiliferous area, KT 12 locality (16°00′N, 18°53′E) was the site of discovery of Australopithecus bahrelghazali (Abel) and in the Toros-Menalla fossiliferous area, TM 266 locality (16°15′N, 17°29′E) was the site of discovery of Sahelanthropus tchadensis (Toumaï). At both localities, the evolutive degree of the associated fossil mammal assemblages allowed a biochronological estimation of the hominid remains: early Pliocene (3–3.5 Ma) at KT 12 and late Miocene (≈7 Ma) at TM 266. Atmospheric 10Be, a cosmogenic nuclide, was used to quasicontinuously date these sedimentary units. The authigenic 10Be/9Be dating of a pelite relic within the sedimentary level containing Abel yields an age of 3.58 ± 0.27 Ma that points to the contemporaneity of Australopithecus bahrelghazali (Abel) with Australopithecus afarensis (Lucy). The 28 10Be/9Be ages obtained within the anthracotheriid unit containing Toumaï bracket, by absolute dating, the age of Sahelanthropus tchadensis to lie between 6.8 and 7.2 Ma. This chronological constraint is an important cornerstone both for establishing the earliest stages of hominid evolution and for new calibrations of the molecular clock. PMID:18305174

  3. The unethical focus on access: a study of medical ethics and the waiting-time guarantee.

    PubMed

    Karlberg, H I; Brinkmo, B-M

    2009-03-01

    All civilized societies favour ethical principles of equity. In healthcare, these principles generally focus on needs for medical care. Methods for establishing priorities among such needs are instrumental in this process. In this study, we analysed whether rules on access to healthcare, waiting-time guarantees, conflict with ethical principles of distributive justice. We interviewed directors, managers and other decision-makers of various healthcare providers of hospitals, primary care organizations and purchasing offices. We also conducted focus group interviews with professionals from a number of distinct medical areas. Our informants and their co-workers were reasonably familiar with the ethical platforms for priority-setting established by the Swedish parliament, giving the sickest patients complete priority. However, to satisfy the waiting-time guarantees, the informants often had to make priority decisions contrary to the ethical principles by favouring access before needs to keep waiting times within certain limits. The common opinion was that the waiting-time guarantee leads to crowding-out effects, overruling the ethical principles based on needs. For more than a decade, the interpretation in Sweden of the equitable principle based on medical needs has been distorted through political decisions, leading to healthcare providers giving priority to access rather than needs for care.

  4. Induction of osteosarcoma and acute myeloid leukaemia in CBA/H mice by the alpha-emitting nuclides, uranium-233, plutonium-239 and amercium-241.

    PubMed

    Ellender, M; Harrison, J D; Pottinger, H; Thomas, J M

    2001-01-01

    To compare tumour induction in CBA/H mice, principally osteosarcoma and acute myeloid leukaemia, resulting from exposure to the alpha-emitting nuclides, uranium-233, plutonium-239 and americium-241, and to relate differences between the three nuclides to the pattern of dose delivery within tissues. Each nuclide was administered intraperitoneally in citrate solution to three groups of adult male CBA/H mice at levels of activity which gave estimated life-time average skeletal doses of about 0.25-0.3 Gy, 0.5-1 Gy and 1-2 Gy. Animals were carefully monitored and sacrificed as soon as they showed signs of ill health; tumours were identified by standard histopathological techniques. Statistical modelling by Cox regression showed that, considering all three nuclides together, there was a highly significant increase in risk of death from osteosarcoma or myeloid leukaemia with increasing dose rate. For osteosarcoma, the effect was significantly greater for 239Pu than 241Am, while separate analysis for 233U showed no significant increase with increasing dose rate. For example, the increase in relative risk of death from osteosarcoma for an increase in life-time average dose rate to bone of 1 mGyd(-1) was 4.2 (2.7-6.5) for 239Pu, 2.3 (1.4-3.4) for 241Am and 1.1 (0.4-3.1) for 233U. For myeloid leukaemia, there was no significant difference between 239Pu and 241Am in the effect of dose rate. The increase in relative risk from myeloid leukaemia for an increase in average dose rate of 1 mGyd(-1) was 1.8 (1.1-2.8) for 239Pu, 2.0 (1.4-2.9) for 241Am and 1.5 (0.8-2.7) for 233U. Significant increases in renal and hepatic carcinomas were also recorded in animals exposed to 233U and 241Am, respectively. Studies of the distribution of the nuclides within the skeleton, published separately, have shown differences in their retention in individual bones and within bone. The proportions of decays occurring near to endosteal bone surfaces and throughout bone marrow were in the order: 239Pu

  5. Learning to wait: A laboratory investigation

    USGS Publications Warehouse

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

    2009-01-01

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

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

    PubMed

    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.

  7. Cosmogenic Nuclides 10Be-21Ne Burial Dating of Middle Miocene Sedimentary Formation of the Hongliu Valley in Southern Ningxia Basin: A Case of Isotopic Geochronology Study for the Cenozoic Sedimentary Strata

    NASA Astrophysics Data System (ADS)

    Ma, Y.; Zhang, H.; Wang, W.; Wu, Y.; Pang, J.; Zheng, D.; Li, D.

    2015-12-01

    Chronology studies for the Cenozoic sedimentary strata based on the magnetostratigraphy cannot afford the unique chronological sequences in the absence of absolute ages from biostratigraphy or volcanic ash chronology. In situ-produced cosmogenic nuclides provide a powerful tool for the sediment dating based on the time-dependent concentration ratio of two nuclides, which are produced in the same mineral but with different half-lives. Thereinto, 10Be-26Al is the most widely used nuclide pairs, of which the available dating range spans the Plio-Pleistocene. But the coupling of 10Be with the stable nuclide 21Ne would significantly improve the burial dating range up to the middle Miocene, which is promising in revolutionizing the chronology study for the Late Cenozoic terrestrial sedimentary sequences. We have applied 10Be-21Ne pair for dating the middle Miocene sediments of the Hongliu Valley in southern Ningxia basin. Two major features of the sediments are involved in our study: (1) sediments originated from the steady erosion of the source area, and (2) the burial depth of our sample after deposition is time dependent due to the gradual accumulation of sediments into basin. The post-burial nuclide production is estimated to be less than 3%, including the contribution by muon interactions, of the total nuclide concentrations measured in our sample. Our 10Be-21Ne analysis demonstrates the age of the burial sample is 12.4(+0.6/-0.4) Ma, and the erosion rate at the source area is 0.26±0.01 cm ka-1. The sample's burial age is consistent with the age constraint set by the Hongliugou Formation (16.7-5.4 Ma) which we collected the sample in. Vertebrate fossils of Platybelodon tongxinensis with an age between 12 and 15 Ma exhumated along with our sample further verifies the reliability of our dating results for the middle Miocene sediments.This study has shown the improved age range of cosmogenic-nuclide burial dating method by incorporating the stable nuclide 21Ne, and

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

    PubMed

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

    2017-01-05

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

  9. Constraining Quaternary ice covers and erosion rates using cosmogenic 26Al/10Be nuclide concentrations

    NASA Astrophysics Data System (ADS)

    Knudsen, Mads Faurschou; Egholm, David Lundbek

    2018-02-01

    Paired cosmogenic nuclides are often used to constrain the exposure/burial history of landforms repeatedly covered by ice during the Quaternary, including tors, high-elevation surfaces, and steep alpine summits in the circum-Arctic regions. The approach generally exploits the different production rates and half-lives of 10Be and 26Al to infer past exposure/burial histories. However, the two-stage minimum-limiting exposure and burial model regularly used to interpret the nuclides ignores the effect of variable erosion rates, which potentially may bias the interpretation. In this study, we use a Monte Carlo model approach to investigate systematically how the exposure/burial and erosion history, including variable erosion and the timing of erosion events, influence concentrations of 10Be and 26Al. The results show that low 26Al/10Be ratios are not uniquely associated with prolonged burial under ice, but may as well reflect ice covers that were limited to the coldest part of the late Pleistocene combined with recent exhumation of the sample, e.g. due to glacial plucking during the last glacial period. As an example, we simulate published 26Al/10Be data from Svalbard and show that it is possible that the steep alpine summits experienced ice-free conditions during large parts of the late Pleistocene and varying amounts of glacial erosion. This scenario, which contrasts with the original interpretation of more-or-less continuous burial under non-erosive ice over the last ∼1 Myr, thus challenge the conventional interpretation of such data. On the other hand, high 26Al/10Be ratios do not necessarily reflect limited burial under ice, which is the common interpretation of high ratios. In fact, high 26Al/10Be ratios may also reflect extensive burial under ice, combined with a change from burial under erosive ice, which brought the sample close to the surface, to burial under non-erosive ice at some point during the mid-Pleistocene. Importantly, by allowing for variable

  10. Factors Associated with Waiting Time for Access to Mental Health Services for Children and Adolescents in Norway

    ERIC Educational Resources Information Center

    Andersson, Helle Wessel

    2004-01-01

    The present study addresses the question of equality of access, as it relates to waiting time for specialised mental health treatment for children and adolescents. The aim was to investigate whether demographic, clinical factors and service-related factors were associated with waiting time. Data was based on a documentation system in which all…

  11. At the Tipping Point

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Wiley, H. S.

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

  12. Poisson-process generalization for the trading waiting-time distribution in a double-auction mechanism

    NASA Astrophysics Data System (ADS)

    Cincotti, Silvano; Ponta, Linda; Raberto, Marco; Scalas, Enrico

    2005-05-01

    In this paper, empirical analyses and computational experiments are presented on high-frequency data for a double-auction (book) market. Main objective of the paper is to generalize the order waiting time process in order to properly model such empirical evidences. The empirical study is performed on the best bid and best ask data of 7 U.S. financial markets, for 30-stock time series. In particular, statistical properties of trading waiting times have been analyzed and quality of fits is evaluated by suitable statistical tests, i.e., comparing empirical distributions with theoretical models. Starting from the statistical studies on real data, attention has been focused on the reproducibility of such results in an artificial market. The computational experiments have been performed within the Genoa Artificial Stock Market. In the market model, heterogeneous agents trade one risky asset in exchange for cash. Agents have zero intelligence and issue random limit or market orders depending on their budget constraints. The price is cleared by means of a limit order book. The order generation is modelled with a renewal process. Based on empirical trading estimation, the distribution of waiting times between two consecutive orders is modelled by a mixture of exponential processes. Results show that the empirical waiting-time distribution can be considered as a generalization of a Poisson process. Moreover, the renewal process can approximate real data and implementation on the artificial stocks market can reproduce the trading activity in a realistic way.

  13. An Estimation Method of Waiting Time for Health Service at Hospital by Using a Portable RFID and Robust Estimation

    NASA Astrophysics Data System (ADS)

    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.

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

    PubMed

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

    2017-01-01

    The intriguing sit-and-wait hypothesis predicts that bacterial durability in the external environment is positively correlated with their virulence. Since its first proposal in 1987, the hypothesis has been spurring debates in terms of its validity in the field of bacterial virulence. As a special case of the vector-borne transmission versus virulence tradeoff, where vector is now replaced by environmental longevity, there are only sporadic studies over the last three decades showing that environmental durability is possibly linked with virulence. However, no systematic study of these works is currently available and epidemiological analysis has not been updated for the sit-and-wait hypothesis since the publication of Walther and Ewald's (2004) review. In this article, we put experimental evidence, epidemiological data and theoretical analysis together to support the sit-and-wait hypothesis. According to the epidemiological data in terms of gain and loss of virulence (+/-) and durability (+/-) phenotypes, we classify bacteria into four groups, which are: sit-and-wait pathogens (++), vector-borne pathogens (+-), obligate-intracellular bacteria (--), and free-living bacteria (-+). After that, we dive into the abundant bacterial proteomic data with the assistance of bioinformatics techniques in order to investigate the two factors at molecular level thanks to the fast development of high-throughput sequencing technology. Sequences of durability-related genes sourced from Gene Ontology and UniProt databases and virulence factors collected from Virulence Factor Database are used to search 20 corresponding bacterial proteomes in batch mode for homologous sequences via the HMMER software package. Statistical analysis only identified a modest, and not statistically significant correlation between mortality and survival time for eight non-vector-borne bacteria with sit-and-wait potentials. Meanwhile, through between-group comparisons, bacteria with higher host-mortality are

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

    PubMed Central

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

    2017-01-01

    The intriguing sit-and-wait hypothesis predicts that bacterial durability in the external environment is positively correlated with their virulence. Since its first proposal in 1987, the hypothesis has been spurring debates in terms of its validity in the field of bacterial virulence. As a special case of the vector-borne transmission versus virulence tradeoff, where vector is now replaced by environmental longevity, there are only sporadic studies over the last three decades showing that environmental durability is possibly linked with virulence. However, no systematic study of these works is currently available and epidemiological analysis has not been updated for the sit-and-wait hypothesis since the publication of Walther and Ewald’s (2004) review. In this article, we put experimental evidence, epidemiological data and theoretical analysis together to support the sit-and-wait hypothesis. According to the epidemiological data in terms of gain and loss of virulence (+/-) and durability (+/-) phenotypes, we classify bacteria into four groups, which are: sit-and-wait pathogens (++), vector-borne pathogens (+-), obligate-intracellular bacteria (--), and free-living bacteria (-+). After that, we dive into the abundant bacterial proteomic data with the assistance of bioinformatics techniques in order to investigate the two factors at molecular level thanks to the fast development of high-throughput sequencing technology. Sequences of durability-related genes sourced from Gene Ontology and UniProt databases and virulence factors collected from Virulence Factor Database are used to search 20 corresponding bacterial proteomes in batch mode for homologous sequences via the HMMER software package. Statistical analysis only identified a modest, and not statistically significant correlation between mortality and survival time for eight non-vector-borne bacteria with sit-and-wait potentials. Meanwhile, through between-group comparisons, bacteria with higher host

  16. Toward systematic reviews to understand the determinants of wait time management success to help decision-makers and managers better manage wait times

    PubMed Central

    2013-01-01

    Background Long waits for core specialized services have consistently been identified as a key barrier to access. Governments and organizations at all levels have responded with strategies for better wait list management. While these initiatives are promising, insufficient attention has been paid to factors influencing the implementation and sustainability of wait time management strategies (WTMS) implemented at the organizational level. Methods A systematic review was conducted using the main electronic databases, such as CINAHL, MEDLINE, and Cochrane Database of Systematic Reviews, to identify articles published between 1990 and 2011 on WTMS for scheduled care implemented at the organizational level or higher and on frameworks for analyzing factors influencing their success. Data was extracted on governance, culture, resources, and tools. We organized a workshop with Canadian healthcare policy-makers and managers to compare our initial findings with their experience. Results Our systematic review included 47 articles: 36 related to implementation and 11 to sustainability. From these, we identified a variety of WTMS initiated at the organizational level or higher, and within these, certain factors that were specific to either implementation or sustainability and others common to both. The main common factors influencing success at the contextual level were stakeholder engagement and strong funding, and at the organizational level, physician involvement, human resources capacity, and information management systems. Specific factors for successful implementation at the contextual level were consultation with front-line actors and common standards and guidelines, and at the organizational level, financial incentives and dedicated staffing. For sustainability, we found no new factors. The workshop participants identified the same major factors as found in the articles and added others, such as information sharing between physicians and managers. Conclusions Factors

  17. Toward systematic reviews to understand the determinants of wait time management success to help decision-makers and managers better manage wait times.

    PubMed

    Pomey, Marie-Pascale; Forest, Pierre-Gerlier; Sanmartin, Claudia; Decoster, Carolyn; Clavel, Nathalie; Warren, Elaine; Drew, Madeleine; Noseworthy, Tom

    2013-06-06

    Long waits for core specialized services have consistently been identified as a key barrier to access. Governments and organizations at all levels have responded with strategies for better wait list management. While these initiatives are promising, insufficient attention has been paid to factors influencing the implementation and sustainability of wait time management strategies (WTMS) implemented at the organizational level. A systematic review was conducted using the main electronic databases, such as CINAHL, MEDLINE, and Cochrane Database of Systematic Reviews, to identify articles published between 1990 and 2011 on WTMS for scheduled care implemented at the organizational level or higher and on frameworks for analyzing factors influencing their success. Data was extracted on governance, culture, resources, and tools. We organized a workshop with Canadian healthcare policy-makers and managers to compare our initial findings with their experience. Our systematic review included 47 articles: 36 related to implementation and 11 to sustainability. From these, we identified a variety of WTMS initiated at the organizational level or higher, and within these, certain factors that were specific to either implementation or sustainability and others common to both. The main common factors influencing success at the contextual level were stakeholder engagement and strong funding, and at the organizational level, physician involvement, human resources capacity, and information management systems. Specific factors for successful implementation at the contextual level were consultation with front-line actors and common standards and guidelines, and at the organizational level, financial incentives and dedicated staffing. For sustainability, we found no new factors. The workshop participants identified the same major factors as found in the articles and added others, such as information sharing between physicians and managers. Factors related to implementation were studied

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

    PubMed

    Harding, K E; Bottrell, J

    2016-12-01

    Waiting lists with triage systems are commonly used in outpatient physiotherapy but may not be effective. Could an alternative model of access and triage reduce waiting times over a sustained period with no additional resources? Observational study comparing retrospective data for 11 months prior to the introduction of a new model of access compared with data for the equivalent 11 months afterwards. Patients referred to a physiotherapy outpatient department at an outer metropolitan hospital before (n=721) and after (n=707) the introduction of the new model. A model of access and triage known as 'specific timely appointments for triage' (STAT), in which appointment slots are preserved in advance specifically for new patients based on calculation of average demand. Time from referral to first assessment, number of appointments per patient, occasions of non-attendance and total length of stay in the service. Median time from referral to first appointment was 18 days [interquartile range (IQR) 11 to 33 days] in the pre-intervention group, compared with 14 days (IQR 9 to 21 days) in the post-intervention group (P<0.01). The number of physiotherapy appointments also reduced (IQR 2 to 6 vs IQR 1 to 4; P<0.01). There were no changes in non-attendance rates or total time in the service. Waiting time for outpatient physiotherapy was 22% lower in the year following the introduction of the STAT model. While acknowledging the limitations of a pre- and post-measurement design, this model may have potential for reducing waiting times for outpatient physiotherapy without additional resources. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  19. Modeling of waiting times and price changes in currency exchange data

    NASA Astrophysics Data System (ADS)

    Repetowicz, Przemysław; Richmond, Peter

    2004-11-01

    A theory which describes the share price evolution at financial markets as a continuous-time random walk (Physica A 287 (2000) 468, Physica A 314 (2002) 749, Eur. Phys. J. B 27 (2002) 273, Physica A 376 (2000) 284) has been generalized in order to take into account the dependence of waiting times t on price returns x. A joint probability density function (pdf) φ(x,t) which uses the concept of a Lévy stable distribution is worked out. The theory is fitted to high-frequency US $/Japanese Yen exchange rate and low-frequency 19th century Irish stock data. The theory has been fitted both to price return and to waiting time data and the adherence to data, in terms of the χ2 test statistic, has been improved when compared to the old theory.

  20. Double Stimulation in the Waiting Experiment with Collectives: Testing a Vygotskian Model of the Emergence of Volitional Action.

    PubMed

    Sannino, Annalisa

    2016-03-01

    This study explores what human conduct looks like when research embraces uncertainty and distance itself from the dominant methodological demands of control and predictability. The context is the waiting experiment originally designed in Kurt Lewin's research group, discussed by Vygotsky as an instance among a range of experiments related to his notion of double stimulation. Little attention has been paid to this experiment, despite its great heuristic potential for charting the terrain of uncertainty and agency in experimental settings. Behind the notion of double stimulation lays Vygotsky's distinctive view of human beings' ability to intentionally shape their actions. Accordingly, human beings in situations of uncertainty and cognitive incongruity can rely on artifacts which serve the function of auxiliary motives and which help them undertake volitional actions. A double stimulation model depicting how such actions emerge is tested in a waiting experiment conducted with collectives, in contrast with a previous waiting experiment conducted with individuals. The model, validated in the waiting experiment with individual participants, applies only to a limited extent to the collectives. The analysis shows the extent to which double stimulation takes place in the waiting experiment with collectives, the differences between the two experiments, and what implications can be drawn for an expanded view on experiments.

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

    PubMed

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

    2017-01-01

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

  2. [Criteria for prioritising patients on surgical waiting lists in the National Health System].

    PubMed

    Allepuz, A; Espallargues, M; Martínez, O

    2009-01-01

    To survey the importance of previously proposed criteria for prioritising patients on surgical waiting lists and to analyse their use in daily practice. Cross-sectional study through a self-auto-administered postal questionnaire to hospital managers, medical directors, admissions managers, and department heads of general surgery, ophthalmology, orthopaedics and traumatology surgery and vascular surgery from 139 centres. The questionnaire comprised 3 sections: a) 3 to 5 of the most important criteria had to be selected and their use in daily practice had to be assessed; b) new criteria were proposed, c) socio-demographic data. The mean and its standard deviation of each criterion of importance were calculated. The proposed criteria were categorised and their frequency was calculated. The questionnaire was answered by the 22% of those surveyed. Disease severity, speed of progression, waiting time and pain were the criteria considered as most important and were the most used. The current clinical situation and the professional environment were the two most common categories defined from the criteria proposed by those surveyed. The surgical priority should be determined by other criteria related to surgery necessity besides waiting time. Establishing prioritisation criteria could enable current implicit criteria to be used explicitly.

  3. [Patients' satisfaction and waiting time in oncology day care centers in Champagne-Ardenne].

    PubMed

    Debreuve-Theresette, A; Jovenin, N; Stona, A C; Kraïem-Leleu, M; Burde, F; Parent, D; Hettler, D; Rey, J B

    2015-12-01

    Quality of life of patients suffering from cancer may be influenced by the way healthcare is organized and by patient experiences. Nowadays, chemotherapy is often provided in day care centers. This study aimed to assess patient waiting time and satisfaction in oncology day care centers in Champagne-Ardenne, France. This cross-sectional survey involved all patients receiving ambulatory chemotherapy during a one-week period in day care centers of Champagne-Ardenne public and private healthcare institutions participating in the study. Sociodemographic, medical and outpatient data were collected. Patient satisfaction was measured using the Out-Patsat35 questionnaire. Eleven (out of 16) oncology day care centers and 441 patients participated in the study. Most of the patients were women (n=252, 57.1%) and the mean age was 61±12 years. The mean satisfaction score was 82±14 (out of 100) and the mean waiting time between the assigned appointment time and administration of chemotherapy was 97±60 min. This study has shown that waiting times are important. However, patients are satisfied with the healthcare organization, especially regarding nursing support. Early preparation of chemotherapy could improve these parameters. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  4. Continuous time random walk model with asymptotical probability density of waiting times via inverse Mittag-Leffler function

    NASA Astrophysics Data System (ADS)

    Liang, Yingjie; Chen, Wen

    2018-04-01

    The mean squared displacement (MSD) of the traditional ultraslow diffusion is a logarithmic function of time. Recently, the continuous time random walk model is employed to characterize this ultraslow diffusion dynamics by connecting the heavy-tailed logarithmic function and its variation as the asymptotical waiting time density. In this study we investigate the limiting waiting time density of a general ultraslow diffusion model via the inverse Mittag-Leffler function, whose special case includes the traditional logarithmic ultraslow diffusion model. The MSD of the general ultraslow diffusion model is analytically derived as an inverse Mittag-Leffler function, and is observed to increase even more slowly than that of the logarithmic function model. The occurrence of very long waiting time in the case of the inverse Mittag-Leffler function has the largest probability compared with the power law model and the logarithmic function model. The Monte Carlo simulations of one dimensional sample path of a single particle are also performed. The results show that the inverse Mittag-Leffler waiting time density is effective in depicting the general ultraslow random motion.

  5. Abuse Pattern of Toluene Exposure Alters Mouse Behavior in a Waiting-for-Reward Operant Task

    PubMed Central

    Bowen, Scott E.; McDonald, Phillip

    2009-01-01

    Inhaling solvents for recreational purposes continues to be a world-wide public health concern. Toluene, a volatile solvent in many abused products, adversely affects the central nervous system. However, the long-term neurobehavioral effects of exposure to high-concentration, binge patterns typical of toluene abuse remain understudied. We studied the behavioral effects of repeated toluene exposure on cognitive function following binge toluene exposure on behavioral impulse control in Swiss Webster mice using a “wait-for-reward” operant task. Mice were trained on a fixed-ratio (FR) schedule using sweetened milk as a reward. Upon achieving FR15, a wait component was added which delivered free rewards in the absence of responses at increasing time intervals (2 sec, 4 sec, 6 sec, etc…). Mice continued to receive free rewards until they pressed a lever that reinstated the FR component (FR Reset). Once proficient in the FR-Wait task, mice were exposed to either 1,000 ppm, 3,600 ppm or 6,000 ppm toluene, or 0 ppm (air controls) for 30 min per day for 40 days. To avoid acute effects of toluene exposure, behavior was assessed 23 hours later. Repeated toluene exposure decreased response rates, the number of FR resets, and increased mean wait time, resulting in a higher response-to-reinforcer ratio than exhibited by controls. Mice receiving the higher exposure level (6,000 ppm) showed a dramatic decrease in the number of rewards received, which was reversed when toluene exposure ceased. Mice receiving the lower exposure level (1,000 ppm) showed little change in the number of rewards. These results indicate that repeated binge exposures to high concentrations of toluene can significantly interfere with performance as measured by a waiting-for-reward task, suggesting a significant impact on cognitive and/or psychomotor function. PMID:18832024

  6. Waiting time for cancer treatment and mental health among patients with newly diagnosed esophageal or gastric cancer: a nationwide cohort study.

    PubMed

    Song, Huan; Fang, Fang; Valdimarsdóttir, Unnur; Lu, Donghao; Andersson, Therese M-L; Hultman, Christina; Ye, Weimin; Lundell, Lars; Johansson, Jan; Nilsson, Magnus; Lindblad, Mats

    2017-01-03

    Except for overall survival, whether or not waiting time for treatment could influences other domains of cancer patients' overall well-being is to a large extent unknown. Therefore, we performed this study to determine the effect of waiting time for cancer treatment on the mental health of patients with esophageal or gastric cancer. Based on the Swedish National Quality Register for Esophageal and Gastric Cancers (NREV), we followed 7,080 patients diagnosed 2006-2012 from the time of treatment decision. Waiting time for treatment was defined as the interval between diagnosis and treatment decision, and was classified into quartiles. Mental disorders were identified by either clinical diagnosis through hospital visit or prescription of psychiatric medications. For patients without any mental disorder before treatment, the association between waiting time and subsequent onset of mental disorders was assessed by hazard ratios (HRs) with 95% confidence interval (CI), derived from multivariable-adjusted Cox model. For patients with a preexisting mental disorder, we compared the rate of psychiatric care by different waiting times, allowing for repeated events. Among 4,120 patients without any preexisting mental disorder, lower risk of new onset mental disorders was noted for patients with longer waiting times, i.e. 18-29 days (HR 0.86; 95% CI 0.74-1.00) and 30-60 days (HR 0.79; 95% CI 0.67-0.93) as compared with 9-17 days. Among 2,312 patients with preexisting mental disorders, longer waiting time was associated with more frequent psychiatric hospital care during the first year after treatment (37.5% higher rate per quartile increase in waiting time; p for trend = 0.0002). However, no such association was observed beyond one year nor for the prescription of psychiatric medications. These data suggest that waiting time to treatment for esophageal or gastric cancer may have different mental health consequences for patients depending on their past psychiatric

  7. Issue a Boil-Water Advisory or Wait for Definitive Information? A Decision Analysis

    PubMed Central

    Wagner, Michael M.; Wallstrom, Garrick L.; Onisko, Agnieszka

    2005-01-01

    Objective Study the decision to issue a boil-water advisory in response to a spike in sales of diarrhea remedies or wait 72 hours for the results of definitive testing of water and people. Methods Decision analysis. Results In the base-case analysis, the optimal decision is test-and-wait. If the cost of issuing a boil-water advisory is less than 13.92 cents per person per day, the optimal decision is to issue the boil-water advisory immediately. Conclusions Decisions based on surveillance data that are suggestive but not conclusive about the existence of a disease outbreak can be modeled. PMID:16779145

  8. The effect of waiting times from general practitioner referral to MRI or orthopaedic consultation for the knee on patient-based outcomes.

    PubMed

    Brealey, S; Andronis, L; Dale, V; Gibbon, A J; Gilbert, F J; Hendry, M; Hood, K; King, D; Wilkinson, C

    2012-11-01

    The purpose of this study was to test for the effect of waiting time from general practitioner (GP) referral to MRI or to orthopaedic consultation on outcomes of patients with knee problems, and to test whether any characteristics of trial participants predicted waiting time to MRI or orthopaedics. We undertook secondary analyses of data on 553 participants from a randomised trial who were recruited from 163 general practices during November 2002 to October 2004. Of the patients allocated to MRI, 263 (94%) had an MRI, and of those referred to orthopaedics, 236 (86%) had an orthopaedic consultation. The median (interquartile range) waiting time in days from randomisation to MRI was 41.0 (21.0-71.0) and to orthopaedic appointment was 78.5 (54.5-167.5). Waiting time was found to have no significant effect on patient outcome for both the Short Form 36-item (SF-36) physical functioning score (p=0.570) and the Knee Quality of Life 26-item (KQoL-26) physical functioning score (p=0.268). There was weak evidence that males waited less time for their MRI (p=0.049) and older patients waited longer for their orthopaedic referral (p=0.049). For patients who resided in the catchment areas of some centres there were significantly longer waiting times for both MRI and orthopaedic appointment. Where patients reside is a strong predictor of waiting time for access to services such as MRI or orthopaedics. There is no evidence to suggest, however, that this has a significant effect on physical well-being in the short term for patients with knee problems.

  9. 13. Detail, northeast facade, original door from platform to waiting ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    13. Detail, northeast facade, original door from platform to waiting room, now non-functional; note holes in mortar joints used to hold masonry anchors for mounting advertising signs for previous building tenants; view to southwest, 90mm lens. - Southern Pacific Depot, 559 El Camino Real, San Carlos, San Mateo County, CA

  10. 27. Interior of former waiting room, now used as restaurant; ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    27. Interior of former waiting room, now used as restaurant; only remaining original fixtures are windows and Romanesque-arched fireplace, the latter uncovered during removal of railroad-placed drywall by restaurant owner; view to south, 65mm lens. - Southern Pacific Depot, 559 El Camino Real, San Carlos, San Mateo County, CA

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

    PubMed

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

    PubMed

    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.

  13. Obesity Surgery Score (OSS) for Prioritization in the Bariatric Surgery Waiting List: a Need of Public Health Systems and a Literature Review.

    PubMed

    Casimiro Pérez, José Antonio; Fernández Quesada, Carlos; Del Val Groba Marco, María; Arteaga González, Iván; Cruz Benavides, Francisco; Ponce, Jaime; de Pablos Velasco, Pedro; Marchena Gómez, Joaquín

    2018-04-01

    In the last decades, we have experienced an increase in the prevalence of obesity in western countries with a higher demand for bariatric surgery and consequently prolonged waiting times. Currently, in many public hospitals, the only criterion that establishes priority for bariatric surgery is waiting time regardless of obesity severity. We propose a new, simple, and homogeneous clinical prioritization system, the Obesity Surgery Score (OSS), which takes into account simultaneously and equitably the time on surgical waiting list and the obesity severity based on three variables: body mass index, obesity-related comorbidities, and functional limitations. We have reviewed the current literature related to obesity clinical staging systems, and we have carried out an analysis of our patients in waiting list and divided their characteristics according to their degree of severity (A, B, or C) in the OSS. Patients with OSS grade C have a higher mean BMI, greater severity in comorbidities, and greater socio-labor impact. The current surgery waiting time of our series is of 26 months. Currently, 27 patients (51.9%) with OSS grade B and 15 patients (51.7%) with OSS grade C have been on our waiting list for more than 1 year. Since the obesity severity, the waiting time and its clinical consequences are associated with an increase in morbidity and mortality, it is important to apply a structured prioritization system for bariatric surgery waiting list. This allows prioritization of patients at greater risk, improves patient prognosis, and optimizes costs and available health resources.

  14. Crisis in the Community: Waiting Lists for MR/DD Services

    ERIC Educational Resources Information Center

    Stasko, Sheila

    2005-01-01

    Waiting lists for people with intellectual disabilities who seek services from Mental Retardation (MR) or Development Disability (DD) systems are a very visible problem across the country and have forced people with disabilities, families and caregivers to respond by pressing their states into action. People living at home with their parents or…

  15. Which factors influence patients' maximum acceptable waiting time for cataract surgery? - a questionnaire survey.

    PubMed

    Weingessel, Birgit; Richter-Mueksch, Sibylla; Vécsei-Marlovits, Pia V

    2011-05-01

    To evaluate patients’ maximum acceptable waiting time (MAWT) and to assess the determinants of patient perceptions of MAWT. A total of 500 consecutive patients with cataract were asked to fill out a preoperative questionnaire, addressing patients’ MAWT to undergo cataract surgery. Patients’ visual impairment (VF-14 score), education, profession and social status were evaluated, and an ophthalmologic examination was performed. Univariate analysis included Spearman’s correlation test, unpaired Student’s t-test and the Mann–Whitney U test. Univariate and multivariate associations were calculated using unconditional logistic regression. The mean MAWT was 3.17 ± 2.12 months. The mean VF-14 score was 72.10 ± 22.54. Between VF-14 score and MAWT, there was a significant correlation (r = 0.180, p = 0.004). Patients with higher education (high school, university) accepted significantly longer MAWT (3.92 ± 2.38 months versus 3.02 ± 2.00 months, p = 0.009). Patients who had self-noticed visual impairment were nearly four times (OR: 3.88, 95% CI = 2.07–7.28, p < 0.001) more likely to accept only MAWT of <3 months. Patients with low tolerance for waiting had greater self-reported difficulty with vision. Patients’ acceptance of waiting was not associated with clinical visual acuity measures. Education, ability to work, living independently and taking care of dependents were also strong predictors from patients’ perspective. Considering the implementation of standards for waiting lists, these facts should be taken into account. © 2010 The Authors. Journal compilation © 2010 Acta Ophthalmol.

  16. Reducing Wait Time for Lung Cancer Diagnosis and Treatment: Impact of a Multidisciplinary, Centralized Referral Program.

    PubMed

    Common, Jessica L; Mariathas, Hensley H; Parsons, Kaylah; Greenland, Jonathan D; Harris, Scott; Bhatia, Rick; Byrne, SuzanneC

    2018-06-04

    A multidisciplinary, centralized referral program was established at our institution in 2014 to reduce delays in lung cancer diagnosis and treatment following diagnostic imaging observed with the traditional, primary care provider-led referral process. The main objectives of this retrospective cohort study were to determine if referral to a Thoracic Triage Panel (TTP): 1) expedites lung cancer diagnosis and treatment initiation; and 2) leads to more appropriate specialist consultation. Patients with a diagnosis of lung cancer and initial diagnostic imaging between March 1, 2015, and February 29, 2016, at a Memorial University-affiliated tertiary care centre in St John's, Newfoundland, were identified and grouped according to whether they were referred to the TTP or managed through a traditional referral process. Wait times (in days) from first abnormal imaging to biopsy and treatment initiation were recorded. Statistical analysis was performed using the Wilcoxon rank-sum test. A total of 133 patients who met inclusion criteria were identified. Seventy-nine patients were referred to the TTP and 54 were managed by traditional means. There was a statistically significant reduction in median wait times for patients referred to the TTP. Wait time from first abnormal imaging to biopsy decreased from 61.5 to 36.0 days (P < .0001). Wait time from first abnormal imaging to treatment initiation decreased from 118.0 to 80.0 days (P < .001). The percentage of specialist consultations that led to treatment was also greater for patients referred to the TTP. A collaborative, centralized intake and referral program helps to reduce wait time for diagnosis and treatment of lung cancer. Copyright © 2018 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

  17. Performance Contracting and Quality Improvement in Outpatient Treatment: Effects on Waiting Time and Length of Stay

    PubMed Central

    Stewart, Maureen T.; Horgan, Constance M.; Garnick, Deborah W.; Ritter, Grant; McLellan, A. Thomas

    2012-01-01

    We evaluate effects of a performance contract (PC) implemented in Delaware in 2001 and participation in quality improvement (QI) programs on waiting time for treatment and length of stay (LOS) using client treatment episode level data from Delaware (n = 12,368) and Maryland (n = 147,151) for 1998 – 2006. Results of difference-in-difference analyses indicate waiting time declined 13 days following the PC, after controlling for client characteristics and historical trends. Participation in the PC and a formal QI program was associated with a decrease of 20 days. LOS increased 22 days under the PC and 24 days under the PC and QI programs, after controlling for client characteristics. The PC and QI program were associated with improvements in LOS and waiting time, although we cannot determine which aspects of the programs (incentives, training, monitoring) resulted in these changes. PMID:22445031

  18. Emergency Department Waiting Times (EDWaT): A Patient Flow Management and Quality of Care Rating mHealth Application.

    PubMed

    Househ, Mowafa; Yunus, Faisel

    2014-01-01

    Saudi hospital emergency departments (ED) have suffered from long waiting times, which have led to a delay in emergency patient care. The increase in the population of Saudi Arabia is likely to further stretch the healthcare services due to overcrowding leading to decreased healthcare quality, long patient waits, patient dissatisfaction, ambulance diversions, decreased physician productivity, and increased frustration among medical staff. This will ultimately put patients at risk for poor health outcomes. Time is of the essence in emergencies and to get to an ED that has the shortest waiting time can mean life or death for a patient, especially in cases of stroke and myocardial infarction. In this paper, we present our work on the development of a mHealth Application - EDWaT - that will: provide patient flow information to the emergency medical services staff, help in quick routing of patients to the nearest hospital, and provide an opportunity for patients to review and rate the quality of care received at an ED, which will then be forwarded to ED services administrators. The quality ratings will help patients to choose between two EDs with the same waiting time and distance from their location. We anticipate that the use of EDWaT will help improve ED wait times and the quality of care provision in Saudi hospitals EDs.

  19. Cost-effectiveness of Wait Time Reduction for Intensive Behavioral Intervention Services in Ontario, Canada.

    PubMed

    Piccininni, Caroline; Bisnaire, Lise; Penner, Melanie

    2017-01-01

    Earlier access to intensive behavioral intervention (IBI) is associated with improved outcomes for children with severe autism spectrum disorder (ASD); however, there are long waiting times for this program. No analyses have been performed modeling the cost-effectiveness of wait time reduction for IBI. To model the starting age for IBI with reduced wait time (RWT) (by half) and eliminated wait time (EWT), and perform a cost-effectiveness analysis comparing RWT and EWT with current wait time (CWT) from government and societal perspectives. Published waiting times were used to model the mean starting age for IBI for CWT, RWT, and EWT in children diagnosed with severe ASD who were treated at Ontario's Autism Intervention Program. Inputs were loaded into a decision analytic model, with an annual discount rate of 3% applied. Incremental cost-effectiveness ratios (ICERs) were determined. One-way and probabilistic sensitivity analyses were performed to assess the effect of model uncertainty. We used data from the year 2012 (January 1 through December 31) provided from the Children's Hospital of Eastern Ontario IBI center for the starting ages. Data analysis was done from May through July 2015. The outcome was independence measured in dependency-free life-years (DFLYs) to 65 years of age. To derive this, expected IQ was modeled based on probability of early (age <4 years) or late (age ≥4 years) access to IBI. Probabilities of having an IQ in the normal (≥70) or intellectual disability (<70) range were calculated. The IQ strata were assigned probabilities of achieving an independent (60 DFLYs), semidependent (30 DFLYs), or dependent (0 DFLYs) outcome. Costs were calculated for provincial government and societal perspectives in Canadian dollars (Can$1 = US$0.78). The mean starting ages for IBI were 5.24 years for CWT, 3.89 years for RWT, and 2.71 years for EWT. From the provincial government perspective, EWT was the dominant strategy, generating the most DFLYs for

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

    PubMed

    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

  1. Evaluation of wet-cupping therapy for persistent non-specific low back pain: a randomised, waiting-list controlled, open-label, parallel-group pilot trial.

    PubMed

    Kim, Jong-In; Kim, Tae-Hun; Lee, Myeong Soo; Kang, Jung Won; Kim, Kun Hyung; Choi, Jun-Yong; Kang, Kyung-Won; Kim, Ae-Ran; Shin, Mi-Suk; Jung, So-Young; Choi, Sun-mi

    2011-06-10

    Persistent non-specific low back pain (PNSLBP) is one of the most frequently experienced types of back pain around the world. Wet-cupping is a common intervention for various pain conditions, especially in Korea. In this context, we conducted a pilot study to determine the effectiveness and safety of wet-cupping treatment for PNSLBP. We recruited 32 participants (21 in the wet-cupping group and 11 in the waiting-list group) who had been having PNSLBP for at least 3 months. The participants were recruited at the clinical research centre of the Korea Institute of Oriental Medicine, Korea. Eligible participants were randomly allocated to wet-cupping and waiting-list groups. Following the practice of traditional Korean medicine, the treatment group was provided with wet-cupping treatment at two acupuncture points among the BL23, BL24 and BL25 6 times within 2 weeks. Usual care, including providing brochures for exercise, general advice for PNSLBP and acetaminophen, was allowed in both groups. Separate assessors participated in the outcome assessment. We used the 0 to 100 numerical rating scale (NRS) for pain, the McGill Pain Questionnaire for pain intensity (PPI) and the Oswestry Disability Questionnaire (ODQ), and we assessed acetaminophen use and safety issues. The results showed that the NRS score for pain decreased (-16.0 [95% CI: -24.4 to -7.7] in the wet-cupping group and -9.1 [-18.1 to -0.1] in the waiting-list group), but there was no statistical difference between the groups (p = 0.52). However, the PPI scores showed significant differences between the two groups (-1.2 [-1.6 to -0.8] for the wet-cupping group and -0.2 [-0.8 to 0.4] for the waiting-list group, p < 0.01). In addition, less acetaminophen was used in the wet-cupping group during 4 weeks (p = 0.09). The ODQ score did not show significant differences between the two groups (-5.60 [-8.90 to -2.30] in the wet-cupping group and -1.8 [-5.8 to 2.2] in the waiting-list group, p = 0.14). There was no

  2. A Support Group for Parents of Children on a Waiting List for an Assessment for Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    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…

  3. A modelling framework for mitigating customers' waiting time at a vehicle inspection centre

    NASA Astrophysics Data System (ADS)

    Ahmad, Norazura; Abidin, Norhaslinda Zainal; Ilyas, Khibtiyah; Abduljabbar, Waleed Khalid

    2017-11-01

    In Malaysia, an agency that is entrusted by the Government to perform mandatory vehicle inspection for public, commercial and private vehicles, receive many customers daily. Often complaints of problems received from the customers are associated with waiting time that leads to lost of business and dissatisfied customers. To address this issue, we propose a framework for modelling a vehicle inspection system using an integration of simulation and optimization approaches. The strengths of simulation and optimization are reviewed briefly that is hoped to reveal the synergy between the established methods in determining an appropriate customer's waiting time for inspection at a vehicle inspection centre. Relevant concepts and preliminary results are also presented and discussed in this paper.

  4. Deficient neural activity subserving decision-making during reward waiting time in intertemporal choice in adult attention-deficit hyperactivity disorder.

    PubMed

    Todokoro, Ayako; Tanaka, Saori C; Kawakubo, Yuki; Yahata, Noriaki; Ishii-Takahashi, Ayaka; Nishimura, Yukika; Kano, Yukiko; Ohtake, Fumio; Kasai, Kiyoto

    2018-04-24

    Impulsivity, which significantly affects social adaptation, is an important target behavioral characteristic in interventions for attention-deficit hyperactivity disorder (ADHD). Typically, people are willing to wait longer to acquire greater rewards. Impulsivity in ADHD may be associated with brain dysfunction in decision-making involving waiting behavior under such situations. We tested the hypothesis that brain circuitry during a period of waiting (i.e., prior to the acquisition of reward) is altered in adults with ADHD. The participants included 14 medication-free adults with ADHD and 16 healthy controls matched for age, sex, IQ, and handedness. The behavioral task had participants choose between a delayed, larger monetary reward and an immediate, smaller monetary reward, where the reward waiting time actually occurred during functional magnetic resonance imaging measurement. We tested for group differences in the contrast values of blood-oxygen-level dependent signals associated with the length of waiting time, calculated using the parametric modulation method. While the two groups did not differ in the time discounting rate, the delay-sensitive contrast values were significantly lower in the caudate and visual cortex in individuals with ADHD. The higher impulsivity scores were significantly associated with lower delay-sensitive contrast values in the caudate and visual cortex. These results suggest that deficient neural activity affects decision-making involving reward waiting time during intertemporal choice tasks, and provide an explanation for the basis of impulsivity in adult ADHD. © 2018 The Author. Psychiatry and Clinical Neurosciences © 2018 Japanese Society of Psychiatry and Neurology.

  5. Implications of two Holocene time-dependent geomagnetic models for cosmogenic nuclide production rate scaling

    NASA Astrophysics Data System (ADS)

    Lifton, Nathaniel

    2016-01-01

    The geomagnetic field is a major influence on in situ cosmogenic nuclide production rates at a given location (in addition to atmospheric pressure and, to a lesser extent, solar modulation effects). A better understanding of how past fluctuations in these influences affected production rates should allow more accurate application of cosmogenic nuclides. As such, this work explores the cosmogenic nuclide production rate scaling implications of two recent time-dependent spherical harmonic geomagnetic models spanning the Holocene. Korte and Constable (2011, Phys. Earth Planet. Inter.188, 247-259) and Korte et al. (2011, Earth Planet. Sci. Lett. 312, 497-505) recently updated earlier spherical harmonic paleomagnetic models with new paleomagnetic data from sediment cores in addition to new archeomagnetic and volcanic data. These updated models offer improved resolution and accuracy over the previous versions, in part due to increased temporal and spatial data coverage. In addition, Pavón-Carrasco et al. (2014, Earth Planet. Sci. Lett. 388, 98-109) developed another time-dependent spherical harmonic model of the Holocene geomagnetic field, based solely on archeomagnetic and volcanic paleomagnetic data from the same underlying paleomagnetic database as the Korte et al. models, but extending to 14 ka. With the new models as input, trajectory-traced estimates of effective vertical cutoff rigidity (RC - the standard method for ordering cosmic ray data) yield significantly different time-integrated scaling predictions when compared to each other and to results using the earlier models. In addition, predictions of each new model using RC are tested empirically using recently published production rate calibration data for both 10Be and 3He, and compared to predictions using corresponding time-varying geocentric dipolar RC formulations and a static geocentric axial dipole (GAD) model. Results for the few calibration sites from geomagnetically sensitive regions suggest that the

  6. Dust and chemical erosion biases in cosmogenic nuclide studies: A factor-of-ten problem that could mask strong climatic effects on landscape evolution

    NASA Astrophysics Data System (ADS)

    Riebe, C. S.; Arvin, L.; Ferrier, K.; Aciego, S.

    2017-12-01

    Cosmogenic nuclides have been widely used to quantify erosion in mountain ranges around the world, creating a global database of erosion rates from climatically and lithologically diverse sites, and providing vital clues about how mountain landscape evolution is coupled to Earth's carbon cycle and thus global climate change over geologic timescales. Despite this wealth of data, few studies have observed the widely expected strong control of erosion rates by climatic factors such as precipitation and temperature. Here we show that cosmogenic nuclide studies are prone to biases due to dust deposition and chemical erosion, which together can obscure strong relationships between climate and erosion rates. Erosion rates of sites exposed to intense chemical weathering can be underestimated by two-fold due to chemical enrichment of the cosmogenic target mineral quartz — a result of its high chemical erosion resistance, which increases its residence time and thus reduces its apparent erosion rate compared to other soil minerals. Meanwhile, erosion rates of sites with rapid dust deposition can be overestimated by more than ten-fold, due to dust's contributions to soil mass and target mineral abundance. Compilations of dust fluxes and cosmogenic nuclide data suggest that steep climatic trends in erosion rates, ranging from slow erosion rates in dry settings to twenty-fold faster erosion rates in wet settings, could be largely masked by the combined effects of dust deposition and chemical erosion. We argue that these effects need to be quantified in many cosmogenic nuclide studies of erosion rates. Doing so will require dust input rates; soil depth and density; quartz-enrichment ratios in both saprolite relative to bedrock and soil relative to saprolite; and quartz concentrations in deposited dust. Failure to quantify these crucial parameters can lead to misinterpretation of the strength — and even the sign — of feedbacks between climate and erosion rates in mountain

  7. Mountain erosion over decades and millennia: New insights from sediment yields and cosmogenic nuclides

    NASA Astrophysics Data System (ADS)

    Callahan, R. P.; Riebe, C. S.; Ferrier, K.

    2017-12-01

    For more than two decades, cosmogenic nuclides have been used to quantify catchment-wide erosion rates averaged over tens of thousands of years. These rates have been used as baselines for comparison with sediment yields averaged over decades, leading to insights on how human activities such as deforestation and agriculture have influenced the production and delivery of sediment to streams and oceans. Here we present new data from the southern Sierra Nevada, California, where sediment yields have been measured over the last ten years using sediment trapping and gauging methods. Cosmogenic nuclides measured in stream sediment reveal erosion rates that are between 13 and 400 (average = 94) times faster than erosion rates inferred from annual accumulations in sediment traps. We show that the discrepancy can be explained by extremely low sediment trapping efficiency, which leads to bias in the short-term rates due to incomplete capture of suspended sediment. Thus the short-term rates roughly agree with the long-term rates, despite intensive timber harvesting in the study catchments over the last century. This differs from results obtained in similar forested granitic catchments of Idaho, where long-term rates are more than ten times greater than short-term rates because large, rare events do not contribute to the short-term averages. Our analysis of a global database indicates that both the magnitude and sign of differences between short- and long-term average erosion rates are difficult to predict, even when the history of land use in known.

  8. The willingness to pay for wait reduction: the disutility of queues for cataract surgery in Canada, Denmark, and Spain.

    PubMed

    Bishai, D M; Lang, H C

    2000-03-01

    We estimate demand curves for a one month reduction in waiting time for cataract surgery based on survey data collected in 1992 in Manitoba, Barcelona, and Denmark. Patients answered, "Would you be willing to pay [Bid, B] to reduce your waiting time for cataract surgery to less than one month?" Controlling for SES and visual status, Barcelonan patients have greater WTP for shortened waiting time than the Danes and Manitobans. We estimate the value (in 1992 $) of lost consumer surplus due to the cataract surgery queue at $128 per patient in Manitoba, $160 in Denmark, and $243 in Barcelona.

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

    PubMed Central

    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 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. Results 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. Conclusion Waiting times were long, it is necessary to take measures to reduce delays and improve access to oral health care for this special population. PMID:25328594

  10. A study on the impact of prioritising emergency department arrivals on the patient waiting time.

    PubMed

    Van Bockstal, Ellen; Maenhout, Broos

    2018-05-03

    In the past decade, the crowding of the emergency department has gained considerable attention of researchers as the number of medical service providers is typically insufficient to fulfil the demand for emergency care. In this paper, we solve the stochastic emergency department workforce planning problem and consider the planning of nurses and physicians simultaneously for a real-life case study in Belgium. We study the patient arrival pattern of the emergency department in depth and consider different patient acuity classes by disaggregating the arrival pattern. We determine the personnel staffing requirements and the design of the shifts based on the patient arrival rates per acuity class such that the resource staffing cost and the weighted patient waiting time are minimised. In order to solve this multi-objective optimisation problem, we construct a Pareto set of optimal solutions via the -constraints method. For a particular staffing composition, the proposed model minimises the patient waiting time subject to upper bounds on the staffing size using the Sample Average Approximation Method. In our computational experiments, we discern the impact of prioritising the emergency department arrivals. Triaging results in lower patient waiting times for higher priority acuity classes and to a higher waiting time for the lowest priority class, which does not require immediate care. Moreover, we perform a sensitivity analysis to verify the impact of the arrival and service pattern characteristics, the prioritisation weights between different acuity classes and the incorporated shift flexibility in the model.

  11. WAITING TIME DISTRIBUTION OF SOLAR ENERGETIC PARTICLE EVENTS MODELED WITH A NON-STATIONARY POISSON PROCESS

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Li, C.; Su, W.; Fang, C.

    2014-09-10

    We present a study of the waiting time distributions (WTDs) of solar energetic particle (SEP) events observed with the spacecraft WIND and GOES. The WTDs of both solar electron events (SEEs) and solar proton events (SPEs) display a power-law tail of ∼Δt {sup –γ}. The SEEs display a broken power-law WTD. The power-law index is γ{sub 1} = 0.99 for the short waiting times (<70 hr) and γ{sub 2} = 1.92 for large waiting times (>100 hr). The break of the WTD of SEEs is probably due to the modulation of the corotating interaction regions. The power-law index, γ ∼more » 1.82, is derived for the WTD of the SPEs which is consistent with the WTD of type II radio bursts, indicating a close relationship between the shock wave and the production of energetic protons. The WTDs of SEP events can be modeled with a non-stationary Poisson process, which was proposed to understand the waiting time statistics of solar flares. We generalize the method and find that, if the SEP event rate λ = 1/Δt varies as the time distribution of event rate f(λ) = Aλ{sup –α}exp (– βλ), the time-dependent Poisson distribution can produce a power-law tail WTD of ∼Δt {sup α} {sup –3}, where 0 ≤ α < 2.« less

  12. Engineering refinements to overcome default nuclide regulatory constraints

    NASA Astrophysics Data System (ADS)

    Finn, R.; Capitelli, P.; Sheh, Y.; Lom, C.; Graham, M.; Germain, J. St.

    2005-12-01

    The "classical" positron emitting radionuclides include oxygen-15, nitrogen-13 and carbon-11 which possess unique properties for medical imaging. They are radionuclides of the fundamental elements of biological matter. They each possess short half-lives which allow their use in designed radiotracers for clinical investigations with minimal risk and they are readily able to be produced in sufficient activities by low energy nuclear reactions. At present several accelerator manufacturers offer production packages for these radionuclides emphasizing targetry with consideration of the cyclotron extracted energies for nuclide production and on-line chemistry systems for the continuous production of specific precursors or radiotracers. Following the installation and acceptance of the MSKCC TR 19/9 Cyclotron, our experience with the procured chemistry module for the preparation of oxygen-15 labeled water has forced us to examine the design and the operation of the synthetic unit with a view toward the state of New York's regulations addressing the environmental pollution from radioactive materials. The chemistry module was refined with subtle modifications to the chemistry procedure/unit and our experience with the unit is presented as an example of our approach to insure regulatory compliance.

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

    ERIC Educational Resources Information Center

    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…

  14. Quality of Life in Rectal Cancer Patients After Chemoradiation: Watch-and-Wait Policy Versus Standard Resection - A Matched-Controlled Study.

    PubMed

    Hupkens, Britt J P; Martens, Milou H; Stoot, Jan H; Berbee, Maaike; Melenhorst, Jarno; Beets-Tan, Regina G; Beets, Geerard L; Breukink, Stéphanie O

    2017-10-01

    Fifteen to twenty percent of patients with locally advanced rectal cancer have a clinical complete response after chemoradiation therapy. These patients can be offered nonoperative organ-preserving treatment, the so-called watch-and-wait policy. The main goal of this watch-and-wait policy is an anticipated improved quality of life and functional outcome in comparison with a total mesorectal excision, while maintaining a good oncological outcome. The aim of this study was to compare the quality of life of watch-and-wait patients with a matched-controlled group of patients who underwent chemoradiation and surgery (total mesorectal excision group). This was a matched controlled study. This study was conducted at multiple centers. The study population consisted of 2 groups: 41 patients after a watch-and-wait policy and 41 matched patients after chemoradiation and surgery. Patients were matched on sex, age, tumor stage, and tumor height. All patients were disease free at the moment of recruitment after a minimal follow-up of 2 years. Quality of life was measured by validated questionnaires covering general quality of life (Short Form 36, European Organization for Research and Treatment of Cancer QLQ-C30), disease-specific total mesorectal excision (European Organization for Research and Treatment of Cancer QLQ-CR38), defecation problems (Vaizey and low anterior resection syndrome scores), sexual problems (International Index of Erectile Function and Female Sexual Function Index), and urinary dysfunction (International Prostate Symptom Score). The watch-and-wait group showed better physical and cognitive function, better physical and emotional roles, and better global health status compared with the total mesorectal excision group. The watch-and-wait patients showed fewer problems with defecation and sexual and urinary tract function. This study only focused on watch-and-wait patients who achieved a sustained complete response for 2 years. In addition, this is a study

  15. Increases in heart rate and serum cortisol concentrations in healthy dogs are positively correlated with an indoor waiting-room environment.

    PubMed

    Perego, Roberta; Proverbio, Daniela; Spada, Eva

    2014-03-01

    Few studies have investigated the effect of veterinary clinical procedures on the welfare of dogs, with specific emphasis on the veterinary practice environment. Clinicopathologic variables have also not been assessed in these potentially stressful situations. Similar to human clinical studies, the veterinary clinical waiting room could present a significant stress factor for dogs. The present study was designed to investigate the effect of waiting-room environment on serum cortisol and glucose alterations as well as heart rate in privately owned healthy dogs. The clinical trial included 24 healthy dogs that were divided into 2 groups: the clinical waiting-room group (A) and the control group (B) that waited outside in a garden. During the entire experiment, 18 dogs (9 dogs per group) were monitored with a human heart rate monitor fastened around the chest. After 20 minutes of waiting, blood samples were collected from all of the dogs (24 dogs) to determine serum cortisol concentration. Serum cortisol concentration and mean, maximum, and minimum heart rate were significantly higher in group A compared with group B, but there was no statistical difference in serum glucose concentrations between the 2 study groups. Results of this study suggest that the waiting room is a potentially stressful situation for dogs in clinical veterinary practice, when compared with a garden, based on the assessment of adrenal cortex function and heart rate evaluation. © 2014 American Society for Veterinary Clinical Pathology and European Society for Veterinary Clinical Pathology.

  16. An update on 'dose calibrator' settings for nuclides used in nuclear medicine.

    PubMed

    Bergeron, Denis E; Cessna, Jeffrey T

    2018-06-01

    Most clinical measurements of radioactivity, whether for therapeutic or imaging nuclides, rely on commercial re-entrant ionization chambers ('dose calibrators'). The National Institute of Standards and Technology (NIST) maintains a battery of representative calibrators and works to link calibration settings ('dial settings') to primary radioactivity standards. Here, we provide a summary of NIST-determined dial settings for 22 radionuclides. We collected previously published dial settings and determined some new ones using either the calibration curve method or the dialing-in approach. The dial settings with their uncertainties are collected in a comprehensive table. In general, current manufacturer-provided calibration settings give activities that agree with National Institute of Standards and Technology standards to within a few percent.

  17. A comparative analysis of centralized waiting lists for patients without a primary care provider implemented in six Canadian provinces: study protocol.

    PubMed

    Breton, Mylaine; Green, Michael; Kreindler, Sara; Sutherland, Jason; Jbilou, Jalila; Wong, Sabrina T; Shaw, Jay; Crooks, Valorie A; Contandriopoulos, Damien; Smithman, Mélanie Ann; Brousselle, Astrid

    2017-01-21

    Having a regular primary care provider (i.e., family physician or nurse practitioner) is widely considered to be a prerequisite for obtaining healthcare that is timely, accessible, continuous, comprehensive, and well-coordinated with other parts of the healthcare system. Yet, 4.6 million Canadians, approximately 15% of Canada's population, are unattached; that is, they do not have a regular primary care provider. To address the critical need for attachment, especially for more vulnerable patients, six Canadian provinces have implemented centralized waiting lists for unattached patients. These waiting lists centralize unattached patients' requests for a primary care provider in a given territory and match patients with providers. From the little information we have on each province's centralized waiting list, we know the way they work varies significantly from province to province. The main objective of this study is to compare the different models of centralized waiting lists for unattached patients implemented in six provinces of Canada to each other and to available scientific knowledge to make recommendations on ways to improve their design in an effort to increase attachment of patients to a primary care provider. A logic analysis approach developed in three steps will be used. Step 1: build logic models that describe each province's centralized waiting list through interviews with key stakeholders in each province; step 2: develop a conceptual framework, separate from the provincially informed logic models, that identifies key characteristics of centralized waiting lists for unattached patients and factors influencing their implementation through a literature review and interviews with experts; step 3: compare the logic models to the conceptual framework to make recommendations to improve centralized waiting lists in different provinces during a pan Canadian face-to-face exchange with decision-makers, clinicians and researchers. This study is based on an inter

  18. Interest of waiting time for spontaneous early reconnection after cavotricuspid isthmus ablation: A monocentric randomized trial.

    PubMed

    Marchandise, Sébastien; Scavée, Christophe; Barbraud, Cynthia; de Meester de Ravenstein, Christophe; Balola Bagalwa, Mittérand; Goesaert, Cédric; Reis-Pinheiro, Ivone; le Polain de Waroux, Jean-Benoit

    2017-12-01

    The aim of this study was to determine the rate of recurrent atrial flutter (AFl) after isolated cavotricuspid isthmus (CTI) ablation and to evaluate the impact of a waiting period with the search for early resumption of the CTI block on the long-term outcome. Three hundred and nineteen consecutive patients referred for typical AFl ablation were randomly assigned to CTI ablation with continuous reevaluation of the CTI block during 30 minutes and early reablation if needed (waiting time [WT] + group, n  =  155) or to CTI ablation with no waiting period after proven bidirectional CTI block (WT - group, n  =  164). All patients were regularly followed-up. In the WT+ group, 10 patients (6%) presented a recovery across the CTI (time to recovery: 17 ± 7') and were reablated at the end of the waiting period. After a median follow-up of 21 months, the rate of recurrent AFl was significantly higher in the WT - group as compared to the WT+ group (11.6% [19/164] vs 2.5% [4/155], respectively; P  =  0.007). However, no significant differences in the subsequent rate of AF were observed between the two groups (29% [WT -] vs 32% [WT+], P  =  0.66). During the follow-up, 28 patients from the WT - group underwent a second ablation procedure (16 AFl redo and 12 AF ablation) versus 10 patients form the WT+ group (three AFl redo and seven AF ablation). Waiting 30 minutes after CTI ablation to check for early resumption and early reablation allows for decreasing significantly the rate of recurrent atrial flutter. © 2017 Wiley Periodicals, Inc.

  19. Access to specialist gastroenterology care in Canada: The Practice Audit in Gastroenterology (PAGE) Wait Times Program

    PubMed Central

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

    2008-01-01

    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. METHODS: Specialist physicians completed the practice audit if they provided digestive health care, accepted new patients and recorded referral dates. For patients seen for consultation or investigation over a one-week period, preprogrammed personal digital assistants were used to collect data including the main reason for referral, initial referral and consultation dates, procedure dates (if performed), personal and family history, and patient symptoms, signs and test results. Patient triaging, appropriateness of the referral and timeliness of care were noted. RESULTS: Over 10 months, 199 physicians recorded details of 5559 referrals, including 1903 visits for procedures. The distribution of total wait times (from referral to procedure) nationally was highly skewed at 91/203 days (median/75th percentile), with substantial interprovincial variation: British Columbia, 66/185 days; Alberta, 134/284 days; Ontario, 110/208 days; Quebec, 71/149 days; New Brunswick, 104/234 days; and Nova Scotia, 42/84 days. The percentage of physicians by province offering average-risk screening colonoscopy varied from 29% to 100%. DISCUSSION: Access to specialist gastroenterology care in Canada is limited by long wait times, which exceed clinically reasonable waits for specialist treatment. Although exhibiting some methodological limitations, this large practice audit sampling offers broadly generalized results, as well as a means to identify barriers to health care delivery and evaluate strategies to address these barriers, with the goals of expediting appropriate care for patients with digestive health disorders and

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

    PubMed

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

    2015-10-01

    Lung transplantation (LTX) is nowadays accepted as a treatment option for selected patients with end-stage pulmonary disease. Idiopathic pulmonary fibrosis (IPF) is characterized by the radiological and histologic appearance of usual interstitial pneumonia. It is associated with a poor prognosis, and LTX is considered an effective treatment to significantly modify the natural history of this disease. The aim of the present study was to analyse mortality during the waiting list in IPF patients at a single institution. A retrospective analysis on IPF patients (n = 90) referred to our Lung Transplant Program in the period 2001-2014 was performed focusing on patients' characteristics and associated risk factors. Diagnosis of IPF was associated with high mortality on the waiting list with respect to other diagnosis (p < 0.05). No differences in demographic, clinical, radiological data and time spent on the waiting list were observed between IPF patients who underwent to LTX or lost on the waiting list. Patients who died showed significant higher levels of pCO2 and needed higher flows of O2-therapy on effort (p < 0.05). Pulmonary function tests failed to predict mortality and no other medical conditions were associated with survival. Patients newly diagnosed with IPF, especially in small to medium lung transplant volume centres and in Countries where a long waiting list is expected, should be immediately referred to transplantation, delay results in increased mortality. Early identification of IPF patients with a rapid progressive phenotype is strongly needed.

  1. Microbial Contamination on Touch Surfaces in Sick- and Well-Child Waiting Rooms in Pediatric Outpatient Facilities.

    PubMed

    Gudakova, Irina; Kim, JinYoung; Meredith, Jennifer F; Webb, Ginny

    2017-12-01

    Healthcare-associated infections are a significant public health burden resulting in approximately 1.7 million infections each year. Much work is done to study the contributing factors in inpatient settings; however, little has been done to study outpatient facilities and their roles in healthcare-associated infections. While many pediatric outpatient offices utilize separated waiting areas for sick and well children to decrease the spread of disease, research has not been done to determine whether this practice is of benefit. In this study, we aimed to determine whether there is a difference in microbial burden between sick- and well-child waiting areas and to identify surfaces with the highest levels of contamination. Touch surfaces in waiting rooms were swabbed and surveyed for total microbial growth, staphylococcal growth and Gram-negative enteric bacterial growth. Selected bacteria were identified to screen for pathogenic organisms. Surfaces sampled included seats, tables, children's tables, children's seats, magazines and books. We found seats, children's seats and children's books to have the highest microbial burden. No conclusions can be made on the differences in microbial contamination in sick- and well-child waiting areas because of high variation. Streptococcus pyogenes was isolated as were several opportunistic pathogens. This study suggests the need for better cleaning practices by pediatric outpatient facilities, to include the disinfection of additional surfaces as well as more frequent and thorough cleaning.

  2. A Study to Determine Patient Waiting Time at the Outpatient Pharmacy at Wilford Hall USAF Medical Center

    DTIC Science & Technology

    1988-06-01

    at Wilford Hall USAF Medical Center significantly reduced the patient wait time at the main outpatient pharmacy. Satellite pharmacies have been ).’l...PRESENTING TO WINDOW 1, 19 MAR 88. 47 C:. A’.’E-:A: -ESCRIRTIONS PER PATIENT ...........48 H. WILFORD HALL MEDICAL CENTER OUTPATIENT QUESTIONNAIRE...that wait times at tne outpatient pharmacy were excessive. It was this concern that motivated the Medical Center Administrator to request that patient

  3. Early Acheulean technology in the Rietputs Formation, South Africa, dated with cosmogenic nuclides.

    PubMed

    Gibbon, Ryan J; Granger, Darryl E; Kuman, Kathleen; Partridge, Timothy C

    2009-02-01

    An absolute dating technique based on the build-up and decay of (26)Al and (10)Be in the mineral quartz provides crucial evidence regarding early Acheulean hominid distribution in South Africa. Cosmogenic nuclide burial dating of an ancient alluvial deposit of the Vaal River (Rietputs Formation) in the western interior of South Africa shows that coarse gravel and sand aggradation there occurred ca 1.57+/-0.22Ma, with individual ages of samples ranging from 1.89+/-0.19 to 1.34+/-0.22Ma. This was followed by aggradation of laminated and cross-bedded fine alluvium at ca 1.26+/-0.10Ma. The Rietputs Formation provides an ideal situation for the use of the cosmogenic nuclide burial dating method, as samples could be obtained from deep mining pits at depths ranging from 7 to 16 meters. Individual dates provide only a minimum age for the stone tool technology preserved within the deposits. Each assemblage represents a time averaged collection. Bifacial tools distributed throughout the coarse gravel and sand unit can be assigned to an early phase of the Acheulean. This is the first absolute radiometric dated evidence for early Acheulean artefacts in South Africa that have been found outside of the early hominid sites of the Gauteng Province. These absolute dates also indicate that handaxe-using hominids inhabited southern Africa as early as their counterparts in East Africa. The simultaneous appearance of the Acheulean in different parts of the continent implies relatively rapid technology development and the widespread use of large cutting tools in the African continent by ca 1.6Ma.

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

    PubMed

    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.

  5. What is the current evidence of the impact on quality of life whilst waiting for management/treatment of orthopaedic/musculoskeletal complaints? A systematic scoping review.

    PubMed

    Morris, Joanne; Twizeyemariya, Asterie; Grimmer, Karen

    2018-04-02

    To describe quality of life (QoL) outcome measures that are reported in the literature in patients waiting for outpatient orthopaedic/musculoskeletal specialist care and how waiting impacts on QoL in these terms. A subset of studies reporting on QoL outcome measures were extracted from literature identified in a recent scoping search of Medline, Embase, Pubmed, NHS Economic Evaluation Database (Prospero registration CRD42016047332). The systematic scoping search examined impacts on patients waiting for orthopaedic specialist care. Two independent reviewers ranked study design using the National Health and Medical Research Council aetiology evidence hierarchy, and appraised study quality using Critical Appraisal Skills Programme tools. QoL measures were mapped against waiting period timepoints. The scoping search yielded 142 articles, of which 18 reported on impact on QoL. These studies reported only on patients waiting for hip and/or knee replacement surgery. The most recent study reported on data collected in 2006/7. The Western Ontario and McMaster Universities Arthritis Index and the SF-36 were the most commonly reported QoL measures. QoL was measured at variable timepoints in the waiting period (from a few weeks to greater than 12 months). The impact of waiting on QoL was inconsistent. The evidence base was over 10 years old, reported only on patients with hip and knee problems, and on limited QoL outcome measures, and with inconsistent findings. A better understanding of the impact on QoL for patients waiting for specialist care could be gained by using standard timepoints in the waiting period, patients with other orthopaedic conditions, comprehensive QoL measures, as well as expectations, choices and perspectives of patients waiting for specialist care.

  6. Do case-generic measures of queue performance for bypass surgery accurately reflect the waiting-list experiences of those most urgent?

    PubMed

    Burstein, Jason; Lee, Douglas S; Alter, David A

    2006-02-01

    Queue performance is typically assessed using generic measures, which capture the queue in aggregate. The objective of this study was to examine whether case-generic measures of queue performance appropriately reflected the waiting-list experiences of those patients with greatest disease severity. We examined the queue for isolated coronary artery bypass grafting (CABG) in Ontario between April 1993 and March 2000 using data obtained from the Cardiac Care Network. Our primary measure of queue performance was the proportion of patients who received their bypass surgery within their recommended maximum waiting times (%RMWTs) in any given month. We compared case-generic measures of queue performance to case-specific measures of queue performance stratified by urgency level. The queue was largely comprised of elective cases ranging from 73% (1993) to 57%(1999). Urgent patients comprised the minority of the queue ranging from 14% (1993) to 20% (1999). Case-generic month-to-month variations in the percentage of cases completed within RMWTs (an aggregated waiting list measure encompassing the characteristics of all patients in the queue) closely resembled the experiences of elective patients (R2 = 0.81), but conversely, bore little relationship to the waiting-list experiences of those most urgent (R2 = 0.15). Case-generic measures of queue performance for bypass surgery in Ontario were not reflective of the waiting-list experiences of those most urgent. Our results reinforce the concept that urgency-specific waiting list monitoring systems are required to best evaluate and appropriately respond to fluctuations in queue performance.

  7. Maternity waiting homes and institutional birth in Nicaragua: policy options and strategic implications.

    PubMed

    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.

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

    PubMed Central

    Gong, Hua; Chen, Daheng; Xu, Ke

    2014-01-01

    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. PMID:24883385

  9. On scaling cosmogenic nuclide production rates for altitude and latitude using cosmic-ray measurements

    NASA Astrophysics Data System (ADS)

    Desilets, Darin; Zreda, Marek

    2001-11-01

    The wide use of cosmogenic nuclides for dating terrestrial landforms has prompted a renewed interest in characterizing the spatial distribution of terrestrial cosmic rays. Cosmic-ray measurements from neutron monitors, nuclear emulsions and cloud chambers have played an important role in developing new models for scaling cosmic-ray neutron intensities and, indirectly, cosmogenic production rates. Unfortunately, current scaling models overlook or misinterpret many of these data. In this paper, we describe factors that must be considered when using neutron measurements to determine scaling formulations for production rates of cosmogenic nuclides. Over the past 50 years, the overwhelming majority of nucleon flux measurements have been taken with neutron monitors. However, in order to use these data for scaling spallation reactions, the following factors must be considered: (1) sensitivity of instruments to muons and to background, (2) instrumental biases in energy sensitivity, (3) solar activity, and (4) the way of ordering cosmic-ray data in the geomagnetic field. Failure to account for these factors can result in discrepancies of as much as 7% in neutron attenuation lengths measured at the same location. This magnitude of deviation can result in an error on the order of 20% in cosmogenic production rates scaled from 4300 m to sea level. The shapes of latitude curves of nucleon flux also depend on these factors to a measurable extent, thereby causing additional uncertainties in cosmogenic production rates. The corrections proposed herein significantly improve our ability to transfer scaling formulations based on neutron measurements to scaling formulations applicable to spallation reactions, and, therefore, constitute an important advance in cosmogenic dating methodology.

  10. The effect of external non-driving factors, payment type and waiting and queuing on fatigue in long distance trucking.

    PubMed

    Williamson, Ann; Friswell, Rena

    2013-09-01

    The aim of this study was to explore the effects of external influences on long distance trucking, in particular, incentive-based remuneration systems and the need to wait or queue to load or unload on driver experiences of fatigue. Long distance truck drivers (n=475) were recruited at truck rest stops on the major transport corridors within New South Wales, Australia and asked to complete a survey by self-administration or interview. The survey covered demographics, usual working arrangements, details of the last trip and safety outcomes including fatigue experiences. On average drivers' last trip was over 2000 km and took 21.5 h to complete with an additional 6h of non-driving work. Incentive payments were associated with longer working hours, greater distances driven and higher fatigue for more drivers. Drivers required to wait in queues did significantly more non-driving work and experienced fatigue more often than those who did not. Drivers who were not paid to wait did the longest trips with average weekly hours above the legal working hours limits, had the highest levels of fatigue and the highest levels of interference by work with family life. In contrast, drivers who were paid to wait did significantly less work with shorter usual hours and shorter last trips. Multivariate analysis showed that incentive-based payment and unpaid waiting in queues were significant predictors of driver fatigue. The findings suggest that mandating payment of drivers for non-driving work including waiting would reduce the amount of non-driving work required for drivers and reduce weekly hours of work. In turn this would reduce driver fatigue and safety risk as well as enhancing the efficiency of the long distance road transport industry. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

    PubMed

    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 (P<0.001). However, gender, urban residence, and valid waiting time showed no significant differences (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<0.001). 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

  12. Does Wait-List Size at Registration Influence Time to Surgery? Analysis of a Population-Based Cardiac Surgery Registry

    PubMed Central

    Sobolev, Boris; Levy, Adrian; Hayden, Robert; Kuramoto, Lisa

    2006-01-01

    Objective To determine whether the probability of undergoing coronary bypass surgery within a certain time was related to the number of patients on the wait list at registration for the operation in a publicly funded health system. Methods A prospective cohort study comparing waiting times among patients registered on wait lists at the hospitals delivering adult cardiac surgery. For each calendar week, the list size, the number of new registrations, and the number of direct admissions immediately after angiography characterized the demand for surgery. Results The length of delay in undergoing treatment was associated with list size at registration, with shorter times for shorter lists (log-rank test 1,198.3, p<.0001). When the list size at registration required clearance time over 1 week patients had 42 percent lower odds of undergoing surgery compared with lists with clearance time less than 1 week (odds ratio [OR] 0.58 percent, 95 percent, confidence interval [CI] 0.53–0.63), after adjustment for age, sex, comorbidity, period, and hospital. The weekly number of new registrations exceeding weekly service capacity had an independent effect toward longer service delays when the list size at registration required clearance time less than 1 week (OR 0.56 percent, 95 percent CI 0.45–0.71), but not for longer lists. Every time the operation was performed for a patient requiring surgery without registration on wait lists, the odds of surgery for listed patients were reduced by 6 percent (OR 0.94, CI 0.93–0.95). Conclusion For wait-listed patients, time to surgery depends on the list size at registration, the number of new registrations, as well as on the weekly number of patients who move immediately from angiography to coronary bypass surgery without being registered on a wait list. Hospital managers may use these findings to improve resource planning and to reduce uncertainty when providing advice on expected treatment delays. PMID:16430599

  13. Headache Education Active-Waiting Directive: A Program to Enhance Well-Being During Long Referral Wait Times.

    PubMed

    Lagman-Bartolome, Ana Marissa; Lawler, Valerie; Lay, Christine

    2018-01-01

    The aim of this initiative was to evaluate the clinical impact, patient acceptability, and sustainability of implementing a newly developed evidence-guided migraine education program in an academic headache center. Headache is the fifth most common reason for emergency department (ED) visits and accounts for more than 10 million physician visits annually. Successful management of headaches presents a challenge to both primary care providers and neurologists. The catchment area for an academic headache specialty center in a large metropolitan area is over 6 million with an average wait time of over 15 months. This delays diagnosis and impacts patients, thus a Headache Education Active-Waiting Directive (HEAD) was developed to improve patient knowledge and self-care skills among migraine patients awaiting an initial appointment. This was a prospective pre- and post-intervention study. English-speaking adults, aged 18-65 years, referred to the Center for Headache at the University of Toronto for headache consultation between May and December 2012, who had not previously been assessed by a headache specialist, were consented and enrolled. Data on Migraine Disability Assessment (MIDAS) with additional questions on emergency visits, lifestyle, and self-efficacy were collected premigraine and postmigraine education program session. Two hundred and forty-eight patients attended the HEAD program and 177 (71%) consented to the study. Detailed predata and postdata were available for 152 participants (mean age 42.5 ± 11.9 years, 86% females); 117/150 (78%) presented with depressive symptoms and 90/146 (62%) presented with anxiety symptoms. One hundred and thirty-seven of 143 (96%) were using headache treatment. Eighty of 137 (58%) were overusing over-the-counter medications and only 21/137 (15%) were on preventative treatment.  There was a decrease in the MIDAS scores of participants at postsession testing prior to neurological consultation (pre-MIDAS mean 50.0

  14. Wait times to rheumatology care for patients with rheumatic diseases: a data linkage study of primary care electronic medical records and administrative data.

    PubMed

    Widdifield, Jessica; Bernatsky, Sasha; Thorne, J Carter; Bombardier, Claire; Jaakkimainen, R Liisa; Wing, Laura; Paterson, J Michael; Ivers, Noah; Butt, Debra; Lyddiatt, Anne; Hofstetter, Catherine; Ahluwalia, Vandana; Tu, Karen

    2016-01-01

    The Wait Time Alliance recently established wait time benchmarks for rheumatology consultations in Canada. Our aim was to quantify wait times to primary and rheumatology care for patients with rheumatic diseases. We identified patients from primary care practices in the Electronic Medical Record Administrative data Linked Database who had referrals to Ontario rheumatologists over the period 2000-2013. To assess the full care pathway, we identified dates of symptom onset, presentation in primary care and referral from electronic medical records. Dates of rheumatologist consultations were obtained by linking with physician service claims. We determined the duration of each phase of the care pathway (symptom onset to primary care encounter, primary care encounter to referral, and referral to rheumatologist consultation) and compared them with established benchmarks. Among 2430 referrals from 168 family physicians, 2015 patients (82.9%) were seen by 146 rheumatologists within 1 year of referral. Of the 2430 referrals, 2417 (99.5%) occurred between 2005 and 2013. The main reasons for referral were osteoarthritis (32.4%) and systemic inflammatory rheumatic diseases (30.6%). Wait times varied by diagnosis and geographic region. Overall, the median wait time from referral to rheumatologist consultation was 74 (interquartile range 27-101) days; it was 66 (interquartile range 18-84) days for systemic inflammatory rheumatic diseases. Wait time benchmarks were not achieved, even for the most urgent types of referral. For systemic inflammatory rheumatic diseases, most of the delays occurred before referral. Rheumatology wait times exceeded established benchmarks. Targeted efforts are needed to promote more timely access to both primary and rheumatology care. Routine linkage of electronic medical records with administrative data may help fill important gaps in knowledge about waits to primary and specialty care.

  15. Traffic pollutants measured inside vehicles waiting in line at a major US-Mexico Port of Entry.

    PubMed

    Quintana, Penelope J E; Khalighi, Mehdi; Castillo Quiñones, Javier Emmanuel; Patel, Zalak; Guerrero Garcia, Jesus; Martinez Vergara, Paulina; Bryden, Megan; Mantz, Antoinette

    2018-05-01

    At US-Mexico border Ports of Entry, vehicles idle for long times waiting to cross northbound into the US. Long wait times at the border have mainly been studied as an economic issue, however, exposures to emissions from idling vehicles can also present an exposure risk. Here we present the first data on in-vehicle exposures to driver and passengers crossing the US-Mexico border at the San Ysidro, California Port of Entry (SYPOE). Participants were recruited who regularly commuted across the border in either direction and told to drive a scripted route between two border universities, one in the US and one in Mexico. Instruments were placed in participants' cars prior to commute to monitor-1-minute average levels of the traffic pollutants ultrafine particles (UFP), black carbon (BC) and carbon monoxide (CO) in the breathing zone of drivers and passengers. Location was determined by a GPS monitor. Results reported here are for 68 northbound participant trips. The highest median levels of in-vehicle UFP were recorded during the wait to cross at the SYPOE (median 29,692particles/cm 3 ) significantly higher than the portion of the commute in the US (median 20,508particles/cm 3 ) though not that portion in Mexico (median 22, 191particles/cm 3 ). In-vehicle BC levels at the border were significantly lower than in other parts of the commute. Our results indicate that waiting in line at the SYPOE contributes a median 62.5% (range 15.5%-86.0%) of a cross-border commuter's exposure to UFP and a median 44.5% (range (10.6-79.7%) of exposure to BC inside the vehicle while traveling in the northbound direction. Reducing border wait time can significantly reduce in-vehicle exposures to toxic air pollutants such as UFP and BC, and these preventable exposures can be considered an environmental justice issue. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Rendering hospital budgets volume based and open ended to reduce waiting lists: does it work?

    PubMed

    van de Vijsel, Aart R; Engelfriet, Peter M; Westert, Gert P

    2011-04-01

    In the past decades fixed budgets for hospitals were replaced by reimbursement based on outputs in several countries in order to bring down waiting lists. This was also the case in the Netherlands where fixed global budgets were replaced by budgets that are to a large extent volume based and in practice open-ended. The objective of this study was to examine the effectiveness of this Dutch policy measure, which was implemented in 2001. We carried out a statistical analysis and interpretation of trends in Dutch hospital admission rates. We observed a significant turn in the development of in-patient admission rates after the abolition of budget caps in 2001: decreasing admission rates turned into an internationally exceptional increase of more than 3% per year. Day care admissions had already been rising explosively for two decades, but the pace increased after 2001. The increase in the number of admissions includes a broad range of patient categories that were not in the first place associated with long waiting times. The growth was attributable for a large part to admissions for observation of the patient and the evaluation of symptoms, not resulting in a definite medical diagnosis. We considered several factors, other than the availability of more resources, to explain the growth: the ageing of the population, making up for waiting list arrears, ditto for "under consumption" of unplanned care and, as to the growth of day care, substitution for inpatient care. However, these factors were all found to fall short as an explanation. Although waiting times have dropped since the change in the budget system, they continue to be long for several procedures. Our study indicates that making available more resources to admit patients, or otherwise an increase in hospital activity, do not in itself lead to equilibrium between demand and supply because the volume and composition of demand are partly induced by supply. We conclude that abolishing budget caps to solve waiting

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

    PubMed

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

    2017-05-01

    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. 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 short-term (i.e., 10.6

  18. Wait times for physical and occupational therapy in the public system for people with arthritis in quebec.

    PubMed

    Delaurier, Ashley; Bernatsky, Sasha; Raymond, Marie-Hélène; Feldman, Debbie Ehrmann

    2013-01-01

    Although arthritis is the leading cause of pain and disability in Canada, and physical therapy (PT) and occupational therapy (OT) are beneficial both for chronic osteoarthritis (OA) and for inflammatory arthritis such as rheumatoid arthritis (RA), there appear to be problems with access to such services. The aim of this study was to document wait times from referral by physician to consultation with PT or OT in the public health care system for people with arthritis in Quebec, Canada. Appointments were requested by telephone, using hypothetical case scenarios; wait times were defined as the time between initial request and appointment date. Descriptive statistics were used to examine the wait times in relation to diagnosis, service provider and geographic area. For both scenarios (OA and RA) combined, 13% were offered an appointment within 6 months, 13% offered given an appointment within 6-12 months, 24% were told they would need to wait longer than 12 months, and 22% were refused services. The remaining 28% were told they would require an evaluation appointment for functional assessment before being given an appointment for therapy. No difference was found between RA and OA diagnoses. Our study suggests that most people with arthritis living in the province of Quebec are not receiving publicly accessible PT or OT intervention in a timely manner.

  19. DIME Students Waiting for Their Turn to Drop Experiment

    NASA Technical Reports Server (NTRS)

    2002-01-01

    Students pause while waiting their turn at the 2.2-second Drop Tower during the second Dropping in a Microgravity Environment (DIME) competition held April 23-25, 2002, at NASA's Glenn Research Center. Competitors included two teams from Sycamore High School, Cincinnati, OH, and one each from Bay High School, Bay Village, OH, and COSI Academy, Columbus, OH. DIME is part of NASA's education and outreach activities. Details are on line at http://microgravity.grc.nasa.gov/DIME_2002.html.

  20. Socioeconomic status and waiting times for health services: An international literature review and evidence from the Italian National Health System.

    PubMed

    Landi, Stefano; Ivaldi, Enrico; Testi, Angela

    2018-04-01

    In the absence of priority criteria, waiting times are an implicit rationing instrument where the absence or limited use of prices creates an excess of demand. Even in the presence of priority criteria, waiting times may be unfair because they reduce health care demand of patients in lower socio-economic conditions due to high opportunity costs of time or a decay in their health level. Significant evidence has shown a relationship between socioeconomic status and the length of waiting time. The first phase of the study involved an extensive review of the existent literature for the period of 2002-2016 in the main databases (Scopus, PubMed and Science Direct). Twenty-eight met the eligibility criteria. The 27 papers were described and classified. The e mpirical objective of this study was to determine whether socioeconomic characteristics affect waiting time for different health services in the Italian national health system. The services studied were specialist visits, diagnostics tests and elective surgeries. A classification tree and logistic regression models were implemented. Data from the 2013 Italian Health National Survey were used. The analysis found heterogeneous results for different types of service. Individuals with lower education and economic resources have a higher risk of experiencing excessive waiting times for diagnostic and specialist visits. For elective surgery, socioeconomic inequalities are present but appear to be lower. Copyright © 2018 Elsevier B.V. All rights reserved.

  1. 29. Attic interior showing roof truss system over waiting room; ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    29. Attic interior showing roof truss system over waiting room; note knob-and-tube wiring system; brick section at far left is rear of tower, which of brick masonry construction above the first story level, joined to the exterior walls of stone masonry; view to southeast along axis of building, 90mm lens and electronic flash illumination. - Southern Pacific Depot, 559 El Camino Real, San Carlos, San Mateo County, CA

  2. Waiting-time distributions of magnetic discontinuities: clustering or Poisson process?

    PubMed

    Greco, A; Matthaeus, W H; Servidio, S; Dmitruk, P

    2009-10-01

    Using solar wind data from the Advanced Composition Explorer spacecraft, with the support of Hall magnetohydrodynamic simulations, the waiting-time distributions of magnetic discontinuities have been analyzed. A possible phenomenon of clusterization of these discontinuities is studied in detail. We perform a local Poisson's analysis in order to establish if these intermittent events are randomly distributed or not. Possible implications about the nature of solar wind discontinuities are discussed.

  3. Waiting-time distributions of magnetic discontinuities: Clustering or Poisson process?

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Greco, A.; Matthaeus, W. H.; Servidio, S.

    2009-10-15

    Using solar wind data from the Advanced Composition Explorer spacecraft, with the support of Hall magnetohydrodynamic simulations, the waiting-time distributions of magnetic discontinuities have been analyzed. A possible phenomenon of clusterization of these discontinuities is studied in detail. We perform a local Poisson's analysis in order to establish if these intermittent events are randomly distributed or not. Possible implications about the nature of solar wind discontinuities are discussed.

  4. Outcome Probability versus Magnitude: When Waiting Benefits One at the Cost of the Other

    PubMed Central

    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

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

    PubMed Central

    Tsai, Chun-Yen; Wang, Mu-Chia; Liao, Wei-Tsen; Lu, Jui-Heng; Sun, Pi-hung; Lin, Blossom Yen-Ju; Breen, Gerald-Mark

    2007-01-01

    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 characteristics when

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

    PubMed

    Tsai, Chun-Yen; Wang, Mu-Chia; Liao, Wei-Tsen; Lu, Jui-Heng; Sun, Pi-Hung; Lin, Blossom Yen-Ju; Breen, Gerald-Mark

    2007-12-05

    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. 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. 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. 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 characteristics when redesigning more comfortable and customized

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

    ERIC Educational Resources Information Center

    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)

  8. Traffic pollutant exposures experienced by pedestrians waiting to enter the U.S. at a major U.S.-Mexico border crossing

    NASA Astrophysics Data System (ADS)

    Galaviz, V. E.; Yost, M. G.; Simpson, C. D.; Camp, J. E.; Paulsen, M. H.; Elder, J. P.; Hoffman, L.; Flores, D.; Quintana, P. J. E.

    2014-05-01

    Pedestrians waiting to cross into the US from Mexico at Ports of Entry experience long wait times near idling vehicles. The near-road environment is associated with elevated pollutant levels and adverse health outcomes. This is the first exposure assessment conducted to quantify northbound pedestrian commuter exposure to traffic-related air pollutants at the U.S.-Mexico border San Ysidro Port of Entry (SYPOE). Seventy-three persons who regularly crossed the SYPOE in the pedestrian line and 18 persons who did not cross were recruited to wear personal air monitors for 24-h to measure traffic pollutants particulate matter less than 2.5 μm (PM2.5), 1-nitropyrene (1-NP) - a marker for diesel exhaust - and carbon monoxide (CO). Fixed site concentrations were collected at SYPOE and occurred during the time subjects were crossing northbound to approximate their exposure to 1-NP, ultrafine particles (UFP), PM2.5, CO, and black carbon (BC) while standing in line during their border wait. Subjects who crossed the border in pedestrian lanes had a 6-fold increase in exposure to 1-NP, a 3-fold increase in exposure to CO, and a 2-fold increase in exposure to gravimetric PM2.5, vs. non-border commuters. Univariate regression analysis for UFP (median 40,000 # cm-3) found that border wait time for vehicles explained 21% of variability and relative humidity 13%, but when modeled together neither predictor remained significant. Concentrations at the SYPOE of UFP, PM2.5, CO, and BC are similar to those in other near-roadway studies that show associations with acute and chronic adverse health effects. Although results are limited by small sample numbers, these findings warrant concern for adverse health effects experienced by pedestrian commuters waiting in a long northbound queue at SYPOE and demonstrates a potential health benefit of reduced wait times at the border.

  9. Waiting for the right time: how and why young Thai women manage to avoid heterosexual intercourse.

    PubMed

    Supametaporn, Pinhatai; Stern, Phyllis Noerager; Rodcumdee, Branom; Chaiyawat, Waraporn

    2010-08-01

    Nineteen young Thai women were purposively selected from networks of nongovernmental organizations involving children and youths in Bangkok. Our grounded theory findings indicated that these young women used the basic social process they called "waiting for the right time" in order to maintain heterosexual abstinence. Waiting for the right time involved one overarching condition, honoring parental love, and included three overlapping properties: learning rules, planning life path, and ways of preserving virginity. The findings provide information that may lead to the development of culturally competent interventions for middle-class Thai youths to remain healthy and avoid pregnancy.

  10. The PRCI study: design of a randomized clinical trial to evaluate a coping intervention for medical waiting periods used by women undergoing a fertility treatment.

    PubMed

    Ockhuijsen, Henrietta D L; van den Hoogen, Agnes; Macklon, Nickolas S; Boivin, Jacky

    2013-09-03

    Many medical situations necessitate a stressful period of waiting for potentially threatening test results. The medical waiting period is often associated with negative anticipatory anxiety and rumination about the outcome of treatment. Few evidence-based self-help coping interventions are available to assist individuals manage these periods. Theory and research suggest that positive reappraisal coping strategies may be particularly useful for this type of unpredictable and uncontrollable stressful context. The objective of this study is to investigate the effects of a Positive Reappraisal Coping Intervention (PRCI) on psychological well-being of women waiting for the outcome of their fertility treatment cycle. In a three-armed randomized controlled trial, the effectiveness of the PRCI will be tested. Consecutive patients undergoing in vitro fertilisation in a Dutch university hospital and meeting selection criteria will be invited to participate. Those who agree will be randomized to one of three experimental groups (N=372). The PRCI Intervention group will receive the intervention that comprises an explanatory leaflet and the 10 statements designed to promote positive reappraisal coping, to be read at least once in the morning, once in the evening. To capture the general impact of PRCI on psychological wellbeing patients will complete questionnaires before the waiting period (pre-intervention), on day ten of the 14-day waiting period (intervention) and six weeks after the start of the waiting period (post-intervention). To capture the specific effects of the PRCI during the waiting period, patients will also be asked to monitor daily their emotions and reactions during the 14-day waiting period. The primary outcome is general anxiety, measured by the Hospital Anxiety and Depression Scale. Secondary outcomes are positive and negative emotions during the waiting period, depression, quality of life, coping and treatment outcome. During recruitment for the RCT it was

  11. Rapid sequential determination of Pu, 90Sr and 241Am nuclides in environmental samples using an anion exchange and Sr-Spec resins.

    PubMed

    Lee, M H; Ahn, H J; Park, J H; Park, Y J; Song, K

    2011-02-01

    This paper presents a quantitative and rapid method of sequential separation of Pu, (90)Sr and (241)Am nuclides in environmental soil samples with an anion exchange resin and Sr Spec resin. After the sample solution was passed through an anion exchange column connected to a Sr Spec column, Pu isotopes were purified from the anion exchange column. Strontium-90 was separated from other interfering elements by the Sr Spec column. Americium-241 was purified from lanthanides by the anion exchange resin after oxalate co-precipitation. Measurement of Pu and Am isotopes was carried out using an α-spectrometer. Strontium-90 was measured by a low-level liquid scintillation counter. The radiochemical procedure of Pu, (90)Sr and (241)Am nuclides investigated in this study validated by application to IAEA reference materials and environmental soil samples. Copyright © 2010 Elsevier Ltd. All rights reserved.

  12. The influence of parametric and external noise in act-and-wait control with delayed feedback.

    PubMed

    Wang, Jiaxing; Kuske, Rachel

    2017-11-01

    We apply several novel semi-analytic approaches for characterizing and calculating the effects of noise in a system with act-and-wait control. For concrete illustration, we apply these to a canonical balance model for an inverted pendulum to study the combined effect of delay and noise within the act-and-wait setting. While the act-and-wait control facilitates strong stabilization through deadbeat control, a comparison of different models with continuous vs. discrete updating of the control strategy in the active period illustrates how delays combined with the imprecise application of the control can seriously degrade the performance. We give several novel analyses of a generalized act-and-wait control strategy, allowing flexibility in the updating of the control strategy, in order to understand the sensitivities to delays and random fluctuations. In both the deterministic and stochastic settings, we give analytical and semi-analytical results that characterize and quantify the dynamics of the system. These results include the size and shape of stability regions, densities for the critical eigenvalues that capture the rate of reaching the desired stable equilibrium, and amplification factors for sustained fluctuations in the context of external noise. They also provide the dependence of these quantities on the length of the delay and the active period. In particular, we see that the combined influence of delay, parametric error, or external noise and on-off control can qualitatively change the dynamics, thus reducing the robustness of the control strategy. We also capture the dependence on how frequently the control is updated, allowing an interpolation between continuous and frequent updating. In addition to providing insights for these specific models, the methods we propose are generalizable to other settings with noise, delay, and on-off control, where analytical techniques are otherwise severely scarce.

  13. High Emergency Lung Transplantation: dramatic decrease of waiting list death rate without relevant higher post-transplant mortality.

    PubMed

    Roux, Antoine; Beaumont-Azuar, Laurence; Hamid, Abdul Monem; De Miranda, Sandra; Grenet, Dominique; Briend, Guillaume; Bonnette, Pierre; Puyo, Philippe; Parquin, François; Devaquet, Jerome; Trebbia, Gregoire; Cuquemelle, Elise; Douvry, Benoit; Picard, Clément; Le Guen, Morgan; Chapelier, Alain; Stern, Marc; Sage, Edouard

    2015-09-01

    Many candidates for lung transplantation (LT) die on the waiting list, raising the question of graft availability and strategy for organ allocation. We report the experience of the new organ allocation program, "High Emergency Lung Transplantation" (HELT), since its implementation in our center in 2007. Retrospective analysis of 201 lung transplant patients, of whom 37 received HELT from 1st July 2007 to 31th May 2012. HELT candidates had a higher impairment grade on respiratory status and higher Lung Allocation Score (LAS). HELT patients had increased incidence of perioperative complications (e.g., perioperative bleeding) and extracorporeal circulatory assistance (75% vs. 36.6%, P = 0.0005). No significant difference was observed between HELT and non-HELT patients in mechanical ventilation duration (15.5 days vs. 11 days, P = 0.27), intensive care unit length of stay (15 days vs. 10 days, P = 0.22) or survival rate at 12 (81% vs. 80%), and 24 months post-LT (72.9% vs. 75.0%). Lastly, mortality on the waiting list was spectacularly reduced from 19% to 2% when compared to the non-HELT 2004-2007 group. Despite a more severe clinical status of patients on the waiting list, HELT provided similar results to conventional LT. These results were associated with a dramatic reduction in the mortality rate of patients on the waiting list. © 2015 Steunstichting ESOT.

  14. SCREEN: A simple layperson administered screening algorithm in low resource international settings significantly reduces waiting time for critically ill children in primary healthcare clinics.

    PubMed

    Hansoti, Bhakti; Jenson, Alexander; Kironji, Antony G; Katz, Joanne; Levin, Scott; Rothman, Richard; Kelen, Gabor D; Wallis, Lee A

    2017-01-01

    In low resource settings, an inadequate number of trained healthcare workers and high volumes of children presenting to Primary Healthcare Centers (PHC) result in prolonged waiting times and significant delays in identifying and evaluating critically ill children. The Sick Children Require Emergency Evaluation Now (SCREEN) program, a simple six-question screening algorithm administered by lay healthcare workers, was developed in 2014 to rapidly identify critically ill children and to expedite their care at the point of entry into a clinic. We sought to determine the impact of SCREEN on waiting times for critically ill children post real world implementation in Cape Town, South Africa. This is a prospective, observational implementation-effectiveness hybrid study that sought to determine: (1) the impact of SCREEN implementation on waiting times as a primary outcome measure, and (2) the effectiveness of the SCREEN tool in accurately identifying critically ill children when utilised by the QM and adherence by the QM to the SCREEN algorithm as secondary outcome measures. The study was conducted in two phases, Phase I control (pre-SCREEN implementation- three months in 2014) and Phase II (post-SCREEN implementation-two distinct three month periods in 2016). In Phase I, 1600 (92.38%) of 1732 children presenting to 4 clinics, had sufficient data for analysis and comprised the control sample. In Phase II, all 3383 of the children presenting to the 26 clinics during the sampling time frame had sufficient data for analysis. The proportion of critically ill children who saw a professional nurse within 10 minutes increased tenfold from 6.4% to 64% (Phase I to Phase II) with the median time to seeing a professional nurse reduced from 100.3 minutes to 4.9 minutes, (p < .001, respectively). Overall layperson screening compared to Integrated Management of Childhood Illnesses (IMCI) designation by a nurse had a sensitivity of 94.2% and a specificity of 88.1%, despite large variance

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

    NASA Technical Reports Server (NTRS)

    1999-01-01

    STS-103 Mission Specialist John M. Grunsfeld (Ph.D.) 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 Commander Curtis L. Brown Jr., Pilot Scott J. Kelly, and Mission Specialists Steven L. Smith, C. Michael Foale (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.

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

    NASA Technical Reports Server (NTRS)

    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.

  17. Using Social Media While Waiting in Pain: A Clinical 12-Week Longitudinal Pilot Study.

    PubMed

    Merolli, Mark; Gray, Kathleen; Martin-Sanchez, Fernando; Mantopoulos, Steven; Hogg, Malcolm

    2015-08-07

    Chronic pain places an enormous burden on health care systems. Multidisciplinary pain management services are well documented as an effective means to improve patient outcomes. However, waiting lists to access these services are long and outcomes deteriorate. Innovative solutions such as social media are gaining attention as a way to decrease this burden and improve outcomes. It is a challenge to design research that demonstrates whether social media are acceptable to patients and clinically effective. The aim was to conduct a longitudinal pilot study to understand what aspects of research design are key to the success of running a larger-scale study of social media use in the clinical management of chronic pain. A 12-week study examined social media use by patients on the waiting list for the Royal Melbourne Hospital Pain Management Service. Selected social media resources were suggested for use by patients waiting for an appointment at the clinic. Patients filled out measures for pain interference and pain self-efficacy before and after the study. Follow-up was conducted at monthly intervals via telephone semistructured interviews to discuss engagement and garner individual perceptions towards social media use. A social media-use instrument was also administered as part of the after-study questionnaire. Targeted recruitment refined 235 patient referrals to 138 (58.7%) suitable potential participants. Contact was made with 84 out of 138 (60.9%) patients. After a further exclusion of 54 out of 84 (64%) patients for various reasons, this left 30 out of 84 (36%) patients fitting the inclusion criteria and interested in study participation. A final study cohort of 17 out of 30 (57%) was obtained. Demographics of the 17 patients were mixed. Low back pain was the primary condition reported as leading to chronic pain. Semistructured interviews collected data from 16 out of 17 (94%) patients who started the trial, and at final follow-up 9 out of 17 (53%) patients

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

    PubMed

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

    2016-10-01

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

  19. Applying ISO 11929:2010 Standard to detection limit calculation in least-squares based multi-nuclide gamma-ray spectrum evaluation

    NASA Astrophysics Data System (ADS)

    Kanisch, G.

    2017-05-01

    The concepts of ISO 11929 (2010) are applied to evaluation of radionuclide activities from more complex multi-nuclide gamma-ray spectra. From net peak areas estimated by peak fitting, activities and their standard uncertainties are calculated by weighted linear least-squares method with an additional step, where uncertainties of the design matrix elements are taken into account. A numerical treatment of the standard's uncertainty function, based on ISO 11929 Annex C.5, leads to a procedure for deriving decision threshold and detection limit values. The methods shown allow resolving interferences between radionuclide activities also in case of calculating detection limits where they can improve the latter by including more than one gamma line per radionuclide. The co"mmon single nuclide weighted mean is extended to an interference-corrected (generalized) weighted mean, which, combined with the least-squares method, allows faster detection limit calculations. In addition, a new grouped uncertainty budget was inferred, which for each radionuclide gives uncertainty budgets from seven main variables, such as net count rates, peak efficiencies, gamma emission intensities and others; grouping refers to summation over lists of peaks per radionuclide.

  20. The Watch-and-Wait Task: On the Reliability and Validity of a New Method of Assessing Self-Control in Preschool Children

    ERIC Educational Resources Information Center

    Neubauer, Anna; Gawrilow, Caterina; Hasselhorn, Marcus

    2012-01-01

    A preschooler's ability to delay gratification in the waiting task is predictive of several developmental outcomes, despite this task's relatively low reliability level. Success in this task depends on the use of distraction strategies. The new Watch-and-Wait Task (WWT) has been developed to enhance reliability and to investigate whether the…