Better queue management in a busy public hospital of a developing country without appointment system::an application using data envelopment analysis

Queuing is a key efficiency criterion in any service industry, including Healthcare. Almost all queue management studies are dedicated to improving an existing Appointment System. In developing countries such as Pakistan, there are no Appointment Systems for outpatients, resulting in excessive wait times. Additionally, excessive overloading, limited resources and cumbersome procedures lead to over-whelming queues. Despite numerous Healthcare applications, Data Envelopment Analysis (DEA) has not been applied for queue assessment. The current study aims to extend DEA modelling and demonstrate its usefulness by evaluating the queue system of a busy public hospital in a developing country, Pakistan, where all outpatients are walk-in; along with construction of a dynamic framework dedicated towards the implementation of the model. The inadequate allocation of doctors/personnel was observed as the most critical issue for long queues. Hence, the Queuing-DEA model has been developed such that it determines the ‘required’ number of doctors/personnel. The results indicated that given extensive wait times or length of queue, or both, led to high target values for doctors/personnel. Hence, this crucial information allows the administrators to ensure optimal staff utilization and controlling the queue pre-emptively, minimizing wait times. The dynamic framework constructed, specifically targets practical implementation of the Queuing-DEA model in resource-poor public hospitals of developing countries such as Pakistan; to continuously monitor rapidly changing queue situation and display latest required personnel. Consequently, the wait times of subsequent patients can be minimized, along with dynamic staff scheduling in the absence of appointments. This dynamic framework has been designed in Excel, requiring minimal training and work for users and automatic update features, with complex technical aspects running in the background. The proposed model and the dynamic framework has the potential to be applied in similar public hospitals, even in other developing countries, where appointment systems for outpatients are non-existent.

区分服务网络中主动队列管理算法

现有区分服务网络的保证转发服务可提供稳定的带宽保证,但缺乏保证时延和分组丢失性能的有效方案.基于对RIO队列的稳态性能分析,提出两种自适应调整控制策略的主动队列管理算法(ARIO-D和ARIO-L).仿真结果表明,这两种算法在保持RIO算法带宽保证能力的同时,还可以提供稳定的和可区分的时延和分组丢失性能.采用ARIO-D和ARIO-L的保证转发服务可以为多媒体流量提供多种服务质量的定量保证. Current assured forwarding (AF) service in differentiated services (DiffServ) networks can provide stable guarantees in throughput, but is lacking of efficient schemes in ensuring queuing delay and loss ratio. By analyzing the steady state operating point of RIO, this paper proposes two active queue management algorithms with adaptive control policy, namely ARIO-D and ARIO-L. These two algorithms can provide differentiated performance in, respectively, queuing delay and loss ratio, in addition to throughput guarantee. By deploying ARIO-D and ARIO-L, AF service can provide quantitative guarantees for multimedia traffic with multiple QoS metrics.

Assessing the queuing process using data envelopment analysis:an application in health centres

Queuing is one of the very important criteria for assessing the performance and efficiency of any service industry, including healthcare. Data Envelopment Analysis (DEA) is one of the most widely-used techniques for performance measurement in healthcare. However, no queue management application has been reported in the health-related DEA literature. Most of the studies regarding patient flow systems had the objective of improving an already existing Appointment System. The current study presents a novel application of DEA for assessing the queuing process at an Outpatients’ department of a large public hospital in a developing country where appointment systems do not exist. The main aim of the current study is to demonstrate the usefulness of DEA modelling in the evaluation of a queue system. The patient flow pathway considered for this study consists of two stages; consultation with a doctor and pharmacy. The DEA results indicated that waiting times and other related queuing variables included need considerable minimisation at both stages.

Challenges for expatriate managers:an exploration of cross-cultural management, adjustment, and training issues faced by Anglo-American managers in Hong Kong

This field work study furthers understanding about expatriate management, in particular, the nature of cross-cultural management in Hong Kong involving Anglo-American expatriate and Chinese host national managers, the important features of adjustment for expatriates living and working there, and the type of training which will assist them to adjust and to work successfully in this Asian environment. Qualitative and quantitative data on each issue was gathered during in-depth interviews in Hong Kong, using structured interview schedules, with 39 expatriate and 31 host national managers drawn from a cross-section of functional areas and organizations. Despite the adoption of Western technology and the influence of Western business practices, micro-level management in Hong Kong retains a cultural specificity which is consistent with the norms and values of Chinese culture. There are differences in how expatriates and host nationals define their social roles, and Hong Kong's recent colonial history appears to influence cross-cultural interpersonal interactions. The inability of the spouse and/or family to adapt to Hong Kong is identified as a major reason for expatriate assignments to fail, though the causes have less to do with living away from family and friends, than with Hong Kong's highly urbanized environment and the heavy demands of work. Culture shock is not identified as a major problem, but in Hong Kong micro-level social factors require greater adjustment than macro-level societal factors. The adjustment of expatriate managers is facilitated by a strong orientation towards career development and hard work, possession of technical/professional expertise, and a willingness to engage in a process of continuous 'active learning' with respect to the host national society and culture. A four-part model of manager training suitable for Hong Kong is derived from the study data. It consists of a pre-departure briefing, post-arrival cross-cultural training, language training in basic Cantonese and in how to communicate more effectively in English with non-native speakers, and the assignment of a mentor to newly arrived expatriate managers.

Career management practices in India:an empirical study

This paper examines and discusses the developments in the field of career management, bringing in the international perspective. In particular, the paper explores career management practices in 108 Indian organizations. A factor analysis procedure suggested five groups of practices: formal planning, formal active management, developmental, career stages and assessment. These are found to be associated with certain organizational and cultural characteristics. The research has both theoretical and practical implications.

Mild cognitive decline. A position statement of the Cognitive Decline Group of the European Innovation Partnership for Active and Healthy Ageing (EIPAHA)

Introduction Mild cognitive impairment (MCI) is a term used to describe a level of decline in cognition which is seen as an intermediate stage between normal ageing and dementia, and which many consider to be a prodromal stage of neurodegeneration that may become dementia. That is, it is perceived as a high risk level of cognitive change. The increasing burden of dementia in our society, but also our increasing understanding of its risk factors and potential interventions, require diligent management of MCI in order to find strategies that produce effective prevention of dementia. Aim To update knowledge regarding mild cognitive impairment, and to bring together and appraise evidence about the main features of clinical interest: definitions, prevalence and stability, risk factors, screening, and management and intervention. Methods Literature review and consensus of expert opinion. Results and conclusion MCI describes a level of impairment in which deteriorating cognitive functions still allow for reasonable independent living, including some compensatory strategies. While there is evidence for some early risk factors, there is still a need to more precisely delineate and distinguish early manifestations of frank dementia from cognitive impairment that is less likely to progress to dementia, and furthermore to develop improved prospective evidence for positive response to intervention. An important limitation derives from the scarcity of studies that take MCI as an endpoint. Strategies for effective management suffer from the same limitation, since most studies have focused on dementia. Behavioural changes may represent the most cost-effective approach.

Distributed processing, reconfigurable processes and active network

The fast spread of the Internet and the increasing demands of the service are leading to radical changes in the structure and management of underlying telecommunications systems. Active networks (ANs) offer the ability to program the network on a per-router, per-user, or even per-packet basis, thus promise greater flexibility than current networks. To make this new network paradigm of active network being widely accepted, a lot of issues need to be solved. Management of the active network is one of the challenges. This thesis investigates an adaptive management solution based on genetic algorithm (GA). The solution uses a distributed GA inspired by bacterium on the active nodes within an active network, to provide adaptive management for the network, especially the service provision problems associated with future network. The thesis also reviews the concepts, theories and technologies associated with the management solution. By exploring the implementation of these active nodes in hardware, this thesis demonstrates the possibility of implementing a GA based adaptive management in the real network that being used today. The concurrent programming language, Handel-C, is used for the description of the design system and a re-configurable computer platform based on a FPGA process element is used for the hardware implementation. The experiment results demonstrate both the availability of the hardware implementation and the efficiency of the proposed management solution.

An adaptive scheduling scheme for fair bandwidth allocation

Class-based service differentiation is provided in DiffServ networks. However, this differentiation will be disordered under dynamic traffic loads due to the fixed weighted scheduling. An adaptive weighted scheduling scheme is proposed in this paper to achieve fair bandwidth allocation among different service classes. In this scheme, the number of active flows and the subscribed bandwidth are estimated based on the measurement of local queue metrics, then the scheduling weights of each service class are adjusted for the per-flow fairness of excess bandwidth allocation. This adaptive scheme can be combined with any weighted scheduling algorithm. Simulation results show that, comparing with fixed weighted scheduling, it effectively improve the fairness of excess bandwidth allocation.

Semantic annotation for knowledge management:requirements and a survey of the state of the art

While much of a company's knowledge can be found in text repositories, current content management systems have limited capabilities for structuring and interpreting documents. In the emerging Semantic Web, search, interpretation and aggregation can be addressed by ontology-based semantic mark-up. In this paper, we examine semantic annotation, identify a number of requirements, and review the current generation of semantic annotation systems. This analysis shows that, while there is still some way to go before semantic annotation tools will be able to address fully all the knowledge management needs, research in the area is active and making good progress.

An in-vitro-in-vivo model for the transdermal delivery of cholecalciferol for the purposes of rodent management

The natural selection of anticoagulant resistant rats has resulted in a need for an alternative to anticoagulant rodenticides which differs in both active ingredient and in the method of dosing. Cholecalciferol toxicity to rodents using the dermal route is demonstrated using a variety of penetration enhancing formulations in two in-vitro models and finally in-vivo. A 1 ml dose of 50/50 (v/v) DMSO/ethanol containing 15% (v/v) PEG 200 and 20% (w/v) cholecalciferol was judged as 'sufficiently effective' in line with the European Union's Biocidal Products Regulation (No. 528/2012) during in-vivo studies. This dose was found to cause 100% mortality in a rat population in 64.4 h (±22 h).

E-blogspot in the teaching of strategic management

E-learning and e-learning applications/tools are available to all educators thanks to the evolution of technology and the internet. Although a great variety of technologies are available it is not always obvious how these can be integrated in traditional teaching to support and enhance the learning experience. The majority of the existing literature proposes the use of blogging as an activity that students should do in order to increase their active participation in learning. This article presents the use of blogspots in the teaching of Strategic Management as a tool used to create greater linkages between theory and practice, discussing the evolution of its utilisation in my modules, the current state of use and a series of reflections on experience gained from its use so far. Overall, I have found that there is limited literature on how blogging could link to teaching activities and its utilisation should be viewed as learning by doing which is evaluated and improved by critical reflection of the user.

Global trends in myopia management attitudes and strategies in clinical practice

PURPOSE: Myopia is a global public health issue; however, no information exists as to how potential myopia retardation strategies are being adopted globally. METHODS: A self-administrated, internet-based questionnaire was distributed in six languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy and adoption of available strategies, and reasons for not adopting specific strategies. RESULTS: Of the 971 respondents, concern was higher (median 9/10) in Asia than in any other continent (7/10, p<0.001) and they considered themselves more active in implementing myopia control strategies (8/10) than Australasia and Europe (7/10), with North (4/10) and South America (5/10) being least proactive (p<0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by increased time outdoors and pharmaceutical approaches, with under-correction and single vision spectacles felt to be the least effective (p<0.05). Although significant intra-regional differences existed, overall most practitioners 67.5 (±37.8)% prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients. The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (35.6%), inadequate information (33.3%) and the unpredictability of outcomes (28.2%). CONCLUSIONS: Regardless of practitioners' awareness of the efficacy of myopia control techniques, the vast majority still prescribe single vision interventions to young myopes. In view of the increasing prevalence of myopia and existing evidence for interventions to slow myopia progression, clear guidelines for myopia management need to be established.

FOCUS : frailty management optimisation through EIPAHA commitments and utilisation of stakeholders’ input – an innovative European project in elderly care

The goal of FOCUS, which stands for Frailty Management Optimization through EIPAHA Commitments and Utilization of Stakeholders’ Input, is to reduce the burden of frailty in Europe. The partners are working on advancing knowledge of frailty detection, assessment, and management, including biological, clinical, cognitive and psychosocial markers, in order to change the paradigm of frailty care from acute intervention to prevention. FOCUS partners are working on ways to integrate the best available evidence from frailty-related screening tools, epidemiological and interventional studies into the care of frail people and their quality of life. Frail citizens in Italy, Poland and the UK and their caregivers are being called to express their views and their experiences with treatments and interventions aimed at improving quality of life. The FOCUS Consortium is developing pathways to leverage the knowledge available and to put it in the service of frail citizens. In order to reach out to the broadest audience possible, the FOCUS Platform for Knowledge Exchange and the platform for Scaling Up are being developed with the collaboration of stakeholders. The FOCUS project is a development of the work being done by the European Innovation Partnership on Active and Healthy Ageing (EIPAHA), which aims to increase the average healthy lifespan in Europe by 2020 while fostering sustainability of health/social care systems and innovation in Europe. The knowledge and tools developed by the FOCUS project, with input from stakeholders, will be deployed to all EIPAHA participants dealing with frail older citizens to support activities and optimize performance.