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.

A túl- és az alulképzés bérhozama 25 európai országban (Returns for over-education and under-education for 25 European countries)

A tanulmányban 25 ország, kétezres évek közepi állapotot tükröző, reprezentatív keresztmetszeti mintáin egyrészt a Duncan-Hoffman-féle modellre támaszkodva megvizsgáljuk, hogy adatbázisunk milyen mértékben tükrözi az illeszkedés bérhozamával foglalkozó irodalom legfontosabb empirikus következtetéseit, másrészt - a Hartog- Oosterbeek-szerzőpáros által javasolt statisztikai próbák segítségével - azt elemezzük, hogy a becslések eredményei alapján mit mondhatunk Mincer emberitőke-, valamint Thurow állásversenymodelljének érvényességéről. Heckman szelekciós torzítást kiküszöbölő becslőfüggvényén alapuló eredményeink jórészt megerősítik az irodalomban vázolt legfontosabb empirikus sajátosságokat, ugyanakkor a statisztikai próbák az országok többségére nézve cáfolják mind az emberi tőke, mind az állásverseny modelljének empirikus érvényességét. / === / Using the Duncan–Hoffman model, the paper estimates returns for educational mismatch using comparable micro data for 25 European countries. The aim is to gauge the extent to which the main empirical regularities shown in other papers on the subject are confirmed by this data base. Based on tests proposed by Hartog and Oosterbeek, the author also considers whether the observed empirical patterns accord with the Mincerian basic human-capital model and Thurow's job-competition model. Heckman's sample-selection estimator shows the returns to be fairly consistent with those found in the literature; the job-competition model and the Mincerian human-capital model can be rejected for most countries.

Intra-industry agri-food trade of the Baltic Countries

The article analyses patterns and country-specific determinants of the Baltic Countries agri-food trade with the European Union. Literature focusing on the country-specific determinants of vertical and horizontal intra-industry trade is rather limited and those analysing agricultural (or agri-food) trade are extremely rare. Therefore, the paper seeks to contribute to the literature by covering latest theory and data available on the topic to provide up to date results and suggestions. Moreover, it seeks to identify the determinants of horizontal and vertical intra-industry trade of the Baltic Countries after EU accession. Results suggest that agri-food trade of these countries is mainly inter-industry in nature but intra-industry trade is dominated by vertical elements. Results verify that determinants of horizontal and vertical IIT differ and suggest that economic size is positively, while factor endowments and distance are negatively related to both sides of IIT. However, the relationship between IIT and FDI is ambiguous.

The impact of the recession on health care expenditure — How does the Czech Republic, Hungary, Poland and Slovakia compare to other OECD countries?

In the past few years, several papers have been published in the international literature on the impact of the economic crisis on health and health care. However, there is limited knowledge on this topic regarding the Central and Eastern European (CEE) countries. The main aims of this study are to examine the effect of the financial crisis on health care spending in four CEE countries (the Czech Republic, Hungary, Poland and Slovakia) in comparison with the OECD countries. In this paper we also revised the literature for economic crisis related impact on health and health care system in these countries. OECD data released in 2012 were used to examine the differences in growth rates before and after the financial crisis. We examined the ratio of the average yearly growth rates of health expenditure expressed in USD (PPP) between 2008–2010 and 2000–2008. The classification of the OECD countries regarding “development” and “relative growth” resulted in four clusters. A large diversity of “relative growth” was observed across the countries in austerity conditions, however the changes significantly correlate with the average drop of GDP from 2008 to 2010. To conclude, it is difficult to capture visible evidence regarding the impact of the recession on the health and health care systems in the CEE countries due to the absence of the necessary data. For the same reason, governments in this region might have a limited capability to minimize the possible negative effects of the recession on health and health care systems.

The impact of the recession on health care expenditure — How does the Czech Republic, Hungary, Poland and Slovakia compare to other OECD countries?

In the past few years, several papers have been published in the international literature on the impact of the economic crisis on health and health care. However, there is limited knowledge on this topic regarding the Central and Eastern European (CEE) countries. The main aims of this study are to examine the effect of the financial crisis on health care spending in four CEE countries (the Czech Republic, Hungary, Poland and Slovakia) in comparison with the OECD countries. In this paper we also revised the literature for economic crisis related impact on health and health care system in these countries. OECD data released in 2012 were used to examine the differences in growth rates before and after the financial crisis. We examined the ratio of the average yearly growth rates of health expenditure expressed in USD (PPP) between 2008–2010 and 2000–2008. The classification of the OECD countries regarding “development” and “relative growth” resulted in four clusters. A large diversity of “relative growth” was observed across the countries in austerity conditions, however the changes significantly correlate with the average drop of GDP from 2008 to 2010. To conclude, it is difficult to capture visible evidence regarding the impact of the recession on the health and health care systems in the CEE countries due to the absence of the necessary data. For the same reason, governments in this region might have a limited capability to minimize the possible negative effects of the recession on health and health care systems.

Resource allocation in multi-user telecommunication networks

This dissertation discussed resource allocation mechanisms in several network topologies including infrastructure wireless network, non-infrastructure wireless network and wire-cum-wireless network. Different networks may have different resource constrains. Based on actual technologies and implementation models, utility function, game theory and a modern control algorithm have been introduced to balance power, bandwidth and customers' satisfaction in the system. ^ In infrastructure wireless networks, utility function was used in the Third Generation (3G) cellular network and the network was trying to maximize the total utility. In this dissertation, revenue maximization was set as an objective. Compared with the previous work on utility maximization, it is more practical to implement revenue maximization by the cellular network operators. The pricing strategies were studied and the algorithms were given to find the optimal price combination of power and rate to maximize the profit without degrading the Quality of Service (QoS) performance. ^ In non-infrastructure wireless networks, power capacity is limited by the small size of the nodes. In such a network, nodes need to transmit traffic not only for themselves but also for their neighbors, so power management become the most important issue for the network overall performance. Our innovative routing algorithm based on utility function, sets up a flexible framework for different users with different concerns in the same network. This algorithm allows users to make trade offs between multiple resource parameters. Its flexibility makes it a suitable solution for the large scale non-infrastructure network. This dissertation also covers non-cooperation problems. Through combining game theory and utility function, equilibrium points could be found among rational users which can enhance the cooperation in the network. ^ Finally, a wire-cum-wireless network architecture was introduced. This network architecture can support multiple services over multiple networks with smart resource allocation methods. Although a SONET-to-WiMAX case was used for the analysis, the mathematic procedure and resource allocation scheme could be universal solutions for all infrastructure, non-infrastructure and combined networks. ^

Resources, strategies, location determinants, and host country location choice by emerging market firms

The extant literature had studied the determinants of the firms’ location decisions with help of host country characteristics and distances between home and host countries. Firm resources and its internationalization strategies had found limited attention in this literature. To address this gap, the research question in this dissertation was whether and how firms’ resources and internationalization strategies impacted the international location decisions of emerging market firms. ^ To explore the research question, data were hand-collected from Indian software firms on their location decisions taken between April 2000 and March 2009. To analyze the multi-level longitudinal dataset, hierarchical linear modeling was used. The results showed that the internationalization strategies, namely market-seeking or labor-seeking had direct impact on firms’ location decision. This direct relationship was moderated by firm resource which, in case of Indian software firms, was the appraisal at CMMI level-5. Indian software firms located in developed countries with a market-seeking strategy and in emerging markets with a labor-seeking strategy. However, software firms with resource such as CMMI level-5 appraisal, when in a labor-seeking mode, were more likely to locate in a developed country over emerging market than firms without the appraisal. Software firms with CMMI level-5 appraisal, when in market-seeking mode, were more likely to locate in a developed country over an emerging market than firms without the appraisal. ^ It was concluded that the internationalization strategies and resources of companies predicted their location choices, over and above the variables studied in the theoretical field of location determinants.^

Forest Resource Islands in a Sub-tropical Marsh: Soil–Site Relationships in Everglades Hardwood Hammocks

Spatial heterogeneity in soils is often characterized by the presence of resource-enriched patches ranging in size from a single shrub to wooded thickets. If the patches persist long enough, the primary constraint on production may transition from one limiting environmental factor to another. Tree islands that are scattered throughout the Florida Everglades basin comprise nutrient-enriched patches, or resource islands, in P-limited oligotrophic marshes. We used principal component analysis and multiple regressions to characterize the belowground environment (soil, hydrology) of one type of tree island, hardwood hammocks, and examined its relationship with the three structural variables (basal area, biomass, and canopy height) indicative of site productivity. Hardwood hammocks in the southern Everglades grow on two distinct soil types. The first, consisting of shallow, organic, relatively low-P soils, is common in the seasonally flooded Marl Prairie landscape. In contrast, hammocks on islands embedded in long hydroperiod marsh have deeper, alkaline, mineral soils with extremely high P concentrations. However, this edaphic variation does not translate simply into differences in forest structure and production. Relative water depth was unrelated to all measures of forest structure and so was soil P, but the non-carbonate component of the mineral soil fraction exhibited a strong positive relationship with canopy height. The development of P-enriched forest resource islands in the Everglades marsh is accompanied by the buildup of a mineral soil; however, limitations on growth in mature islands appear to differ substantively from those that dominate incipient stages in the transformation from marsh to forest. Key words: resource island; tree

A study of stock market linkages between the US and frontier countries

My dissertation investigates the financial linkages and transmission of economic shocks between the US and the smallest emerging markets (frontier markets). The first chapter sets up an empirical model that examines the impact of US market returns and conditional volatility on the returns and conditional volatilities of twenty-one frontier markets. The model is estimated via maximum likelihood; utilizes the GARCH model of errors, and is applied to daily country data from the MSCI Barra. We find limited, but statistically significant exposure of Frontier markets to shocks from the US. Our results suggest that it is not the lagged US market returns that have impact; rather it is the expected US market returns that influence frontier market returns The second chapter sets up an empirical time-varying parameter (TVP) model to explore the time-variation in the impact of mean US returns on mean Frontier market returns. The model utilizes the Kalman filter algorithm as well as the GARCH model of errors and is applied to daily country data from the MSCI Barra. The TVP model detects statistically significant time-variation in the impact of US returns and low, but statistically and quantitatively important impact of US market conditional volatility. The third chapter studies the risk-return relationship in twenty Frontier country stock markets by setting up an international version of the intertemporal capital asset pricing model. The systematic risk in this model comes from covariance of Frontier market stock index returns with world returns. Both the systematic risk and risk premium are time-varying in our model. We also incorporate own country variances as additional determinants of Frontier country returns. Our results suggest statistically significant impact of both world and own country risk in explaining Frontier country returns. Time-variation in the world risk premium is also found to be statistically significant for most Frontier market returns. However, own country risk is found to be quantitatively more important.

The Impact of the Internet in Six Latin American Countries

Access to the Internet has grown exponentially in Latin America over the past decade. The International Telecommunications Union (ITU) estimates that in 2009 there were 144.5 million Internet users in South America, 6.4 million in Central America, and 8.2 million in the Caribbean, or a total 159.2 million users in all of Latin America.1 At that time, ITU reported an estimated 31 million Internet users in Mexico, which would bring the overall number of users in Latin America to 190.2 million people. More recent estimates published by Internet World Stats place Internet access currently at an estimated 204.6 million out of a total population of 592.5 million in the region (this figure includes Mexico).2 According to those figures, 34.5 per cent of the Latin American population now enjoys Internet access. In recent years, universal access policies contributed to the vast increase in digital literacy and Internet use in Argentina, Brazil, Chile, Colombia, and Costa Rica. Whereas the latter was the first country in the region to adopt a policy of universal access, the most expansive and successful digital inclusion programs in the region have taken hold in Brazil and Chile. These two countries have allocated considerable resources to the promotion of digital literacy and Internet access among low income and poor populations; in both cases, civil society groups significantly assisted in the promotion of inclusion at the grassroots level. Digital literacy and Internet access have come to represent, particularly in the area of education, a welcome complementary resource for populations chronically underserved in nations with a long-standing record of inadequate public social services. Digital inclusion is vastly expanding throughout the region, thanks to stabilizing economies, increasingly affordable technology, and the rapid growth in the supply of cellular mobile telephony. A recent study by the global advertising agency Razorfish revealed significant shifts in the demographics of digital inclusion in the major economies of South America, where Web access is rapidly increasing amid the lower middle class and the working poor.3 Several researchers have suggested that Internet access will bring about greater civic participation and engagement, although skeptics remain unsure this could happen in Latin America. Yet, there have been some recent instances of political mobilization facilitated through the use of the Web and social media applications, starting in Chile when “smart mobs” nationwide demonstrated against former Chilean President Michelle Bachelet when she failed to enact education reforms in May 2006. The Internet has also been used by marginalized groups and by guerrillas groups to highlight their stories. In sum, Internet access in Latin is no longer a medium restricted to the elite. It is rather a public sphere upon which civil society has staked its claim. Some of the examples noted in this study point toward a developing trend whereby civil society, through online grassroots movements, is able to effectively pressure public officials, instill transparency and demand accountability in government. Access to the Internet has also made it possible for voices on the margins to participate in the conversation in a way that was never previously feasible. 1 International Telecommunications Union [ITU], “Information Technology Public & Report,” accessed May 15, 2011, http://www.itu.int/. 2 Internet World Stats, “Internet Usage Statistics for the Americas,” accessed March 24, 2011, http://www.internetworldstats.com/stats2.htm 3 J. Crump, “The finch and the fox,” London, UK (2010), http://www.slideshare.net/razorfishmarketing/the-finch-and-the-fox.

Metacommunity Structure Along Resource and Disturbance Gradients in Everglades Wetlands

We evaluated metacommunity hypotheses of landscape arrangement (indicative of dispersal limitation) and environmental gradients (hydroperiod and nutrients) in structuring macroinvertebrate and fish communities in the southern Everglades. We used samples collected at sites from the eastern boundary of the southern Everglades and from Shark River Slough, to evaluate the role of these factors in metacommunity structure. We used eigenfunction spatial analysis to model community structure among sites and distance-based redundancy analysis to partition the variability in communities between spatial and environmental filters. For most animal communities, hydrological parameters had a greater influence on structure than nutrient enrichment, however both had large effects. The influence of spatial effects indicative of dispersal limitation was weak and only periphyton infauna appeared to be limited by regional dispersal. At the landscape scale, communities were well-mixed, but strongly influenced by hydrology. Local-scale species dominance was influenced by water-permanence and nutrient enrichment. Nutrient enrichment is limited to water inflow points associated with canals, which may explain its impact in this data set. Hydroperiod and nutrient enrichment are controlled by water managers; our analysis indicates that the decisions they make have strong effects on the communities at the base of the Everglades food web.

Learning leadership: a resource for aspiring nurse leaders

Background/purpose – Nurse leaders play a key role in the growth of the nursing profession; hence the development of future leaders is essential. Despite its importance, opportunities for leadership development can be limited. The purpose of the practicum project was to develop a comprehensive, yet concise resource to assist aspiring nurse leaders in their journey towards effective leadership. Methods – The methods used to achieve the practicum objectives were: (a) explore the literature and complete a comprehensive review (b) conduct expert consultations with current nurse leaders, and (c) develop a learning resource for aspiring nurse leaders. Results – The literature review and expert consultations highlighted the importance of effectively developing aspiring nurse leaders. The information obtained allowed for the development of a comprehensive learning resource. A detailed background, leadership theory, leadership framework, leader competencies and learning activities are presented throughout the resource. Conclusion – In order to for the nursing profession to continue to advance, effective nurse leaders are of paramount importance. However, it is essential that aspiring leaders are given appropriate opportunities for development. The learning resource was developed to provide aspiring leaders with a comprehensive tool to enhance their leadership development.

Reviewing mHealth in developing countries: A stakeholder perspective

Infrastructural deficiencies, limited access to medicare, and shortage of health care workers are just a few of the barriers to health care in developing countries. As a consequence, the burden of disease and its impact on the livelihoods and the economic productivity of people are staggering. mHealth has been extolled as one possible solution to overcoming these challenges, yet discussion of mHealth systems is often limited to specific tasks and user groups. To address this, we adopt a stakeholder perspective and analyze existing research on the mHealth process in developing countries. Specifically, we focus on three key stakeholder groups, i.e. healthcare workers, patients, and system developers. We perform an in-depth analysis of 60 peer-reviewed studies to determine the extent to which different mHealth stakeholder interactions are researched, and to identify high-level themes emerging within these interactions. This analysis illustrates two key gaps in existing mHealth research. First, while interactions involving healthcare workers and/or patients have received significant attention, relatively little research has looked at the role of patient-to-patient interactions. Second, the interactions between system developers and the other stakeholder groups are strikingly under-represented. We conclude by calling for more mHealth research that explicitly addresses these stakeholder interactions.

Policy mixes for resource efficiency – conceptual issues, design and assessment challenges

Since the 1950s the global consumption of natural resources has skyrocketed, both in magnitude and in the range of resources used. Closely coupled with emissions of greenhouse gases, land consumption, pollution of environmental media, and degradation of ecosystems, as well as with economic development, increasing resource use is a key issue to be addressed in order to keep the planet Earth in a safe and just operating space. This requires thinking about absolute reductions in resource use and associated environmental impacts, and, when put in the context of current re-focusing on economic growth at the European level, absolute decoupling, i.e., maintaining economic development while absolutely reducing resource use and associated environmental impacts. Changing behavioural, institutional and organisational structures that lock-in unsustainable resource use is, thus, a formidable challenge as existing world views, social practices, infrastructures, as well as power structures, make initiating change difficult. Hence, policy mixes are needed that will target different drivers in a systematic way. When designing policy mixes for decoupling, the effect of individual instruments on other drivers and on other instruments in a mix should be considered and potential negative effects be mitigated. This requires smart and time-dynamic policy packaging. This Special Issue investigates the following research questions: What is decoupling and how does it relate to resource efficiency and environmental policy? How can we develop and realize policy mixes for decoupling economic development from resource use and associated environmental impacts? And how can we do this in a systemic way, so that all relevant dimensions and linkages—including across economic and social issues, such as production, consumption, transport, growth and wellbeing­—are taken into account? In addressing these questions, the overarching goals of this Special Issue are to: address the challenges related to more sustainable resource-use; contribute to the development of successful policy tools and practices for sustainable development and resource efficiency (particularly through the exploration of socio-economic, scientific, and integrated aspects of sustainable development); and inform policy debates and policy-making. The Special Issue draws on findings from the EU and other countries to offer lessons of international relevance for policy mixes for more sustainable resource-use, with findings of interest to policy makers in central and local government and NGOs, decision makers in business, academics, researchers, and scientists.