Editorial

Full text: Welcome to issue 1 of 2012 and a belated Happy New Year to all CLAE readers and BCLA members. The hardest job I had for this issue was to decide which papers to include and which papers to hang on to and save for issue 2 of 2012. At the end of December when I was choosing the content for this issue there were additional 5 papers that could have been included. The final choice came down to various factors; such as first come first served – i.e. which papers had been ready and waiting the longest; secondly which papers had been submitted the earliest; are there similar papers so that it may be beneficial to publish them alongside this paper; and also was the content something which needed to be out there quicker than other papers as it was a current hot topic? But it should be noted that once papers are proofed and deemed ready by authors they are published in the epub version and put online for others to see in their final version. An epub version is given a DOI number (digital object identifier) so that it can be cited by other authors. Apart from being on line the only other difference is that an epub version is essentially waiting to be assigned to a particular issue. So those papers that are being held off for issue 2 of this year are actually already available for you to read (and cite) on line. In this issue there is a paper related to the cost of different contact lens replacement schedules – this may be a topic that is debated more in the future since as a society we are thinking more ‘green’ and all trying to help by reducing our carbon footprint, whether that be by recycling or using less in the first place. A timely review paper on the management of allergic eye disease may help us to better manage those patients we see in the spring with pollen allergies. We have two papers looking at different aspects in keratoconus patients, another looking at a modified fluoret strip and its application in measuring tear break up time and a review paper on corneal erosions. Another interesting paper comes from Professor Harminder Dua and his team. Professor Dua is the UK Royal College of Ophthalmologists’ president and has been interested in corneal anatomy and physiology for much of his research career. Finally, an unusual case of an ocular injury related to a snake bite. Overall I would say there is enough to sink your ‘fangs’ into! Finally, it gives me great pleasure in announcing the newest person to join our Editorial Board, Dr Florence Malet. Dr Malet is an Ophthalmologist and since September 2000 she has been at the Bordeaux Hospital in France developing the Contact Lens Unit of in the Ophthalmology University Department. She is ex-president of the French Contact Lens Society and president of the European Contact Lens Society of Ophthalmologists.

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.

Combined quality function deployment and logical framework analysis to improve quality of emergency care in Malta

Purpose – The purpose of this paper is to develop an integrated patient-focused analytical framework to improve quality of care in accident and emergency (A&E) unit of a Maltese hospital. Design/methodology/approach – The study adopts a case study approach. First, a thorough literature review has been undertaken to study the various methods of healthcare quality management. Second, a healthcare quality management framework is developed using combined quality function deployment (QFD) and logical framework approach (LFA). Third, the proposed framework is applied to a Maltese hospital to demonstrate its effectiveness. The proposed framework has six steps, commencing with identifying patients’ requirements and concluding with implementing improvement projects. All the steps have been undertaken with the involvement of the concerned stakeholders in the A&E unit of the hospital. Findings – The major and related problems being faced by the hospital under study were overcrowding at A&E and shortage of beds, respectively. The combined framework ensures better A&E services and patient flow. QFD identifies and analyses the issues and challenges of A&E and LFA helps develop project plans for healthcare quality improvement. The important outcomes of implementing the proposed quality improvement programme are fewer hospital admissions, faster patient flow, expert triage and shorter waiting times at the A&E unit. Increased emergency consultant cover and faster first significant medical encounter were required to start addressing the problems effectively. Overall, the combined QFD and LFA method is effective to address quality of care in A&E unit. Practical/implications – The proposed framework can be easily integrated within any healthcare unit, as well as within entire healthcare systems, due to its flexible and user-friendly approach. It could be part of Six Sigma and other quality initiatives. Originality/value – Although QFD has been extensively deployed in healthcare setup to improve quality of care, very little has been researched on combining QFD and LFA in order to identify issues, prioritise them, derive improvement measures and implement improvement projects. Additionally, there is no research on QFD application in A&E. This paper bridges these gaps. Moreover, very little has been written on the Maltese health care system. Therefore, this study contributes demonstration of quality of emergency care in Malta.

Preferences of Hungarian consumers for quality, access and price attributes of health care services — result of a discrete choice experiment

In 2010, a household survey was carried out in Hungary among 1037 respondents to study consumer preferences and willingness to pay for health care services. In this paper, we use the data from the discrete choice experiments included in the survey, to elicit the preferences of health care consumers about the choice of health care providers. Regression analysis is used to estimate the effect of the improvement of service attributes (quality, access, and price) on patients’ choice, as well as the differences among the socio-demographic groups. We also estimate the marginal willingness to pay for the improvement in attribute levels by calculating marginal rates of substitution. The results show that respondents from a village or the capital, with low education and bad health status are more driven by the changes in the price attribute when choosing between health care providers. Respondents value the good skills and reputation of the physician and the attitude of the personnel most, followed by modern equipment and maintenance of the office/hospital. Access attributes (travelling and waiting time) are less important. The method of discrete choice experiment is useful to reveal patients’ preferences, and might support the development of an evidence-based and sustainable health policy on patient payments.

Adatbányászati alkalmazások lehetőségei egy multinacionális vállalat magyarországi leányvállalatának információs rendszerében (Opportunities of datamining applications in the information system of a multinational company’s Hungarian subsidiary)

A tanulmány Magyarország egyik legnagyobb foglalkoztatójának megrendelésére készült abból a célból, hogy milyen megoldásokkal lehetne a vállalati működést hatékonyabbá tenni. Ennek keretében a szerzők megvizsgálták, hol tart ma a HR adatbányászati kutatás a világban. Milyen eszközök állnak rendelkezésre ahhoz, hogy a munkavállalói elmenetelt előre jelezzék, illetve figyeljék, valamint milyen lehetőség van a hálózati kutatások felhasználására a biztonság területén. Szerencsés, hogy a vállalkozói kérdések és erőforrások találkozhattak a kutatói szféra aktuális kutatási területeivel. A tanulmány szerzői úgy gondolják, hogy a cikkben megfogalmazott állítások, következtetések, eredmények a jövőben hasznosíthatók lesznek a vállalat és más cégek számára is. _____ The authors were pleased to take part in this research project initiated by one of Hungary’s largest employer. The goal of the project was to work out BI solutions to improve upon their business process. In the framework of the project first the authors made a survey on the current trends in the world of HR datamining. They reviewed the available tools for the prediction of employee promotion and investigated the question on how to utilize results achieved in social network analysis in the field of enterprise security. When real business problems and resources meet the mainstream research of the scientific community it is always a fortunate and it is rather fruitful. The authors are certain that the results published in this document will be beneficial for Foxconn in the near future. Of course, they are not done. There are continually new research perspectives opening up and huge amount of information is accumulating in the enterprises just waiting for getting discovered and analysed. Also the environment in which an enterprise operates is dynamically changing and thus the company faces new challenges and new type of business problems arise. The authors are in the hope that their research experience will help decision makers also in the future to solve real world business problems.

Facets of operational performance in an emergency room (ER)

This paper, using detailed time measurements of patients complemented by interviews with hospital management and staff, examines three facets of an emergency room's (ER) operational performance: (1) effectiveness of the triage system in rationing patient treatment; (2) factors influencing ER's operational performance in general and the trade-offs in flow times, inventory levels (that is the number of patients waiting in the system), and resource utilization; (3) the impacts of potential process and staffing changes to improve the ER's performance. Specifically, the paper discusses four proposals for streamlining the patient flow: establishing designated tracks (fast track, diagnostic track), creating a holding area for certain type of patients, introducing a protocol that would reduce the load on physicians by allowing a registered nurse to order testing and treatment for some patients, and potentially and in the longer term, moving from non-ER specialist physicians to ER specialists. The paper's findings are based on analyzing the paths and flow times of close to two thousand patients in the emergency room of the Medical Center of Leeuwarden (MCL), The Netherlands. Using exploratory data analysis the paper presents generalizable findings about the impacts of various factors on ER's lead-time performance and shows how the proposals fit with well-documented process improvement theories. © 2010 Elsevier B.V. All rights reserved.

Development of a medium-capacity guideway transit planning guide

Rapid population increase and booming economic growth have caused a significant escalation in car ownership in many cities, leading to additional or, multiple traffic problems on congested roadways. The increase of automobiles is generating a significant amount of congestion and pollution in many cities. It has become necessary to find a solution to the ever worsening traffic problems in our cities. Building more roadways is nearly impossible due to the limitations of right-of-way in cities. Studies have shown that guideway transit could provide effective transportation and could stimulate land development. The Medium-Capacity Guideway Transit (MCGT) is one of the alternatives to solve this problem. The objective of this research was to better understand the characteristics of MCGT systems, to investigate the existing MCGT systems around the world and determine the main factors behind the planning of successful systems, and to develop a MCGT planning guide. The factors utilized in this study were determined and were analyzed using Excel. A MCGT Planning Guide was developed using Microsoft Visual Basic. ^ A MCGT was defined as a transit system whose capacity can carry up to 20,000 passengers per hour per direction (pphpd). The results shown that Light Rail Transit (LRT) is favored when peak hour demand is less than 13,000 pphpd. Automated People Mover (APM) is favored when the peak hour demand is more than 18,000 pphpd. APM systems could save up to three times the waiting time cost compared to that of the LRT. If comfort and convenience are important, then using an APM does make sense. However, if cost is the critical factor, then LRT will make more sense because it is reasonable service at a reasonable price. If travel time and safety (accident/crush) costs were included in calculating life-cycle “total” costs, the capital cost advantage of LRT disappeared and APM could become very competitive. The results also included a range of cost-performance criteria for MCGT systems that help planners, engineers, and decision-makers to select the most feasible system for their respective areas. ^

Business process quantitative analysis and optimization for service industries

The total time a customer spends in the business process system, called the customer cycle-time, is a major contributor to overall customer satisfaction. Business process analysts and designers are frequently asked to design process solutions with optimal performance. Simulation models have been very popular to quantitatively evaluate the business processes; however, simulation is time-consuming and it also requires extensive modeling experiences to develop simulation models. Moreover, simulation models neither provide recommendations nor yield optimal solutions for business process design. A queueing network model is a good analytical approach toward business process analysis and design, and can provide a useful abstraction of a business process. However, the existing queueing network models were developed based on telephone systems or applied to manufacturing processes in which machine servers dominate the system. In a business process, the servers are usually people. The characteristics of human servers should be taken into account by the queueing model, i.e. specialization and coordination. ^ The research described in this dissertation develops an open queueing network model to do a quick analysis of business processes. Additionally, optimization models are developed to provide optimal business process designs. The queueing network model extends and improves upon existing multi-class open-queueing network models (MOQN) so that the customer flow in the human-server oriented processes can be modeled. The optimization models help business process designers to find the optimal design of a business process with consideration of specialization and coordination. ^ The main findings of the research are, first, parallelization can reduce the cycle-time for those customer classes that require more than one parallel activity; however, the coordination time due to the parallelization overwhelms the savings from parallelization under the high utilization servers since the waiting time significantly increases, thus the cycle-time increases. Third, the level of industrial technology employed by a company and coordination time to mange the tasks have strongest impact on the business process design; as the level of industrial technology employed by the company is high; more division is required to improve the cycle-time; as the coordination time required is high; consolidation is required to improve the cycle-time. ^

Toward A Better Understanding of the Evolution of Hotel Development: A Discussion of Product-specific Lodging Demand

In his essay - Toward a Better Understanding of the Evolution of Hotel Development: A Discussion of Product-Specific Lodging Demand - by John A. Carnella, Consultant, Laventhol & Horwath, cpas, New York, Carnella initially describes his piece by stating: “The diversified hotel product in the united states lodging market has Resulted in latent room-night demand, or supply-driven demand resulting from the introduction of a lodging product which caters to a specific set of hotel patrons. The subject has become significant as the lodging market has moved toward segmentation with regard to guest room offerings. The author proposes that latent demand is a tangible, measurable phenomenon best understood in light of the history of the guest room product from its infancy to its present state.” The article opens with an ephemeral depiction of hotel development in the United States, both pre’ and post World War II. To put it succinctly, the author wants you to know that the advent of the inter-state highway system changed the complexion of the hotel industry in the U.S. “Two essential ingredients were necessary for the next phase of hotel development in this country. First was the establishment of the magnificently intricate infrastructure which facilitated motor vehicle transportation in and around the then 48 states of the nation,” says Carnella. “The second event…was the introduction of affordable highway travel. Carnella goes on to say that the next – big thing – in hotel evolution was the introduction of affordable air travel. “With the airways filled with potential lodging guests, developers moved next to erect a new genre of hotel, the airport hotel,” Carnella advances his picture. Growth progressed with the arrival of the suburban hotel concept, which wasn’t fueled by developments in transportation, but by changes in people’s living habits, i.e. suburban affiliations as opposed to urban and city population aggregates. The author explores the distinctions between full-service and limited service lodging operations. “The market of interest with consideration to the extended-stay facility is one dominated by corporate office parks,” Carnella proceeds. These evolutional states speak to latent demand, and even further to segmentation of the market. “Latent demand… is a product-generated phenomenon in which the number of potential hotel guests increases as the direct result of the introduction of a new lodging facility,” Carnella brings his unique insight to the table with regard to the specialization process. The demand is already there; just waiting to be tapped. In closing, “…there must be a consideration of the unique attributes of a lodging facility relative to its ability to attract guests to a subject market, just as there must be an examination of the property's ability to draw guests from within the subject market,” Carnella proposes.

Avaliação do desenvolvimento infantil e a influência dos fatores biopsicossociais em crianças com cardiopatia congênita

Child development is the result of the interaction of biological, psychological and social factors. Hostile environment, income, offered stimuli, as well as the presence of a chronic illness are issues that may interfere significantly. Considering the chronic diseases, we can identify congenital heart disease (CHD) is characterized by anatomical heart defects and functional and currently has presented an incidence of up to 1% of the population of live births. This research aimed to evaluate child development and verify an association with the commitment by biopsychosocial factors of children with and without CHD. Study participants were children from zero to six years, divided into three groups: Group1- 29 children pre-surgical congenital heart disease, Group2- 43 children post-surgical cardiac patients and Group3- 56 healthy children. The instruments used were a biopsychosocial questionnaire and the Screening Test Denver II. Of the total of 128 children evaluated, 66 (51.56%) are girls, and ages ranged from two months to six years (median 24.5 months). In G1 and G2 predominated acyanotic heart disease (55.2% and 58.1%). Regarding the Denver II reviews, children with heart disease had more development ratings "suspicious" and "suspect/abnormal", and 41.9% of children who have gone through surgery had characterized its development as "suspect/abnormal" . In the group of healthy children 53.6% were classified as developmental profile "normal" (p = ˂0,0001). On the areas of Denver II, among children with heart disease was greatest change in motor areas (p = 0.016, p = ˂0,001). The biopsychosocial variables that were related to a possible developmental delay were gender (p = 0.042), child's age (p = 0.0001) and income per capita (p = 0.019). There were no associations between the variables related to the treatment of disease, information, understanding of the disease and the way parents treat their children. In the group of healthy children showed that children who underwent hospitalization rates were more changes in development (p = 0.025) and the higher the number of admissions over these changes have intensified (p = 0.023). The results suggest that children with congenital heart disease have likely delayed development. It was also observed that there is a significant difference between the children who have gone through surgery, those who are still waiting for surgery only doing clinical follow-up. Changes in the development are more connected motor areas can be explained by the characteristic features of the disease and treatment, such as dyspnea, fatigue, care and limitations in daily activities. The gender and age appear to be decisive in the development as well as healthy children go through hospitalization experience. Already in children with heart disease, it was realized that social variables involved in the disease and the treatment did not affect the development. This question can be understood by means of protective factors and resiliency, as this population receives family and social support.

Esforços governamentais locais para o desenvolvimento: desenhos, tendências e limites dos Fundos de Desenvolvimento Industrial nos estados do Rio Grande do Norte, Maranhão e Ceará (1985-2010)

This research aimed to analyze the main government efforts to promote economic development in the Northeast, from 1985 to 2010, under the view that growth is crucial for increasing industrialization process and allows for more significant growth patterns. The analysis was the context in which state governments react to the abandonment of developmental line the federal level, in the 1980s, incorporating features of the actions called endogenous regional development and providing local players with greater responsibility in the development process. Justifies the need to analyze the following scenario: state governments in northeastern Brazil using relevant part of its resources to finance the installation and expansion of companies through tax incentives, with a view to generating income and employment, whilst waiting for an increase in output and a positive change in economic dynamism. In addition, it puts in question the fact that these policies receive such importance of state administrations for the purpose of achieving regional development. It was left to consider, therefore, the contents of the shares elected by state governments to examine the scope of these policies both in the pattern of growth, the transformation of the industrial sector and the development of the region attention to changes in state production structures. Due to limitations on the availability of data and time to carry out research, we were elected three states for the study: Rio Grande do Norte, Ceará and Maranhão. The study found that, despite the contribution of policies analyzed to economic growth, sub-national states are unable to compensate for the lack of development agencies structured at the federal level.

Vazios urbanos e a dinâmica imobiliária na produção do espaço em Natal

In Brazil, the discussion about the urban voids appear related to the capitalist urban expansion process, when the urban growth act the cities were expanding toward the periphery, leaving in the interstices vacant land, kept out of the market waiting for the real estate valuation. In Natal, the formation of voids was triggered by the process of fragmentation of space promoted mainly by the urban sprawl with the emergence of new neighborhoods, lots of openings, housing developments and the emergence of new lines of commercial centrality. In this sense, this study aims to understand the role played by urban voids in the real estate dynamics and the production process of the Natal city space. For this, it was adressed the concept building on the conception of different authors and were characterized four types of gaps that best explained the phenomenon in the context of the work proposal addressed, such as idle, empty expectant, empty-brownfield areas and institutional areas. For each of these events were considered an example in the general context of the city through semi-structured interviews with technicians, managers and public officials in promoting the city and /or related to management of urban voids.

Transplantes de córneas no estado do Rio Grande do Norte: aspectos epidemiológicos e clínicos

This study aimed to characterize in a clinical and epidemiological way the patients who are on a waiting list for transplantation and the patients transplanted with corneal tissue in a corneal transplants reference service in the state of Rio Grande do Norte. It is an epidemiological study of a quantitative approach, with cross-sectional, descriptive and analytical cut including all patients on the waiting list for transplantation (population A) and the patients already transplanted with a corneal tissue (population B) in a reference service. In population A, there was a census conducted of patients on the waiting list for corneal transplantation (n=62 patients). In population B, the sample was non-probabilistic and corresponded to all corneal transplants performed in the service in the period from 2010 to 2014 (n=258). This study is approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte, in Opinion 876 177 and CAAE 37533014.8.0000.5537. Data were collected in full in the period from January to April 2015, by two instruments built to systematize the necessary data collection. After being coded and tabulated, data were analyzed using the Statistical Package for Social Sciences software, version 20.0. The definition of variables and their distribution patterns were presented as frequencies and measures of central tendency while, for multivariate analysis, the effect of magnitude measures were applied (prevalence ratio) and measures of association (chi-square test or Fisher's exact test) for a 0.05 significance level. The results are shown in two scientific articles coming from the field survey data. It was found that the epidemiological profile of patients on the waiting list (n=62) showed a prevalence of individuals aged over 50 years old, female (54.84%) and residents of the middle region of East Rio Grande do Norte (66.13%). The clinical profile of patients with corneal transplantation (n=258) was characterized by being male (51.16%) with an average age of 49.33 years old and 57.75% were coming from East Rio Grande do Norte. The average time on the waiting list was 172.63 days in elective transplants and 9.03 days in urgent transplants. Keratoconus was the main indicator condition to perform the transplant. For patients on the waiting list, the variable “type of disorder of the cornea” showed statistically significant association with gender and age. For patients with corneal transplants, the variable "type of disorder of the cornea" was associated with the variables gender, age, previous surgery, failure of previous graft, classification of the eye and glaucoma. By characterizing the clinical and epidemiological profile of corneal transplants, it is possible to question the reality, pointing about the care that should be offered and develop targeted interventions to collective and individual needs intrinsic to patients who need this surgery as a treatment option.

Otimização de parâmetros mecânicos e microestruturais dos moldes em areia de sílica ligados quimicamente pelo processo de cura a frio em fundição de aço

Surface defects on steel parts borne costs of smelting industries due to the need of rework. Sand molds are frequently used in foundry industries and largely responsible for providing surface defects. This study aims to optimize the levels of the molding process variables to minimize the occurrence of surface defects in steel castings in silica sand molds chemically linked by cold cure process. The methodology used the experimental design with split plot, being considered in the study the resin percentage factors in the mold formulation, addition of iron oxide, type of paint, the paint application method, amount of ink layers, use of hot air along the lines and waiting time of the mold before casting. They were analyzed as response variables erosion defects, sand inclusion, penetration, porosity and surface finish. Tensile strength tests were performed to evaluate the influence of factors on mechanical parameters and the microstructural parameters were carried out the analysis of X-ray diffraction, scanning electron microscopy (SEM) and thermal analysis (TG / DSC / dilatometry). The results elucidate that for the faulty erosion, the only significant factor with a 95% confidence level was the type of ink and the ink alumina-based superior results obtained. For the sand inclusion of defect, there were three significant factors, with best results obtained with alumina-based paint and spray applied using hot air in the mold before casting the metal. For the defect penetration, there were four significant factors, the best results being achieved with 0.8% of resin and addition of iron oxide in the molding formulation, the paint being applied by brush and standby time of 24 hours before leak. For the defect porosity with a 95% confidence level, no significant factors. For the defect surface finish, the best results were achieved with the 0.8% formulation of the resin in the mold and application of the paint brush. To obtain the levels of the factors that optimize all defects simultaneously, we performed a weighted average of the results of each type of fault, concluding that the best levels of the factors were: 0.8% resin and addition of iron oxide in the formulation of the template, application of two coats of paint applied with a brush or spray, using hot air in the mold before casting and 24 hours of waiting ready the mold before casting. These levels of the optimized factors were used in an experiment to confirm that ratified the results, helping to reduce rework and consequently reducing costs of cast steel parts.

Estudo da Acessibilidade Organizacional aos Serviços de Saúde Bucal de um Município de Pequeno Porte do Nordeste Brasileiro

Objective: This study aimed to evaluate the accessibility to oral health services in Santa Cruz (RN), focusing on the organizational aspect which is characterized by variables like delay in getting consultation, waiting lines, difficulty scheduling appointments, lack of material, among others. Material and Methods: For such purpose, questionnaires were addressed to 194 users’ houses based on census tract. Results: It has been found that 12.9% of the population has never gone to the dentist’s office, and that the service demand has not been affected by users’ individual and socioeconomic characteristics, except for gender. Data have revealed that 36.1% of users went to the dentist’s in less than a year. In addition, the youngest users are among those who seek the dentist’s office more frequently (p<0.05). 63.3% of the interviewees have reported they find some kind of difficulty when seek for dental care, and 43.2% of users have waited three weeks or more for assistance. It is also noteworthy that 7.4% of the interviewees have been finding difficulties in getting access to urgency care, and that long wait for the consultation is the most frequently cited matter. Conclusion: It could be verified that accessibility to oral health services in the municipality of Santa Cruz (RN) has been hampered by factors related to public policies organization, especially with regards to the work process.