Reducing voter waiting time : how to allocate voting machines to the polls.

Mode of access: Internet.

Patients in waiting:A qualitative study of type 2 diabetes patients' perceptions of diagnosis

Objective. Our aim was to examine how diagnosis is perceived by a sample of newly diagnosed type 2 diabetes patients. Methods. A qualitative study was carried out in the Lothian region of Scotland using in-depth interviews of 40 newly diagnosed type 2 diabetes patients recruited from 16 general practices in four Local Health Care Co-operatives and three hospital clinics. Purposive selection ensured that the sample's demographic characteristics were broadly representative of newly diagnosed type 2 diabetes patients in Lothian/Scotland. Results. Clarity, timing and authority of the diagnosis delivery were highly salient for patients. Many patients perceived their GP as unwilling to deliver/confirm the diagnosis. Patients who were not referred to hospital were unclear why a referral had not taken place. Those referred perceived confirmation of diagnosis by the consultant as a central reason. Waiting for a hospital appointment could be problematic for patients. Most wanted the diagnosis confirmed before they felt confident making lifestyle changes. Input from health services during the period prior to the hospital visit was highly valued. Waiting was taken by some asymptomatic patients to indicate that they did not have the condition. Others used a lengthy period of waiting to confirm their view that they had a 'milder' or 'less serious' form of diabetes than other patients. Conclusions. Adequate input from practitioners is needed to ensure that diagnosis is fully exploited as a crucial period in which patients learn to adapt to their condition. Being explicit about the diagnosis at first contact may avoid the problem of patients feeling 'in limbo' or uncertain whether they have type 2 diabetes. Practitioners should convey to patients that post-diagnosis/initial care is a process, stages of this process should be clarified to avoid misunderstanding and services should be integrated during this interim period to best effect. © Oxford University Press 2004; all rights reserved.

Which rationing rule does a single consumer follow?

We will investigate the amount of residual demand in a market consisting of only one consumer and two producers. Since there is only one consumer, we cannot really speak about a rationing rule, but we can ask ourselves whether a known rationing rule reflects the consumer’s utility maximizing behavior. We will show that, if the consumer has a Cobb-Douglas utility function, then the amount purchased by the consumer from the high-price firm lies between the values determined according to the efficient rationing rule and the random rationing rule. We will show further, that if the consumer has a quasilinear utility function, then in the economically interesting case his residual demand function will be equal to the residual demand function under efficient rationing.

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.

Optimization of waiting time at toll plazas

Toll plazas have several toll payment types such as manual, automatic coin machines, electronic and mixed lanes. In places with high traffic flow, the presence of toll plaza causes a lot of traffic congestion; this creates a bottleneck for the traffic flow, unless the correct mix of payment types is in operation. The objective of this research is to determine the optimal lane configuration for the mix of the methods of payment so that the waiting time in the queue at the toll plaza is minimized. A queuing model representing the toll plaza system and a nonlinear integer program have been developed to determine the optimal mix. The numerical results show that the waiting time can be decreased at the toll plaza by changing the lane configuration. For the case study developed an improvement in the waiting time as high as 96.37 percent was noticed during the morning peak hour.

Waiting room at an abortion clinic

General note: Title and date provided by Bettye Lane.

Homeless woman waiting for bus to take her to women's shelter for the night

General note: Title and date provided by Bettye Lane.

Homeless women waiting for bus to take them to women's shelter

General note: Title and date provided by Bettye Lane.

Women waiting in line at Battery Park

Inscriptions: Verso: [stamped] Photograph by Freda Leinwand. [463 West Street, Studio 229G, New York, NY 10014].

We Are the Ones We Have Been Waiting for: Pan-African Consciousness Raising and Organizing in the United States and Venezuela

We Are the Ones We Have Been Waiting for: Pan-African Consciousness Raising and Organizing in the United States and Venezuela, draws on fifteen months of field research accompanying organizers, participating in protests, planning/strategy meetings, state-run programs, academic conferences and everyday life in these two countries. Through comparative examination of the processes by which African Diaspora youth become radically politicized, this work deconstructs tendencies to deify political s/heroes of eras past by historicizing their ascent to political acclaim and centering the narratives of present youth leading movements for Black/African liberation across the Diaspora. I employ Manuel Callahan’s description of “encuentros”, “the disruption of despotic democracy and related white middle-class hegemony through the reconstruction of the collective subject”; “dialogue, insurgent learning, and convivial research that allows for a collective analysis and vision to emerge while affirming local struggles” to theorize the moments of encounter, specifically, the moments (in which) Black/African youth find themselves becoming politically radicalized and by what. I examine the ways in which Black/African youth organizing differs when responding to their perpetual victimization by neoliberal, genocidal state-politics in the US, and a Venezuelan state that has charged itself with the responsibility of radically improving the quality of life of all its citizens. Through comparative analysis, I suggest the vertical structures of “representative democracy” dominating the U.S. political climate remain unyielding to critical analyses of social stratification based on race, gender, and class as articulated by Black youth. Conversely, I contend that present Venezuelan attempts to construct and fortify more horizontal structures of “popular democracy” under what Hugo Chavez termed 21st Century Socialism, have resulted in social fissures, allowing for a more dynamic and hopeful negation between Afro-Venezuelan youth and the state.

‘Failure to maintain’: care rationing and the clinical and financial burden of nurse sensitive hospital-acquired complications in complex older patients

Background: The ageing population, with concomitant increase in chronic conditions, is increasing the presence of older people with complex needs in hospital. People with dementia are one of these complex populations and are particularly vulnerable to complications in hospital. Registered nurses can offer simultaneous assessment and intervention to prevent or mitigate hospital-acquired complications through their skilled brokerage between patient needs and hospital functions. A range of patient outcome measures that are sensitive to nursing care has been tested in nursing work environments across the world. However, none of these measures have focused on hospitalised older patients. Method: This thesis explores nursing-sensitive complications for older patients with and without dementia using an internationally recognised, risk-adjusted patient outcome approach. Specifically explored are: the differences between rates of complications; the costs of complications; and cost comparisons of patient complexity. A retrospective cohort study of an Australian state’s 2006–07 public hospital discharge data was utilised to identify patient episodes for people over age 50 (N=222,440) where dementia was identified as a primary or secondary diagnosis (N=44,422). Extra costs for patient episodes were estimated based on length of stay (LOS) above the average for each patient’s Diagnosis Related Group (DRG) (N=157,178) and were modelled using linear regression analysis to establish the strongest patient complexity predictors of cost. Results: Hospitalised patients with a primary or secondary diagnosis of dementia had higher rates of complications than did their same-age peers. The highest rates and relative risk for people with dementia were found in four key complications: urinary tract infections; pressure injuries; pneumonia, and delirium. While 21.9% of dementia patients (9,751/44,488, p<0.0001) suffered a complication, only 8.8% of non-dementia patients did so (33,501/381,788, p<0.0001), giving dementia patients a 2.5 relative risk of acquiring a complication (p<0.0001). These four key complications in patients over 50 both with and without dementia were associated with an eightfold increase in length of stay (813%, or 3.6 days/0.4 days) and double the increased estimated mean episode cost (199%, or A$16,403/ A$8,240). These four complications were associated with 24.7% of the estimated cost of additional days spent in hospital in 2006–07 in NSW (A$226million/A$914million). Dementia patients accounted for 22.0% of these costs (A$49million/A$226million) even though they were only 10.4% of the population (44,488/426,276 episodes). Hospital-acquired complications, particularly for people with a comorbidity of dementia, cost more than other kinds of inpatient complexity but admission severity was a better predictor of excess cost. Discussion: Four key complications occur more often in older patients with dementia and the high rate of these complications makes them expensive. These complications are potentially preventable. However, the care that can prevent them (such as mobility, hydration, nutrition and communication) is known to be rationed or left unfinished by nurses. Older hospitalised people who have complex needs, such as those with dementia, are more likely to experience care rationing as their care tends to take longer, be less predictable and less curative in nature. This thesis offers the theoretical proposition that evidence-based nursing practices are rationed for complex older patients and that this rationed care contributes to functional and cognitive decline during hospitalisation. This, in turn, contributes to the high rates of complications observed. Thus four key complications can be seen as a ‘Failure to Maintain’ complex older people in hospital. ‘Failure to Maintain’ is the inadequate delivery of essential functional and cognitive care for a complex older person in hospital resulting in a complication, and is recommended as a useful indicator for hospital quality. Conclusions: When examining extra length of stay in hospital, complications and comorbid dementia are costly. Complications are potentially preventable, and dementia care in hospitals can be improved. Hospitals and governments looking to decrease costs can engage in risk-reduction strategies for common nurse sensitive complications such as healthy nursing work environments that minimise nurses’ rationing of functional and cognitive care. The conceptualisation of complex older patients as ‘business as usual’ rather than a ‘burden’ is likely necessary for sustainable health care services of the future. The use of the ‘Failure to Maintain’ indicators at institution and state levels may aid in embedding this approach for complex older patients into health organisations. Ongoing investigation is warranted into the relationships between the largest health services expense (hospitals), the largest hospital population (complex older patients), and the largest hospital expense (nurses). The ‘Failure to Maintain’ quality indicator makes a useful and substantive contribution to further clinical, administrative and research developments.