Facilitated post-model coding in discrete event simulation (DES): a case study in healthcare

Research on facilitated discrete event simulation (DES) is gathering pace but there is still a need to put forward real examples to explain the process to newcomers. This paper is part of a line of research on the methodology of facilitated DES. In this paper we explain in more detail the facilitation process and the tools used to support the experimentation and implementation stages in a DES study involving workshops with a group of stakeholders, after an initial simulation model has been coded on the computer. A real case study is used to describe the process followed and the interactions at the workshops. Extracts from the transcripts are also included, with the view to providing evidence of the stakeholders’ involvement and their mood during the workshops. We conclude with a discussion on the process and tools used to support the facilitation process. Future research directions are also put forward

Using Strategic Options Development and Analysis (SODA) to Understand the Simulation Accessibility Problem

Simulation modelling is applied to a wide range of problems, including defense and healthcare. However, there is a concern within the simulation community that there is a limited use and implementation of simulation studies in practice. This suggests that despite its benefits, simulation may not be reaching its potential in making a real-world impact. The main reason for this could be that simulation tools are not widely accessible in industry. In this paper, we investigate the issues that affect simulation modelling accessibility through a workshop with simulation practitioners. We use Strategic Options Development and Analysis (SODA), a problem-structuring approach that allows for the stakeholder views to be expressed and linked in a systematic way. The causal map derived represents the emerging concepts and their effects, with the view to identifying their impact on the accessibility problem. We present our analysis of the issues and options identified. Based on our findings, we discuss the implications and recommendations for the future uptake of simulation

Abortion in Nepal: perspectives of a cross-section of sexual and reproductive health and rights professionals.

BACKGROUND: Globally, women face many barriers in the attainment of sexual and reproductive health and rights (SRHR). Since 2002, the legalisation of abortion in Nepal has seen significant progress in the expansion of safe abortion and family planning services. METHODS: This qualitative, exploratory study was conducted in 2014 and uses nine in-depth, open-ended interviews with a cross-section of SRHR professionals, to explore their perspectives on abortion in Nepal. The study was underpinned by the Assets Focused Rapid Participatory Appraisal (AFRPA) research methodology and used the health information pyramid conceptual framework. RESULTS: Thematic content analysis revealed emerging themes relating to barriers to access and uptake of skilled safe abortion services and post-abortion family planning. Findings also emphasised current practical and legal components relating to the provision of medical abortion through pharmacies and highlighted issues of sex-selective abortion within the predominantly patriarchal society. CONCLUSION: Effective and ongoing sector-wide monitoring and evaluation of safe abortion services and their staff is essential for women in Nepal to have adequate access to effective and efficient safe abortion services, access to contraception and sexual and reproductive health (SRH) information post-abortion and to ensure adherence to current Safe Abortion Policy. It is critical that the unsafe (less and least safe) provision of medical abortion through pharmacies and sex-selective abortion continues to be investigated and that innovative strategies are formulated to ensure the cultural, reproductive and sexual health and rights of Nepali women are realised

A participative and facilitative conceptual modelling framework for discrete event simulation studies in healthcare

Existing approaches to conceptual modelling (CM) in discrete-event simulation (DES) do not formally support the participation of a group of stakeholders. Simulation in healthcare can benefit from stakeholder participation as it makes possible to share multiple views and tacit knowledge from different parts of the system. We put forward a framework tailored to healthcare that supports the interaction of simulation modellers with a group of stakeholders to arrive at a common conceptual model. The framework incorporates two facilitated workshops. It consists of a package including: three key stages and sub-stages; activities and guidance; tools and prescribed outputs. The CM framework is tested in a real case study of an obesity system. The benefits of using this framework in healthcare studies and more widely in simulation are discussed. The paper also considers how the framework meets the conceptual modeling requirements

A Tutorial on Involving Stakeholders in Facilitated Simulation Studies

This tutorial introduces the PartiSim approach, aimed at supporting analysts and simulation modellers to carry out facilitated discrete event simulation studies. Facilitated simulation offers an alternative mode of engagement with stakeholders (clients) in simulation projects. It is particularly beneficial when modelling systems with complex behaviour, involving many stakeholders with plurality of opinions and objectives. PartiSim short for Participative Simulation, is a facilitated modelling approach developed to support simulation projects through a framework, stakeholder-oriented tools and manuals in facilitated workshops. A PartiSim study includes six stages, four of which involve facilitated workshops. PartiSim was developed more than 10 years ago. It can be applied to analyse operational problems in many contexts within the services and manufacturing domain. This tutorial presents the PartiSim framework and tools, some applications and example tools, a roadmap to adopting it and concludes with some tips for potential users

THE MANTECA YELLOW BEAN: A GENETIC RESOURCE OF FAST COOKING AND HIGH IRON BIOAVAILABILITY PHENOTYPES FOR THE NEXT GENERATION OF DRY BEANS (\u3ci\u3ePhaseolus vulgaris\u3c/i\u3e L.)

Dry beans (Phaseolus vulgaris L.) are a nutrient dense food produced globally as a major pulse crop for direct human consumption. Despite being rich in protein and micronutrients, long cooking times limit the use of dry beans worldwide, especially in regions relying on wood and charcoal as the primary sources of fuel for cooking, such as Sub-Sahara Africa and the Caribbean. Coincidently, these same regions also have high densities of women and children at risk for micronutrient deficiencies [1]. There is need for a fast cooking bean, which can positively impact consumers by reducing fuel cost and preparation time, while simultaneously complementing the nutritional quality of house-hold based meals [2]. To help accelerate a reliable increase in dry bean production for Sub-Saharan Africa, the Andean Bean Diversity Panel (ADP; http://arsftfbean.uprm.edu/bean/) was assembled as a genetic resource in the development of fast cooking, nutritional improved, biotic/abiotic resistant varieties. A germplasm screening for atmospheric cooking time (100oC) of over 200 bean accessions from the ADP identified only five fast cooking entries [3]. Two entries were white beans from Burundi (Blanco Fanesquero) and Ecuador (PI527521). Native to Chile, two of the six fast cooking entries were collected from Angola, and had a pale lemon ‘Manteca’ yellow seed color (Cebo, Mantega Blanca). Traditional knowledge from Chile suggests Manteca yellow beans are low flatulence and easy to digest [4]. Yellow beans of various shades are important in Eastern and Southern Africa. Their popularity has increased in recent years and they often fetch the highest prices at the marketplace. There is evidence to suggest that Manteca yellow beans have a unique nutritional profile when compared to other yellow seed types; with more soluble dietary fiber, less indigestible protein and starch, and are also free of condensed tannins. The hypothesis was tested that this unique composition would also have a positive influence on the bioavailability of iron in an in vitro digestion/Caco-2 cell culture bioassay

Biofortified red mottled beans (Phaseolus vulgaris L.) in a maize and bean diet provide more bioavailable iron than standard red mottled beans: Studies in poultry (Gallus gallus) and an in vitro digestion/Caco-2 model

<p>Abstract</p> <p>Background</p> <p>Our objective was to compare the capacities of biofortified and standard colored beans to deliver iron (Fe) for hemoglobin synthesis. Two isolines of large-seeded, red mottled Andean beans (<it>Phaseolus vulgaris </it>L.), one standard ("Low Fe") and the other biofortified ("High Fe") in Fe (49 and 71 μg Fe/g, respectively) were used. This commercial class of red mottled beans is the preferred varietal type for most of the Caribbean and Eastern and Southern Africa where almost three quarters of a million hectares are grown. Therefore it is important to know the affect of biofortification of these beans on diets that simulate human feeding studies.</p> <p>Methods</p> <p>Maize-based diets containing the beans were formulated to meet the nutrient requirements for broiler except for Fe (Fe concentrations in the 2 diets were 42.9 ± 1.2 and 54.6 ± 0.9 mg/kg). One day old chicks (<it>Gallus gallus</it>) were allocated to the experimental diets (n = 12). For 4 wk, hemoglobin, feed-consumption and body-weights were measured.</p> <p>Results</p> <p>Hemoglobin maintenance efficiencies (HME) (means ± SEM) were different between groups on days 14 and 21 of the experiment (P < 0.05). Final total body hemoglobin Fe contents were different between the standard (12.58 ± 1.0 mg {0.228 ± 0.01 μmol}) and high Fe (15.04 ± 0.65 mg {0.273 ± 0.01 μmol}) bean groups (P < 0.05). At the end of the experiment, tissue samples were collected from the intestinal duodenum and liver for further analyses. Divalent-metal-transporter-1, duodenal-cytochrome-B, and ferroportin expressions were higher and liver ferritin was lower (P < 0.05) in the standard group vs. the biofortified group. <it>In-vitro </it>analysis showed lower iron bioavailability in cells exposed to standard ("Low Fe") bean based diet.</p> <p>Conclusions</p> <p>We conclude that the <it>in-vivo </it>results support the <it>in-vitro </it>observations; biofortified colored beans contain more bioavailable-iron than standard colored beans. In addition, biofortified beans seems to be a promising vehicle for increasing intakes of bioavailable Fe in human populations that consume these beans as a dietary staple. This justifies further work on the large-seeded Andean beans which are the staple of a large-region of Africa where iron-deficiency anemia is a primary cause of infant death and poor health status.</p

Hyperglycaemia lowering activity and hypoglycaemic risk assessment of Sarenta, an Ivorian traditional herbal remedy

Background: Diabetes remains a major public health problem for which traditional medicine is a better therapeutic alternative for low-income populations, including African populations. The aim of this work was to evaluate the effect of Sarenta, an herbal preparation used in Ivorian traditional medicine as anti-diabetic, on hyperglycaemia and on basic glycaemia.Methods: Hyperglycaemia lowering activity was led in rats receiving glucose at 5 g/kg body weight by gavage after oral pre-treatment with either Sarenta at 125, 206 or 209.5 mg/kg b. wt., either glibenclamide at 10 mg/kg b. wt., or physiological saline solution. Hypoglycaemic risk was assessed by administering the same doses of Sarenta to native i.e. NaCl-treated rats. For both tests, blood glucose was measured before any substance was administered and then every hour for 4 hours.Results: After 4 hours, Sarenta at 206 mg/kg b. wt. and 209.5 mg/kg b. wt. significantly reduced the induced hyperglycaemia in rats by 33.87% and 37.39%, respectively. The degree of the hyperglycaemia lowering effect of the remedy at these two doses was not significantly different from that of glibenclamide. In addition, Sarenta at 209.5 mg/kg b. wt. resulted in a significant reduction of basic blood sugar to 29.78% four hours after administration.Conclusions: The remedy Sarenta has a hyperglycaemia lowering activity that could partially justify its traditional use in the treatment of diabetes. However, considering its hypoglycemic effect, precautions should be taken when using this traditional medicine

Evaluating Community-Based Integrated Health and Social Care Services: The Simtegr8 Approach

This paper introduces a new facilitated simulation approach, called SIMTEGR8, developed to evaluate the effectiveness of integrated community-based health and social care services. This involves developing and using simulation models, which serve as a catalyst for generating discussion about the effectiveness of the patient pathway and for identifying potential improvements to the service. The simulation analyst works jointly with different stakeholder groups: service providers, commissioners, and service users. Service users, a stakeholder group that can contribute to the knowledge generated in facilitated modelling sessions, have not been included in facilitated simulation studies reported so far in the literature. For illustration purposes, the Lightbulb project, a housing support service helping elderly and frail people in Leicestershire in the UK stay safe at home, is presented in this paper. The outcomes of the study and the challenges faced with involving patients in simulation projects are discussed