Integral resource capacity planning for inpatient care services based on hourly bed census predictions

The design and operations of inpatient care facilities are typically largely historically shaped. A better match with the changing environment is often possible, and even inevitable due to the pressure on hospital budgets. Effectively organizing inpatient care requires simultaneous consideration of several interrelated planning issues. Also, coordination with upstream departments like the operating theater and the emergency department is much-needed. We present a generic analytical approach to predict bed census on nursing wards by hour, as a function of the Master Surgical Schedule (MSS) and arrival patterns of emergency patients. Along these predictions, insight is gained on the impact of strategic (i.e., case mix, care unit size, care unit partitioning), tactical (i.e., allocation of operating room time, misplacement rules), and operational decisions (i.e., time of admission/discharge). The method is used in the Academic Medical Center Amsterdam as a decision support tool in a complete redesign of the inpatient care operations

Flexible nurse staffing based on hourly bed census predictions

Workload on nursing wards depends highly on patient arrivals and patient lengths of stay, which are both inherently variable. Predicting this workload and staffing nurses accordingly is essential for guaranteeing quality of care in a cost effective manner. This paper introduces a stochastic method that uses hourly census predictions to derive efficient nurse staffing policies. The generic analytic approach minimizes staffing levels while satisfying so-called nurse-to-patient ratios. In particular, we explore the potential of flexible staffing policies which allow hospitals to dynamically respond to their fluctuating patient population by employing float nurses. The method is applied to a case study of the surgical inpatient clinic of the Academic Medical Center (AMC) Amsterdam. This case study demonstrates the method's potential to study the complex interaction between staffing requirements and several interrelated planning issues such as case mix, care unit partitioning and size, and surgical block planning. Inspired by the numerical results, the AMC decided that this flexible nurse staffing methodology will be incorporated in the redesign of the inpatient care operations during the upcoming years

The emergency observation and assessment ward

A recent development to reduce ED crowding and increase urgent patient admissions is the opening of an Emergency Observation and Assessment Ward (EOA Ward). At these wards urgent patients are temporarily hospitalized until they can be transferred to an inpatient bed. In this paper we present an overflow model to evaluate the effect of employing an EOA Ward on elective and urgent patient admissions

Characterizing CDMA downlink feasibility via effective interference

This paper models and analyses downlink power assignment feasibility in Code Division Multiple Access (CDMA) mobile networks. By discretizing the area into small segments, the power requirements are characterized via a matrix representation that separates user and system characteristics. We obtain a closed-form analytical expression of the so-called Perron-Frobenius eigenvalue of that matrix, which provides a quick assessment of the feasibility of the power assignment for each distribution of calls over the segments. Although the obtained relation is non-linear, it basically provides an effective interference characterisation of downlink feasibility. Our results allow for a fast evaluation of outage and blocking probabilities, and enable a quick evaluation of feasibility that may be used for Call Acceptance Control. \u

Delay in a tandem queueing model with mobile queues : an analytical approximation

In this paper, we analyze the end-to-end delay performance of a tandem queueing system with mobile queues. Due to state-space explosion there is no hope for a numerical exact analysis for the joint-queue length distribution. For this reason, we present an analytical approximation that is based on queue length analysis. Through extensive numerical validation, we find that the queue length approximation exhibits excellent performance for light and moderate traffic load

Blocking the CGRP Receptor:Differences across Human Vascular Beds

Multiple drugs targeting the calcitonin gene-related peptide (CGRP) receptor have been developed for the treatment of migraine. Here, the effect of the small-molecule CGRP receptor antagonist zavegepant (0.1 nM–1 µM) on CGRP-induced relaxation in isolated human coronary arteries (HCAs) was investigated. A Schild plot was constructed and a pA2 value was calculated to determine the potency of zavegepant. The potency and Schild plot slopes of atogepant, olcegepant, rimegepant, telcagepant, ubrogepant and zavegepant in HCAs and human middle meningeal arteries (HMMAs), obtained from our earlier studies, were compared. Zavegepant shifted the concentration–response curve to CGRP in HCAs. The corresponding Schild plot slope was not different from unity, resulting in a pA2 value of 9.92 ± 0.24. No potency difference between HCAs and HMMAs was observed. Interestingly, olcegepant, atogepant and rimegepant, with a Schild plot slope &lt; 1 in HCAs, were all &gt;1 log unit more potent in HMMAs than in HCAs, while telcagepant, ubrogepant and zavegepant, with a Schild plot slope not different from unity, showed similar (&lt;1 log difference) potency across both tissues. As a Schild plot slope &lt; 1 may point to the involvement of multiple receptors, it is important to further identify the receptors involved in the relaxation to CGRP in HCAs, which may be used to improve the cardiovascular safety of future antimigraine drugs.</p

Uniformization for λ-positive Markov chains

We show that a variant of the uniformization method for the numerical calculation of transient state probabilities of positive recurrent Markov chains, in which the truncation error can be made arbitrarily small uniformly over time, can be extended to lambda-positive Markov chains

Architectural aspects of QoS-aware personal networks

Personal Networks (PN) are future communication systems that combine wireless and infracuture based networks to provide users a variety of services anywhere and anytime. PNs introduce new design challenges due to the heterogeneity of the involved technologies, the need for self-organization, the dynamics of the system composition, the application-driven nature, the co-operation with infrastructure-based networks, and the security hazards. This paper discusses the challenges of security and QoS provisioning in designing self-organized personal networks and combines them all into an integrated architectural framework