A system dynamics-based simulation study for managing clinical governance and pathways in a hospital

This paper examines the development of clinical pathways in a hospital in Australia based on empirical clinical data of patient episodes. A system dynamics (SD)-based decision support system (DSS) is developed and analyzed for this purpose. System dynamics was used as the simulation modeling tool because of its rigorous approach in capturing interrelationships among variables and in handling dynamic aspects of the system behavior in managing healthcare. The study highlights the scenarios that will help hospital administrators to redistribute caseloads amongst admitting clinicians with a focus on multiple Diagnostic Related Groups (DRG’s) as the means to improve the patient turnaround and hospital throughput without compromising quality patient care. DRG’s are the best known classification system used in a casemix funding model. The classification system groups inpatient stays into clinically meaningful categories of similar levels of complexity that consume similar amounts of resources. Policy explorations reveal various combinations of the dominant policies that hospital management can adopt. The analyses act as a scratch pad for the executives as they understand what can be feasibly achieved by the implementation of clinical pathways given a number of constraints. With the use of visual interfaces, executives can manipulate the DSS to test various scenarios. Experimental evidence based on focus groups demonstrated that the DSS can enhance group learning processes and improve decision making. The simulation model findings support recent studies of CP implementation on various DRG’s published in the medical literature. These studies showed substantial reductions in length of stay, costs and resource utilization

A dynamic policy model to manage temporal performance amongst contracting firms in a competitive situation

Studies have been conducted to measure competitiveness in the construction industry. Such research has focused on all levels from the national picture to individual projects. While useful, the results are limited in that they present a snapshot picture at one point in time. Moreover, they do not suggest how under-performance might be improved. The research reported here is part of a large collaborative study to evaluate sustained competitiveness in the UK construction industry. It enhances previous research in that a system dynamics model of contracting firms operating in competition is used to not only measure each firm’s temporal performance by means of a dynamic competitive index, but it can also suggest high leverage policies which mitigate against under-performance. The model structure is described and simulated scenario runs presented. Besides the contribution to strategic policy making at the level of the contracting firm, the exemplar shows that the system dynamics methodology could have significant utility in the field of construction management

System dynamics modelling and its implications for childhood obesity prevention: evidence from improving the consumption of portion size and meal frequency

The childhood obesity has rapidly increased, though little is known about the impact of frequency of meals and portion size on weight and obesity. The objective of this study is to compare and to determine the effective strategy for obesity prevention by improving the consumption of portion size and meal frequency. This study utilised the secondary data obtained from the Health Survey for England for the child population aged between 2 to 15 years in United Kingdom. This study combines the different strands of knowledge from nutrition, physical activity and body metabolism and synthesizing this knowledge into a system dynamics model which the model offers unique insights into the cause-and-effect relationships among the influencing factors. Findings from the simulation analysis demonstrated that reducing meal frequency is the most effective controlling strategy for obesity prevention. This is asserted by the fact that the highest reduction in average weight (3.14%-4.5%) and average body mass index (3.14%-4.5%) between 2020 and 2030 was observed by improving meal frequency. This paper concludes that system dynamics utilised in this study will be advantageous to guide the food stakeholder to gain insight into the complex of eating behavior and to experiment with various intervention strategies for obesity prevention

Tracking The Development Of Critical Self-Reflective Practice Of A Novice Sign Language Interpreter: A Case Study

The purpose of this case study was to track the progression of a novice interpreter’s use of self-reflective practice while interpreting a series of six University lecture segments, in a controlled environment over a period of three months. It became evident that the novice interpreter in this case study was able to articulate a variety of coping strategies used, and found improvements in her self-reflective practice skills. The results of this study support key suggestions in the literature: that interpreters need to be motivated to aim for expertise by improving their skills through self-reflective practices, via supported environments such as ongoing mentorship, training and professional development. This longitudinal case study was developed as a multi-methods qualitative study that triangulated three forms of data (quasi-experimental, ethnographic, and retrospective), comparing the novice interpreter’s performance through observations from both the researcher and the participant. A rubric (Appendix 1) was designed based on a variety of assessment tools and taxonomies related to interpreting, and used to track the participant and researcher perceptions each session. This case study has contributed to the field of interpreting in that very few case studies to date have focused on novice interpreters’ self-reflective practices over a period of time

Venular basement membranes contain specific matrix protein low expression regions that act as exit points for emigrating neutrophils.

Published versio

The eventization of leisure and the strange death of alternative Leeds

The communicative potential of city spaces as leisure spaces is a central assumption of political activism and the creation of alternative, counter-cultural and subcultural scenes. However, such potential for city spaces is limited by the gentrification, privatization and eventization of city centres in the wake of wider societal and cultural struggles over leisure, work and identity formation. In this paper, we present research on alternative scenes in the city of Leeds to argue that the eventization of the city centre has led to a marginalization and of alternative scenes on the fringes of the city. Such marginalization has not caused the death of alternative Leeds or political activism associated with those scenes—but it has changed the leisure spaces (physical, political and social) in which alternative scenes contest the mainstream

Methyl 6-de­oxy-6-iodo-α-d-galactoside

In the crystal of the title compound, C7H13IO5, the molecules are linked by O—H⋯O hydrogen bonds, which build linkages around one screw axis of the cell. These C(5) and C(6) packing motifs expand to R 2 2(10) and C2 2(11) motifs and are similar to those found for closely related compounds. The galactoside ring has a 1 C 4 chair conformation