Using Computer Simulation for Reducing the Appointment Lead-Time in a Public Pediatric Outpatient Department

Pediatric outpatient departments aim to provide a pleasant, effective and continuing care to children. However, a problem in these units is the long waiting time for children to receive an appointment. Prolonged appointment lead-time remains a global challenge since it results in delayed diagnosis and treatment causing increased morbidity and dissatisfaction. Additionally, it leads to an increased number of hospitalization and emergency department visits which augments the financial burden faced by healthcare systems. Despite these considerations, the studies directly concentrating on the reduction of appointment lead-time in these departments are largely limited. Therefore, this paper proposes the application of Discrete-event Simulation (DES) approach to evaluate potential improvement strategies aiming at reducing average appointment lead-time. Initially, the outpatient department is characterized to effectively identify the main activities, process variables, interactions, and system constraints. After data collection, input analysis is conducted through intra-variable independence, homogeneity and goodness-of-fit tests followed by the creation of a simulation model representing the real pediatric outpatient department. Then, Mann-Whitney tests are used to prove whether the model was statistically comparable with the real-world system. After this, the outpatient department performance is assessed in terms of average appointment lead-time and resource utilization. Finally, three improvement scenarios are assessed technically and financially, to determine if they are viable for implementation. A case study of a mixed-patient type environment in a public pediatric outpatient department has been explored to validate the proposed methodology. Statistical tests demonstrate that appointment lead-time in pediatric outpatient departments may be meaningfully minimized using this approach. © 2019, Springer Nature Switzerland AG

Identifying the most appropriate classifier for underpinning assistive technology adoption for people with dementia: an integration of Fuzzy AHP and VIKOR methods

Recently, the number of People with Dementia (PwD) has been rising exponentially across the world. The main symptoms that PwD experience include AQ1 impairments of reasoning, memory, and thought. Owing to the burden faced by this chronic condition, Assistive Technology-based solutions (ATS) have been prescribed as a form of treatment. Nevertheless, it is widely acknowledged that low adoption rates of ATS have hampered their benefits within a health and social care context. It is then necessary to effectively discriminate between adopters and non-adopters of such solutions to avoid cost implications, improve the life quality of adopters, and find intervention alternatives for non-adopters. Several classifiers have been proposed as advancement towards the personalisation of self-management interventions for dementia in a scalable way. As multiple algorithms have been developed, an important step in technology adoption is to select the most appropriate classification alternative based on different criteria. This paper presents the integration of Fuzzy AHP (FAHP) and VIKOR to address this challenge. First, FAHP was used to calculate the criteria and sub-criteria weights under uncertainty and then VIKOR was implemented to rank the classifiers. A case study considering a mobile-based self-management and reminding solution for PwD is described to validate the proposed approach. The results revealed that Easiness of interpretation (GW = 0.192) and Handling of missing data (GW = 0.145) were the two most important criteria. Furthermore, SVM (Qj = 1.0) and AB (Qj = 0.891) were concluded to be the most suitable classifiers for supporting ATS adoption in PwD

Choosing the most suitable classifier For supporting assistive technology adoption In people with Parkinson’s disease: a fuzzy Multi-criteria approach

Parkinson’s disease (PD) is the second most common neurodegenerative disorder which requires a long-term, interdisciplinary disease management. While there remains no cure for Parkinson’s disease, treatments are available to help reduce the main symptoms and maintain quality of life for as long as possible. Owing to the global burden faced by chronic conditions such as PD, Assistive technologies (AT’s) are becoming an increasingly common prescribed form of treatment. Low adoption is hampering the potential of digital technologies within health and social care. It is then necessary to employ classification algorithms have been developed for differentiating adopters and non-adopters of these technologies; thereby, potential negative effects on people with PD and cost overruns can be further minimized. This paper bridges this gap by extending the Multi-criteria decision-making approach adopted in technology adoption modeling for people with dementia. First, the fuzzy Analytic Hierarchy Process (FAHP) is applied to estimate the initial relative weights of criteria and sub-criteria. Then, the Decisionmaking Trial and Evaluation Laboratory (DEMATEL) is used for evaluating the interrelations and feedback among criteria and sub-criteria. The Technique for Order of Preferences by Similarity to Ideal Solution (TOPSIS) is finally implemented to rank three classifiers (Lazy IBk – knearest neighbors, Naïve bayes, and J48 decision tree) according to their ability to model technology adoption. A real case study considering is presented to validate the proposed approach

Discrete-Event Simulation for Performance Evaluation and Improvement of Gynecology Outpatient Departments: A Case Study in the Public Sector

Gynecology outpatient units are in charge of treating different gynecological diseases such as tumorous, cancer, urinary incontinence, gynecological pain, and abnormal discharge. On-time attention is thus needed to avoid severe complications, patient dissatisfaction, and elevated healthcare costs. There is then an urgent need for assessing whether the gynecology outpatient departments are cost-effective and what interventions are required for improving clinical outcomes. Despite this context, the studies directly concentrating on diagnosis and improvement of these departments are widely limited. To address these concerns, this paper aims to provide a Discrete-event Simulation (DES) modelling framework to help healthcare managers gain a better understanding of the gynecology outpatient services and evaluate improvement strategies. First, the patient journey through the gynecology outpatient service is mapped. To correctly represent the system uncertainty, collected data is then processed through input analysis. Third, the data is used to model and simulate the real gynecology outpatient unit. This model is later validated to determine whether it is statistically equivalent to the real system. After this, using performance metrics derived from the simulation model, the gynecology outpatient department is analyzed to identify potential improvements. We finally pretest potential interventions to define their viability during implementation. A case study of a mixed-patient type environment in a public gynecology outpatient unit is presented to verify the applicability of the proposed methodology. The results evidenced that appointment lead times could be efficiently reduced using this approach. © 2019, Springer Nature Switzerland AG

Metabolic interactions between vitamin A and conjugated linoleic acid

Lipid-soluble molecules share several aspects of their physiology due to their common adaptations to a hydrophilic environment, and may interact to regulate their action in a tissue-specific manner. Dietary conjugated linoleic acid (CLA) is a fatty acid with a conjugated diene structure that is found in low concentrations in ruminant products and available as a nutritional supplement. CLA has been shown to increase tissue levels of retinol (vitamin A alcohol) and its sole specific circulating carrier protein retinol-binding protein (RBP or RBP4). However, the precise mechanism of this action has not been elucidated yet. Here, we provide a summary of the current knowledge in this specific area of research and speculate that retinol and CLA may compete for catabolic pathways modulated by the activity of PPAR- and RXR heterodimer. We also present preliminary data that may position PPAR- at the crossroads between the metabolism of lipids and vitamin

Amarilis a Belardo: epístola de una escritora novohispana a un autor peninsular

Poetry was a genre grown in the American colonies and the writers were determined by the influence of the authors of the peninsula as Góngora, Quevedo and Lope de Vega, not only in the type of creations and themes. The case of Amarilis is known, who wrote an epistle dedicated to Lope de Vega in which she demonstrates her capacity for creation, the knowledge of the classical tradition and the forms that affected poetry. Her work represents a sample of colonial ingenuity.La poesía fue un género cultivado en las colonias americanas y los escritores se vieron determinados por la influencia de los autores de la península como Góngora, Quevedo y Lope de Vega, no solo en el tipo de creaciones y en los temas. Se conoce el caso de Amarilis, quien escribió una epístola dedicada a Lope de Vega en la que demuestra su capacidad para la creación, el conocimiento de la tradición clásica y de las formas que afectaban en la poesía. Su obra representa una muestra del ingenio colonial

Los personajes femeninos en los cuentos de Amparo Dávila. Un enfoque interdisciplinario

Amparo Dávila takes the experience as a starting point, that is, that which is experienced and carried within, but which comes out and is shared with others. However, their work is not a simple sharing, but an abandonment in literary art and although his intention is merely artistic, in his works he reflects a type of social criticism, which includes denouncing unworthy conditions in which modern women live. The use of the written word occupies a central place in this transmitting. What is the word? What is the man who uses it? What is the sense of human existence?Amparo Dávila toma como punto de partida la vivencia, es decir, aquello que se experimenta y se lleva dentro, pero que sale y se comparte con los demás. Sin embargo, su quehacer no es un simple compartir, sino un abandonarse en el arte literario y aunque su intención es meramente artística, en sus obras se refleja un tipo de crítica social, que incluye la denuncia de las condiciones indignas en que vive la mujer moderna. El uso de la palabra escrita ocupa un lugar central en este transmitir. ¿Qué es la palabra?, ¿qué es el hombre que la utiliza?, ¿cuál es el sentido de la existencia humana

Algebraic Approach to Interacting Quantum Systems

We present an algebraic framework for interacting extended quantum systems to study complex phenomena characterized by the coexistence and competition of different states of matter. We start by showing how to connect different (spin-particle-gauge) {\it languages} by means of exact mappings (isomorphisms) that we name {\it dictionaries} and prove a fundamental theorem establishing when two arbitrary languages can be connected. These mappings serve to unravel symmetries which are hidden in one representation but become manifest in another. In addition, we establish a formal link between seemingly unrelated physical phenomena by changing the language of our model description. This link leads to the idea of {\it universality} or equivalence. Moreover, we introduce the novel concept of {\it emergent symmetry} as another symmetry guiding principle. By introducing the notion of {\it hierarchical languages}, we determine the quantum phase diagram of lattice models (previously unsolved) and unveil hidden order parameters to explore new states of matter. Hierarchical languages also constitute an essential tool to provide a unified description of phases which compete and coexist. Overall, our framework provides a simple and systematic methodology to predict and discover new kinds of orders. Another aspect exploited by the present formalism is the relation between condensed matter and lattice gauge theories through quantum link models. We conclude discussing applications of these dictionaries to the area of quantum information and computation with emphasis in building new models of computation and quantum programming languages.Comment: 44 pages, 14 psfigures. Advances in Physics 53, 1 (2004

Simulating chemistry using quantum computers

The difficulty of simulating quantum systems, well-known to quantum chemists, prompted the idea of quantum computation. One can avoid the steep scaling associated with the exact simulation of increasingly large quantum systems on conventional computers, by mapping the quantum system to another, more controllable one. In this review, we discuss to what extent the ideas in quantum computation, now a well-established field, have been applied to chemical problems. We describe algorithms that achieve significant advantages for the electronic-structure problem, the simulation of chemical dynamics, protein folding, and other tasks. Although theory is still ahead of experiment, we outline recent advances that have led to the first chemical calculations on small quantum information processors.Comment: 27 pages. Submitted to Ann. Rev. Phys. Che