Guidelines for Scheduling in Primary Care: An Empirically Driven Mathematical Programming Approach

Primary care practices play a vital role in healthcare delivery since they are the first point of contact for most patients, and provide health prevention, counseling, education, diagnosis and treatment. Practices, however, face a complex appointment scheduling problem because of the variety of patient conditions, the mix of appointment types, the uncertain service times with providers and non-provider staff (nurses/medical assistants), and no-show rates which all compound into a highly variable and unpredictable flow of patients. The end result is an imbalance between provider idle time and patient waiting time. To understand the realities of the scheduling problem we analyze empirical data collected from a family medicine practice in Massachusetts. We study the complete chronology of patient flow on nine different workdays and identify the main patient types and sources of inefficiency. Our findings include an easy-to-identify patient classification, and the need to focus on the effective coordination between nurse and provider steps. We incorporate these findings in an empirically driven stochastic integer programming model that optimizes appointment times and patient sequences given three well-differentiated appointment types. The model considers a session of consecutive appointments for a single-provider primary care practice where one nurse and one provider see the patients. We then extend the integer programming model to account for multiple resources, two nurses and two providers, since we have observed that such team primary care practices are common in the course of our data collection study. In these practices, nurses prepare patients for the providers’ appointments as a team, while providers are dedicated to their own patients to ensure continuity of care. Our analysis focuses on finding the value of nurse flexibility and understanding the interaction between the schedules of the two providers. The team practice leads us to a challenging and novel multi step multi-resource mixed integer stochastic scheduling formulation, as well as methods to tackle the ensuing computational challenge. We also develop an Excel scheduling tool for both single provider and team practices to explore the performance of different schedules in real time. Overall, the main objective of the dissertation is to provide easy-to-implement scheduling guidelines for primary care practices using both an empirically driven stochastic optimization model and a simulation tool

Ionothermal Synthesis of Metal-Organic Framework

Ionothermal synthesis employs ionic liquids for synthesis of metal organic frameworks (MOFs) as solvent and template. The cations and anions of ionic liquids may be finely adjusted to produce a great variety of reaction environments and thus frameworks. Organisation of the structures synthesised from related ionic liquid combinations give rise to provocative chemical trends that may be used to predict future outcomes. Further analysis of their structures is possible by reducing the complex framework to its underlying topology, which by itself brings more precision to prediction. Through reduction, many seemingly different, but related classes of structures may be merged into larger groups and provide better understanding of the nanoscopic structures and synthesis conditions that gave rise to them. Ionothermal synthesis has promised to enable us to effectively plan the synthesis ahead for a given purpose. However, for its promise to be kept, several difficult limitations must be overcome, including the inseparable cations from the solvent that reside in the framework pore

Recovery of the mitochondrial COI barcode region in diverse Hexapoda through tRNA-based primers

<p>Abstract</p> <p>Background</p> <p>DNA barcoding uses a 650 bp segment of the mitochondrial cytochrome <it>c </it>oxidase I (COI) gene as the basis for an identification system for members of the animal kingdom and some other groups of eukaryotes. PCR amplification of the barcode region is a key step in the analytical chain, but it sometimes fails because of a lack of homology between the standard primer sets and target DNA.</p> <p>Results</p> <p>Two forward PCR primers were developed following analysis of all known arthropod mitochondrial genome arrangements and sequence alignment of the tRNA-W gene which was usually located within 200 bp upstream of the COI gene. These two primers were combined with a standard reverse primer (LepR1) to produce a cocktail which generated a barcode amplicon from 125 of 141 species that included representatives of 121 different families of Hexapoda. High quality sequences were recovered from 79% of the species including groups, such as scale insects, that invariably fail to amplify with standard primers.</p> <p>Conclusions</p> <p>A cocktail of two tRNA-W forward primers coupled with a standard reverse primer amplifies COI for most hexapods, allowing characterization of the standard barcode primer binding region in COI 5' as well as the barcode segment. The current results show that primers designed to bind to highly conserved gene regions upstream of COI will aid the amplification of this gene region in species where standard primers fail and provide valuable information to design a primer for problem groups.</p

In vivo functional photoacoustic tomography of traumatic brain injury in rats

In this study, we demonstrate the potential of photoacoustic tomography for the study of traumatic brain injury (TBI) in rats in vivo. Based on spectroscopic photoacoustic tomography that can detect the absorption rates of oxy- and deoxy-hemoglobins, the blood oxygen saturation and total blood volume in TBI rat brains were visualized. Reproducible cerebral trauma was induced using a fluid percussion TBI device. The time courses of the hemodynamic response following the trauma initiation were imaged with multi-wavelength photoacoustic tomography with bandwidth-limited spatial resolution through the intact skin and skull. In the pilot set of experiments, trauma induced hematomas and blood oxygen saturation level changes were detected, a finding consistent with the known physiological responses to TBI. This new imaging method will be useful for future studies on TBI-related metabolic activities and the effects of therapeutic agents