Waiting lists, waiting times and admissions: an empirical analysis at hospital and general practice level

We report an empirical analysis of the responses of the supply and demand for secondary care to waiting list size and waiting times. Whereas previous empirical analyses have used data aggregated to area level, our analysis is novel in that it focuses on the supply responses of a single hospital and the demand responses of the GP practices it serves, and distinguishes between outpatient visits, inpatient admissions, daycase treatment and emergency admissions. The results are plausible and in line with the theoretical model. For example: the demand from practices for outpatient visits is negatively affected by waiting times and distance to the hospital. Increases in waiting times and waiting lists lead to increases in supply; the supply of elective inpatient admissions is affected negatively by current emergency admissions and positively by lagged waiting list and waiting time. We use the empirical results to investigate the dynamic responses to one off policy measures to reduce waiting times and lists by increasing supply

A mixed integer linear programming model for optimal sovereign debt issuance

Copyright @ 2011, Elsevier. NOTICE: this is the author’s version of a work that was accepted for publication in the European Journal of Operational Research. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version is available at the link below.Governments borrow funds to finance the excess of cash payments or interest payments over receipts, usually by issuing fixed income debt and index-linked debt. The goal of this work is to propose a stochastic optimization-based approach to determine the composition of the portfolio issued over a series of government auctions for the fixed income debt, to minimize the cost of servicing debt while controlling risk and maintaining market liquidity. We show that this debt issuance problem can be modeled as a mixed integer linear programming problem with a receding horizon. The stochastic model for the interest rates is calibrated using a Kalman filter and the future interest rates are represented using a recombining trinomial lattice for the purpose of scenario-based optimization. The use of a latent factor interest rate model and a recombining lattice provides us with a realistic, yet very tractable scenario generator and allows us to do a multi-stage stochastic optimization involving integer variables on an ordinary desktop in a matter of seconds. This, in turn, facilitates frequent re-calibration of the interest rate model and re-optimization of the issuance throughout the budgetary year allows us to respond to the changes in the interest rate environment. We successfully demonstrate the utility of our approach by out-of-sample back-testing on the UK debt issuance data

Implementing concurrent-training and nutritional strategies in professional football: a complex challenge for coaches and practitioners

Purpose: To study concurrent-training (CT) and nutritional practices within a professional soccer team. Methods: Twenty-one professional football players competing in the English professional league participated in this study (mean ± standard deviations [M ± SD] 26 ± 4 years, stature 1.84 ± 0.1 m, body mass 83 ± 7 kg, VO2max; 58 ± 3 ml · kg−1 · min−1). A range of internal and external training metrics, the organisation of CT (training sequence, training rest period between bouts) and the nutritional intake around CT (timing, type and quantity) was collected for 10 weeks. Results: CT; n = 17 (endurance-training [ET] + resistance-training [RT]; n = 11; RT + ET; n = 6) rest period between bouts was not consistent and varied depending on the sequence of CT (RT + ET, 75 ± 48 min; ET + RT; 60 ± 5 min; P = 0.04). sRPE of football-specific ET was higher in RT + ET (RT + ET, 7 ± 1; ET + RT, 6 ± 1; P = 0.05). The timing of meals around training was influenced by the organisation of CT. Subsequently, CHO consumption before training session one was significantly less in RT + ET (CHO 0.10 ± 0.5 g · kg−1 vs. CHO 0.45 ± 0.2 g · kg−1). Conclusion: The present data demonstrate that the organisation of CT (i.e., exercise order and/or recovery time between bouts) and nutrition (i.e., timing of meal intake) can be unsystematic in the applied environment. The organisation of training and nutrition might influence the players’ ability to perform high-intensity actions in secondary training sessions and could potentially impact acute metabolic processes associated with muscle recovery and muscle adaptation

Will a breast screening programme change the workload and referral practice of general practitioners?

This article has been made available through the Brunel Open Access Publishing Fund and is available from the specified link - Copyright © 1990 BMJ Publishing Group.STUDY OBJECTIVE--The aim of the study was to consider possible changes in the clinical activities of general practitioners whose patients are registered in a breast cancer screening programme. DESIGN--The study was a survey based on completion of forms recording breast consultations carried out by participating general practitioners during a four week period. SETTING--One of three intervention centres and one of three comparison centres in the national trial of early detection of breast cancer was selected. The intervention centre was in Guildford; the comparison centre in Stoke on Trent. PARTICIPANTS--The participants were general practitioners in the selected centres. In Guildford, 64 of 99 general practitioners approached took part (65%); in Stoke on Trent, 81 of 177 took part (46%). The proportion of male and female participants in the two centres was similar. Doctors in Stoke on Trent were older and worked in smaller practices than in Guildford. RESULTS--A comparison of workloads showed that in the screening centre there was less demand for doctor consultations from those in the screened age group, but those excluded from screening made more use of the general practitioners' services. A difference in referral practice was also apparent, with doctors in the screening centre referring more frequently for specialist advice. CONCLUSIONS--The evidence suggests that no significant change in the overall use of general practice resources can be expected with the introduction of national screening, but there may be greater pressure on assessment services

Composites of Heavy Rain Producing Elevated Thunderstorms in the Central United States

Composite analyses of the atmosphere over the central United States during elevated thunderstorms producing heavy rainfall are presented. Composites were created for five National Weather Service County Warning Areas (CWAs) in the region. Events studied occurred during the warm season (April–September) during 1979–2012. These CWAs encompass the region determined previously to experience the greatest frequency of elevated thunderstorms in the United States. Composited events produced rainfall of \u3e50 mm 24 hr−1 within the selected CWA. Composites were generated for the 0–3 hr period prior to the heaviest rainfall, 6–9 hours prior to it, and 12–15 hours prior to it. This paper focuses on the Pleasant Hill, Missouri (EAX) composites, as all CWA results were similar; also these analyses focus on the period 0–3 hours prior to event occurrence. These findings corroborate the findings of previous authors. What is offered here that is unique is (1) a measure of the interquartile range within the composite mean fields, allowing for discrimination between variable fields that provided a strong reliable signal, from those that may appear strong but possess large variability, and (2) composite soundings of two subclasses of elevated thunderstorms. Also, a null case (one that fits the composite but failed to produce significant rainfall) is also examined for comparison

Recently Expired Individual Tax Provisions (Tax Extenders"): In Brief

This report provides background information on individual income tax provisions that expired in 2016. Information on costs associated with extending individual income tax expired provisions is provided in Table 1. The provisions that were extended in the PATH Act were extended for two years, retroactive for 2015 and through 2016. The estimated cost to make expired provisions permanent is as reported by the Congressional Budget Office (CBO). The CBO reports estimated deficit effects of extending expired and expiring tax provisions through the 10-year budget window (2018 – 2027)

Block Rate Pricing of Water in Indonesia: An Analysis of Welfare Effects

Block rate pricing of piped water in Indonesian cities has a progressive structure: the marginal price paid increases with the volume of demand. This paper estimates household water demand in Salatiga city using the Burtless and Hausman model, and finds that its distribution is not unimodal—that data cluster around kinks. The main estimation results are a price elasticity of approximately –1.2 and an income elasticity of 0.05. These elasticities are mutually dependent. The estimated model is used to investigate the social welfare consequences of a shift to uniform pricing. The principal beneficiaries would be large households, which are not necessarily wealthy. While replacing the complex rate structure by a uniform marginal price would have positive effects on average welfare, the equity consequences would be small. To improve equity, water companies could reduce installation fees, giving low-income households access to water connections, or reinvest profits in network expansion to unserviced areas

Waiting time distribution in public health care: empirics and theory

Excessive waiting times for elective surgery have been a long-standing concern in many national healthcare systems in the OECD. How do the hospital admission patterns that generate waiting lists affect different patients? What are the hospitals characteristics that determine waiting times? By developing a model of healthcare provision and analysing empirically the entire waiting time distribution we attempt to shed some light on those issues. We first build a theoretical model that describes the optimal waiting time distribution for capacity constraint hospitals. Secondly, employing duration analysis, we obtain empirical representations of that distribution across hospitals in the UK from 1997–2005. We observe important differences on the ‘scale’ and on the ‘shape’ of admission rates. Scale refers to how quickly patients are treated and shape represents trade-offs across duration-treatment profiles. By fitting the theoretical to the empirical distributions we estimate the main structural parameters of the model and are able to closely identify the main drivers of these empirical differences. We find that the level of resources allocated to elective surgery (budget and physical capacity), which determines how constrained the hospital is, explains differences in scale. Changes in benefits and costs structures of healthcare provision, which relate, respectively, to the desire to prioritise patients by duration and the reduction in costs due to delayed treatment, determine the shape, affecting short and long duration patients differently