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Healthcare call centers serve an important role in the healthcare system to support patients' access to care and satisfaction and optimize medical resource allocation. Limited research has provided sufficient evidence on how to increase healthcare call center's efficiency from managerial aspects. In this study, a simulation model is built based on real-life healthcare call center settings and call information, to identify the opportunities for improvement. This call center processes approximately 2638 calls for 25 clinic sites every day. The call abandon rate was at 16.7%, which was far from the organization's goal of 5%. Some improvement opportunities based on managerial interests such as cross-coverage, non-scheduling call transition, staff availability and staff allocation without increasing staff numbers, are identified and their operational impacts are evaluated by the simulation model. Moreover, a genetic algorithm is used to find the optimal shift for staff allocation. The simulation results demonstrate the validity of the proposed model, provide valuable insights for decision-making before the implementation and provide other healthcare call centers' alternatives to improve performance. The recommendations were communicated to call center staff and consentaneous opportunities were implemented. The results showed a significant reduction of 39.5% in the call abandon rate. [ABSTRACT FROM AUTHOR]

In this article, we address a two-stage scheduling problem that requires coordination between clinical and surgical appointments for specialized surgeries. First, patients have a clinical appointment with a surgeon to determine whether they are an appropriate candidate for the surgical procedure. Subsequently, if the decision to pursue the surgery is made the patient undergoes the procedure on a later date. However, the scheduling process aims to book both the clinical and surgical appointments for a patient at the time of the initial appointment request. Two sources of uncertainty make this scheduling process challenging: (i) the patient may or may not need surgery after the clinical appointment and (ii) the surgery duration for each patient and procedure is unknown. We present a Distributionally Robust Optimization (DRO) approach for coordinating clinical and surgical appointments under these uncertainties. A case study of the Transcatheter Aortic Valve Replacement procedure at Mayo Clinic, Rochester, MN is presented. Numerical results include comparisons with the current practice and four heuristic scheduling policies from the literature. Results show that the DRO-based scheduling policies lead to lower total surgeon idle-time and overtime per day. The proposed policies also restrict the under and over utilization of clinical capacity. [ABSTRACT FROM AUTHOR]

This study creates a Chinese financial cycle index to examine the lead-and-lag relations between business and financial cycles. We examine the macroeconomic performance when these cycles are in boom, bust, and other combinations. We have four interesting results. First, financial cycles occur less frequently than business cycles. Second, the upturn phase of a financial cycle is significantly longer than the downturn phase. Third, gross domestic product growth rates are at their lowest when the two cycles are in troughs and the highest when they reach their peaks. We find similar results for employment, inflation, and consumption rates. Fourth, financial cycles lead business cycles but not vice versa. Hence, policymakers should consider the financial system before bailing out the real economy, which alone is insufficient for the recovery of the macro economy. [ABSTRACT FROM AUTHOR]

This study compares credit ratings between FHC affiliated banks and independent banks using Taiwan bank and FHC data. The results show banks that join Insurance- or Security-FHCs obtain better ratings than those that join Bank-FHCs. Second, banks that join FHCs with higher activity diversification can obtain better credit ratings. Third, joining government-owned FHCs enhances bank credit ratings and mitigates bank default risk compared to joining non-government-owned FHCs. Fourth, prior to the financial crisis, banks joining FHCs can obtain better credit ratings and reduce the cost of debt. However, during the financial crisis, rating agencies stopped regarding banks joining privately owned bank-based FHCs as risk diversification and assigning better credit ratings on this basis. [ABSTRACT FROM PUBLISHER]

Objective: To investigate lung function associated with asthma and body mass index (BMI) among adolescents at 96 northern Taiwan junior high schools participating in an asthma screening program. Methods: The questionnaires and lung function test results measured for 3669 boys and 3523 girls were included in this study for data analysis. Measures of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and FEV1/FVC ratio were compared by sex, asthma status and BMI. Results: Overall mean FVC levels were similar between students with and without asthma, 3.71 L vs. 3.71 L for boys (p = 0.991) and 2.79 vs. 2.78 for girls (p = 0.517). The overall mean FEV1 levels were also similar between girls with and without asthma. Asthmatic boys had lower FEV1 than non-asthmatic boys. Mean FEV1/FVC was significantly lower in students with asthma than those without asthma. Mean FVC and FEV1 increased with BMI in both sexes. A lower mean FEV1/FVC was observed among students with asthma and high BMI, and was more pronounced in boys than in girls. Multivariable regression analysis also showed that FEV1/FVC ratios were negatively associated with asthma and high BMI, stronger in boys than in girls for asthma (β = −2.176 (standard errors (SE) = 0.268) vs. −1.085 (SE = 0.258) and for BMI (β = −0.309 (SE = 0.025) vs. −0.218 (SE = 0.029)). Conclusion: This northern Taiwan study suggests that FEV1/FVC is negatively associated with asthma and high BMI in adolescents, stronger for boys than for girls. [ABSTRACT FROM AUTHOR]

This study evaluated biohydrogen production by co-culture of Clostridium butyricum and Rhodopseudomonas palustris. C. butyricum and R. palustris were grown separately and together as batch cultures. Hydrogen production, growth, NH4-N, total volatile fatty acid production, and sucrose degradation were monitored. The hydrogen production of the co-culture produced 562 ml, R. palustris 426 ml, and C. butyricum 333 ml. The co-culture produced 2.16 mol H2/mol sucrose, C. butyricum and R. palustris produced 1.77 and 1.64 mol H2/mol sucrose, respectively. The co-culture was more efficient in the hydrogen production. Therefore, the co-culture is a good method for biohydrogen fermentation. [ABSTRACT FROM PUBLISHER]

Patient no-show in outpatient clinics has been a long recognized issue, which negatively impacts clinic operational efficiency in terms of costs and patient access to care. One way to reduce these negative impacts is to allow urgent walk-ins during a clinic day. Some clinics allow random walk-ins and some purposely leave open time slots to accommodate them. The objective of this paper is to develop a cost-effective urgent care policy that is added on top of a full schedule and takes into account scheduled patients' no-show rates to improve patient access to care in a dynamic clinic environment. The findings indicate that the proposed approach outperforms the current random and urgent slot approaches. This paper demonstrates a dynamic approach for accommodating urgent patients into a patient scheduling system, based on the prediction of an individual patient's no-show probability and the maximum number of urgent patients allowed. [ABSTRACT FROM AUTHOR]

Background aims. We investigated bone marrow stromal cell (BMSC) transplantation combined with angiotensin-converting enzyme inhibitor (ACEI) treatment in acute myocardial infarction (AMI) and the role of insulin-like growth factor-1 (IGF-1). Methods. AMI models were established in Sprague-Dawley rats by ligation of the left anterior descending coronary artery and grouped into blank control (BC), ACEI treatment (ACEI), BMSC transplantation (BMSC) and BMSC transplantation plus ACEI (combined). Perindopril (2.5 mg/kg) was administered by gavage to ACEI and combined groups from the day after AMI. BMSC (2 × 108) were injected into the border of the MI area a week later in the BMSC and combined groups. Results. After 4 weeks, hemodynamics in the BMSC and combined groups were significantly improved ( P < 0.05 versus BC), with the greatest improvement in the combined group ( P < 0.05). In addition, an increased number of BMSC survived in the combined group ( P < 0.05 versus BMSC). A proportion of BMSC was positive for troponin T, as detected by immunofluorescence. The number of apoptotic cardiomyocytes was decreased in the BMSC and ACEI groups, and even further in the combined group ( P < 0.05). IGF-1 expression was up-regulated in the BMSC and combined groups ( P < 0.05 versus BC), but not in the ACEI group. B cell lymphoma-2 (Bcl-2) expression was up-regulated in the ACEI, BMSC and combined groups, with the highest expression in the combined group ( P < 0.05). Conclusions. Our results show that BMSC engrafted in AMI can survive well and secrete IGF-1 and preserve cardiac function significantly. These data suggest that BMSC transplantation inhibits apoptosis of cardiomyocytes by up-regulation of Bcl-2 expression in the myocardium, and this effect might be sensitized by ACEI. [ABSTRACT FROM AUTHOR]

Patient wait time has long been a recognized problem in modern outpatient health care delivery systems. Despite all the efforts to develop appointment rules and solutions, the problem of long patient waits persists. Regardless of the reasons for this problem, the fact remains that there are few implemented models for effective scheduling that consider patient wait times as well as physician idle time and are generalized sufficiently to accommodate a variety of outpatient clinic settings. This paper presents a solution of designing appointment slots for scheduling appointments in outpatient facilities that both patient wait time and physician idle time meet the declared scheduling policies without overbooking and double-booking. Furthermore, this paper provides the implementation results from three case studies to support the approach. The results confirm that the system can effectively reduce patient wait time as much as 56% without significantly increasing physician idle time per patient and still allow physician to see and schedule exactly same number of patients per clinic session. Consequently, this research improves the outpatient experience for both patients and the medical professions, changes the perception of long waits in a physician's office and ultimately enhances the quality of care. [ABSTRACT FROM PUBLISHER]