A hierarchical facility layout planning approach for large and complex hospitals

The transportation processes for patients, personnel, and material in large and complex maximum-care hospitals with many departments can consume significant resources and thus induce substantial logistics costs. These costs are largely determined by the allocation of the different departments and wards in possibly multiple connected hospital buildings. We develop a hierarchical layout planning approach based on an analysis of organizational and operational data from the Hannover Medical School, a large and complex university hospital in Hannover, Germany. The purpose of this approach is to propose locations for departments and wards for a given system of buildings such that the consumption of resources due to those transportation processes is minimized. We apply the approach to this real-world organizational and operational dataset as well as to a fictitious hospital building and analyze the algorithmic behavior and resulting layout.     

Optimizing time and resource allocation trade-offs for investment into morphological and behavioral defense

Prey organisms are confronted with time and resource allocation trade-offs. Time allocation trade-offs partition time, for example, between foraging effort to acquire resources and behavioral defense. Resource allocation trade-offs partition the acquired resources between multiple traits, such as growth or morphological defense. We develop a mathematical model for prey organisms that comprise time and resource allocation trade-offs for multiple defense traits. Fitness is determined by growth and survival during ontogeny. We determine optimal defense strategies for environments that differ in their resource abundance, predation risk, and defense effectiveness. We compare the results with results of simplified models where single defense traits are optimized. Our results indicate that selection acts in favor of integrated traits. The selective advantage of expressing multiple defense traits is most pronounced at intermediate environmental conditions. Optimizing single traits generally leads to a more pronounced response of the defense traits, which implies that studying single traits leads to an overestimation of their response to predation. Behavioral defense and morphological defense compensate for and augment each other depending on predator densities and the effectiveness of the defense mechanisms. In the presence of time constraints, the model shows peak investment into morphological and behavioral defense at intermediate resource levels.     

VRAA: virtualized resource auction and allocation based on incentive and penalty

Virtualization is widely used in cloud computing environments to efficiently manage resources, but it also raises several challenges. One of them is the fairness issue of resource allocation among virtual machines. Traditional virtualized resource allocation approaches distribute physical resources equally without taking into account the actual workload of each virtual machine and thus often leads to wasting. In this paper, we propose a virtualized resource auction and allocation model (VRAA) based on incentive and penalty to correct this wasting problem. In our approach, we use Nash equilibrium of cooperative games to fairly allocate resources among multiple virtual machines to maximize revenue of the system. To illustrate the effectiveness of the proposed approach, we then apply the basic laws of auction gaming to investigate how CPU allocation and contention can affect applications’ performance (i.e., response time), and its effect on CPU utilization. We find that in our VRAA model, the fairness index is high, and the resource allocation is closely proportional to the actual workloads of the virtual machines, so the wasting of resources is reduced. Experiment results show that our model is general, and can be applied to other virtualized non-CPU resources.     

黑龙江省综合医院人力资源部门人员现状分析

随着医院人力资源管理工作职能的转变,对人力资源部门人员的整体素质、知识结构、梯队建设等方面提出了更高的要求。通过对黑龙江省10个市60所综合医院人力资源部门人员现状调查,明确人力资源部门人员现状及存在的问题,提出合理的改善建议,为医院人力资源部门人员合理配置提供借鉴。     

DOES THE TRADE-OFF BETWEEN GROWTH AND REPRODUCTION SELECT FOR FEMALE-BIASED SEXUAL ALLOCATION IN COSEXUAL PLANTS?

We analyzed sexual allocation in cosexual plants while taking the trade-off between growth and reproduction into consideration and showed that this trade-off does not select for female-biased sexual allocation. There are two problems in sexual allocation: optimizing the amount of resources allocated to reproduction in a growing season and equalizing the resources allocated to the male and the female functions. If these two are possible at the same time, equal resource allocation to the male and the female functions is the evolutionarily stable strategy (ESS; given that the fitness gains through the male and the female functions are proportional to the amount of the resources allocated to these functions). Biased sexual allocation only occurs when constraints make it impossible to simultaneously optimize allocation to reproduction and allocation to male and female functions. However, even if female-biased sexual allocation occurs due to the addition of other constraints, the trade-off between growth and reproduction itself is not an important factor that selects for female-biased sexual allocation.     

Conserved ontogeny and allometric scaling of resource acquisition and allocation in the Daphniidae

Life histories vary widely among taxa, but within phylogenetic groups there may be a fundamental framework around which trait variation is organized, perhaps as a consequence of lineage-specific developmental constraints. In organisms with indeterminate growth, there is an ongoing problem of optimally allocating resources between growth and reproduction, and that allocation decision may manifest itself through allometric scaling. Previous work on freshwater zooplankton has shown that the ontogenetic pattern of resource allocation can be described by simple mathematical functions. An important component of understanding how such functions can explain life-history variation is to discover which parameters in these functions are robust, with respect to both resource availability and evolutionary diversification, and which parameters exhibit interspecific allometry. To shed light on these issues, detailed life table experiments were conducted on eight species in the family Daphniidae (Crustacea) at high and low levels of resources. Using data on growth, reproduction, and instar duration, the ontogeny of resource allocation to growth and reproduction could be described as functions that plateau at or shortly after the onset of maturity. To be sure that the results were not an artifact of phylogenetic structure, the parameters were tested in a phylogenetically controlled fashion. The results suggest a simple set of resource allocation rules for daphniids, whereby all species exhibit a similar form of ontogenetic change in allocation, and reach a plateau where approximately 94% of available resources are allocated to reproduction. The asymptotically maximal rate of net resources incorporated in growth and reproduction was positively related to size at maturity, whereas the rates of approach to plateaus (for both net resource assimilation and proportional allocation to reproduction) were negatively related to body size. Per-offspring investment was positively related to the square root of size at maturity. Using this approach, a wide range of interspecific variation in life-history features can be related to a single underlying trait, the size at first reproductive investment.     

服务蓝图在出入院服务流程优化中的应用及效果分析

目的 对出入院服务流程进行梳理与优化，提高服务效率、改善患者体验。方法 利用服务蓝图确定住院患者的出入院服务体验、内部服务流程、后台支持保障系统等，并对服务效率和患者体验进行评价。结果 在某三甲综合性医院建立出入院服务中心，统筹协调所有出入院相关服务后，患者术前待床时间、办理出入院手续时间、术前检查等待时间和往返距离，均比去年同期有所降低。结论 将服务蓝图应用于医院出入院服务流程的优化，通过资源合理配置、跨部门协作、信息平台支撑、规章制度保障，能够有效地保障患者安全、提高运行效率、提高患者满意度。     

Effects of phenological constraints on sex allocation in cosexual monocarpic plants

The effects of two phenological constraints in resource investment to reproduction – resource limitation at the flowering stage and unpredictability of resources gained after flowering – on the resource allocation between male and female functions in monocarpic plants are considered using the ESS (evolutionarily stable strategy) approach. The model predicts that the sex allocation including the seed maturation stage has a female bias, when the quantity of reproductive resources available at flowering is small compared with that which is obtained after flowering, or when the cost of seed maturation relative to ovule production is low. The fluctuation of the quantity of resources available for seed maturation favors overproduction of ovules. As a result, more resources are allocated to female function and less to male function at flowering. The ESS allocation depends on the variability of resources and the cost of seed maturation relative to ovule production. The probability that total resource allocation has a female bias becomes higher than 0.5, and it depends on the cost of seed maturation relative to ovule production rather than resource variability. On the other hand, the probability that resource allocation has a female bias decreases with resource variability if we assume that the floral sex ratio is fixed. Future studies of plant sex allocation would profit by taking account of the phenological process of reproduction such as ovule production or seed maturation.     

非营利性医院融资现状、关键因素与政策支撑体系研究

在分析我国非营利性医院各种融资方式现状的基础上,对影响融资的关键因素进行了识别,包括非营利性医院产权归属、补偿机制、规模与区域卫生规划三个方面,并从管理模式、治理结构、财政补偿、医疗保险制度、卫生资源配置和社会筹资等方面,构建了促进非营利性医院融资的政策支撑体系。     

Quantifying multivariate plasticity: genetic variation in resource acquisition drives plasticity in resource allocation to components of life history

Acquisition and allocation of resources are central to life‐history theory. However, empirical work typically focuses only on allocation despite the fact that relationships between fitness components may be governed by differences in the ability of individuals to acquire resources across environments. Here, we outline a statistical framework to partition the genetic basis of multivariate plasticity into independent axes of genetic variation, and quantify for the first time, the extent to which specific traits drive multitrait genotype–environment interactions. Our framework generalises to analyses of plasticity, growth and ageing. We apply this approach to a unique, large‐scale, multivariate study of acquisition, allocation and plasticity in the life history of the cricket, Gryllus firmus. We demonstrate that resource acquisition and allocation are genetically correlated, and that plasticity in trade‐offs between allocation to components of fitness is 90% dependent on genetic variance for total resource acquisition. These results suggest that genotype–environment effects for resource acquisition can maintain variation in life‐history components that are typically observed in the wild.     

Clinical Audit of COPD Patients Requiring Hospital Admissions in Spain: AUDIPOC Study

BACKGROUNDS: AUDIPOC is a nationwide clinical audit that describes the characteristics, interventions and outcomes of patients admitted to Spanish hospitals because of an exacerbation of chronic obstructive pulmonary disease (ECOPD), assessing the compliance of these parameters with current international guidelines. The present study describes hospital resources, hospital factors related to case recruitment variability, patients' characteristics, and adherence to guidelines. METHODOLOGY/PRINCIPAL FINDINGS: An organisational database was completed by all participant hospitals recording resources and organisation. Over an 8-week period 11,564 consecutive ECOPD admissions to 129 Spanish hospitals covering 70% of the Spanish population were prospectively identified. At hospital discharge, 5,178 patients (45% of eligible) were finally included, and thus constituted the audited population. Audited patients were reassessed 90 days after admission for survival and readmission rates. A wide variability was observed in relation to most variables, hospital adherence to guidelines, and readmissions and death. Median inpatient mortality was 5% (across-hospital range 0-35%). Among discharged patients, 37% required readmission (0-62%) and 6.5% died (0-35%). The overall mortality rate was 11.6% (0-50%). Hospital size and complexity and aspects related to hospital COPD awareness were significantly associated with case recruitment. Clinical management most often complied with diagnosis and treatment recommendations but rarely (<50%) addressed guidance on healthy life-styles. CONCLUSIONS/SIGNIFICANCE: The AUDIPOC study highlights the large across-hospital variability in resources and organization of hospitals, patient characteristics, process of care, and outcomes. The study also identifies resources and organizational characteristics associated with the admission of COPD cases, as well as aspects of daily clinical care amenable to improvement.     

上海黄浦区社区卫生服务绩效评价与SWOT分析

公立医院规划布局是卫生资源配置极为最重要的一个环节。公立医院的合理配置、优化布局有助于提高医疗资源运行效率,使居民获得最大健康产出。从系统角度出发,要更好地配置公立医院资源,必须更好地发挥公立医院与社区卫生服务机构的协同作用,建立有序的分级诊疗模式。因此,文章结合全民健康覆盖的四个条件,对上海市黄浦区社区卫生服务作绩效评估与SWOT分析,为社区卫生服务的进一步发展提供建议,也为更好地配置公立医院资源提供参考。     

Daily nurse requirements planning based on simulation of patient flows

Nurses account for approximately 50 % of total hospital budgets and their allocation to medical units and shifts can significantly affect the quality of care provided to patients. The adoption of flexible shift schedules and the assessment of actual nursing time can enable sensible resource planning, balancing the quality of care with efficiency in resource use. Starting from the concept that nurse requirements are triggered by patient needs, which are stochastic in nature both for clinical activities and their duration, this paper proposes an innovative Nurse Requirement Planning model grounded on the concept of the clinical pathway (the “standard” sequence of diagnostic, therapeutic and care activities a patient with certain pathology should undertake over time) with its inner routing probability and patient dependence on nurses, which can be correlated to the time needed to perform nursing tasks. In merging and modelling these two aspects, the method summarizes the best features of acuity-quality and timed-task/activity techniques, well known although not usually applied for reasons of demands on clinicians’ time. Instead, in this paper, for each shift of the day, hospital management is enabled to choose the optimal number of nurses to meet actual requirements according to a desired service level and personnel saturation by means of a tool that simulates the patient flow in a medical unit based on automatic data retrieval from hospital databases. The validation and verification of the proposal were undertaken in a stroke unit.     

Self‐admission in psychiatry: The ethics

Self‐admission to inpatient treatment is a novel approach that aims to increase agency and autonomy for patients with severe psychiatric illness and a history of high utilization of inpatient care. By focusing on brief, preventive hospital admissions in times of increased risk of relapse, self‐admission seeks to reduce the need for prolonged episodes of inpatient treatment. Participants are generally satisfied with the model, which is not surprising given that self‐admission programs allocate a scarce resource—hospital beds—to a select group. However, the patients targeted by these programs are not necessarily those in most need of hospital admission, which may compromise the commonly accepted ‘principle of need’ in allocation of public healthcare resources. In light of the current lack of consistent evidence of the usefulness and cost‐effectiveness of the model, several aspects need to be further studied in order to guide any large‐scale implementation of self‐admission in psychiatry.     

Resource allocation for epidemic control over short time horizons

We present a model for allocation of epidemic control resources among a set of interventions. We assume that the epidemic is modeled by a general compartmental epidemic model, and that interventions change one or more of the parameters that describe the epidemic. Associated with each intervention is a 'production function' that relates the amount invested in the intervention to values of parameters in the epidemic model. The goal is to maximize quality-adjusted life years gained or the number of new infections averted over a fixed time horizon, subject to a budget constraint. Unlike previous models, our model allows for interacting populations and non-linear interacting production functions and does not require a long time horizon. We show that an analytical solution to the model may be difficult or impossible to derive, even for simple cases. Therefore, we derive a method of approximating the objective functions. We use the approximations to gain insight into the optimal resource allocation for three problem instances. We also develop heuristics for solving the general resource allocation problem. We present results of numerical studies using our approximations and heuristics. Finally, we discuss implications and applications of this work.     

广东省三级医院护理人力资源配置现状及对策研究

目的 了解广东省三级医院护 理人力资源的配置现状,探讨更合理的配置对策。方法 自行设计问卷,对广东省21个地市的76所三级医院护理人力资源数量、护理人力资源内部结构、人员流失、支持保障系统情况等现状进行研究分析。结果 8所（13.33%）医院未成立临床支持中心; 23所（38.33%）医院普通病房实际床位总数与普通病房护士总数比不达标;职业性别比例严重失衡,男性仅占2.61%;34岁及以下护士占76.38%;大专及以下学历占78.61%;高级职称占4.65%;近年离职比由3.62%上升至5.08%。结论 广东省三级医院护理人员非护理工作负担较重;人力资源总量相对不足,队伍结构欠合理;护士人力流失逐年增加。建议优化三级医院护理人力配置,重视临床服务指标,建立并完善后勤保障系统,积极开展护士岗位改革等是适应社会高速发展需求和护理学科专业化的重要举措。     

Carbon allocation and competition maintain variation in plant root mutualisms

Plants engage in multiple root symbioses that offer varying degrees of benefit. We asked how variation in partner quality persists using a resource‐ratio model of population growth. We considered the plant's ability to preferentially allocate carbon to mutualists and competition for plant carbon between mutualist and nonmutualist symbionts. We treated carbon as two nutritionally interchangeable, but temporally separated, resources—carbon allocated indiscriminately for the construction of the symbiosis, and carbon preferentially allocated to the mutualist after symbiosis establishment and assessment. This approach demonstrated that coexistence of mutualists and nonmutualists is possible when fidelity of the plant to the mutualist and the cost of mutualism mediate resource competition. Furthermore, it allowed us to trace symbiont population dynamics given varying degrees of carbon allocation. Specifically, coexistence occurs at intermediate levels of preferential allocation. Our findings are consistent with previous empirical studies as well the application of biological market theory to plantroot symbioses.     

Sex allocation and reproductive success in the andromonoecious perennial Solanum carolinense (Solanaceae). I. Female

Relative allocation of resources to growth vs. reproduction has long been known to be an important determinant of reproductive success. The importance of variation in allocation to different structures within reproductive allocation is somewhat less clear. This study was designed to elucidate the importance of allocation to vegetative vs. reproductive functions, and allocation within reproductive functions (sex allocation), to realized female success in an andromonoecious plant, Solanum carolinense. Allocation measurements were taken on plants in experimental arrays exposed to natural pollination conditions. These measurements included total flower number, the proportion of flowers that were male, flower size, and vegetative size. Flower number explained the majority of the variation among individuals in their success-that is, there was strong selection for increased flower production. There was also selection to decrease the proportion of flowers that were male, but neither flower size nor vegetative size (a measure of overall resource availability) were direct determinants of female success. After Bonferroni corrections for multiple comparisons, most phenotypic correlations among the traits measured were nonsignificant. Thus, in this andromonoecious species there is not a strong relationship between resource availability (vegetative size) and female success, and female success is instead determined by the relative production of the two different flower types.     

Factors Associated with the Time of Admission among Notified Dengue Fever Cases in Region VIII Philippines from 2008 to 2014

In cases of Dengue fever, late hospital admission can lead to treatment delay and even death. In order to improve early disease notification and management, it is essential to investigate the factors affecting the time of admission of Dengue cases. This study determined the factors associated with the time of admission among notified Dengue cases. The study covered the period between 2008 and 2014 in Region VIII, Philippines. The factors assessed were age, sex, hospital sector, hospital level, disease severity based on the 1997 WHO Dengue classification, and period of admission (distinguishing between the 2010 Dengue epidemic and non-epidemic time). We analysed secondary data from the surveillance of notified Dengue cases. We calculated the association through chi-square test, ordinal logistic regression and linear regression at p value < 0.05. The study included 16,357 admitted Dengue cases. The reported cases included a majority of children (70.09%), mild cases of the disease (64.00%), patients from the public sector (69.82%), and non-tertiary hospitals (62.76%). Only 1.40% of cases had a laboratory confirmation. The epidemic period in 2010 comprised 48.68% of all the admitted cases during this period. Late admission was more likely among adults than children (p<0.05). The severe type of the disease was more likely to be admitted late than the mild type (p<0.05). Late admission was also more likely in public hospitals than in private hospitals (p<0.05); and within tertiary level hospitals than non-tertiary hospitals (p<0.05). Late admission was more likely during the non-epidemic period than the 2010 epidemic period (p<0.05). A case fatality rate of 1 or greater was significantly associated with children, severe diseases, tertiary hospitals and public hospitals when admitted late (p<0.05). Data suggests that early admission among child cases was common in Region VIII. This behavior is encouraging, and should be continued. However, further study is needed on the late admission among tertiary, public hospitals and non-epidemic period with reference to the quality of care, patient volume, out of pocket expense, and accessibility We recommend the consistent use of the 2009 WHO Dengue guidelines in order to standardize the admission criteria and time across hospitals.     

Physiological dynamics,reproduction‐maintenance allocations,and life history evolution

Allocation of resources to competing processes of growth, maintenance, or reproduction is arguably a key process driving the physiology of life history trade‐offs and has been shown to affect immune defenses, the evolution of aging, and the evolutionary ecology of offspring quality. Here, we develop a framework to investigate the evolutionary consequences of physiological dynamics by developing theory linking reproductive cell dynamics and components of fitness associated with costly resource allocation decisions to broader life history consequences. We scale these reproductive cell allocation decisions to population‐level survival and fecundity using a life history approach and explore the effects of investment in reproduction or tissue‐specific repair (somatic or reproductive) on the force of selection, reproductive effort, and resource allocation decisions. At the cellular level, we show that investment in protecting reproductive cells increases fitness when reproductive cell maturation rate is high or reproductive cell death is high. At the population level, life history fitness measures show that cellular protection increases reproductive value by differential investment in somatic or reproductive cells and the optimal allocation of resources to reproduction is moulded by this level of investment. Our model provides a framework to understand the evolutionary consequences of physiological processes underlying trade‐offs and highlights the insights to be gained from considering fitness at multiple levels, from cell dynamics through to population growth.