Efficiency evaluation for pooling resources in health care

Hospitals traditionally segregate resources into centralized functional departments such as diagnostic departments, ambulatory care centers, and nursing wards. In recent years this organizational model has been challenged by the idea that higher quality of care and efficiency in service delivery can be achieved when services are organized around patient groups. Examples include specialized clinics for breast cancer patients and clinical pathways for diabetes patients. Hospitals are struggling with the question of whether to become more centralized to achieve economies of scale or more decentralized to achieve economies of focus. In this paper we examine service and patient group characteristics to study the conditions where a centralized model is more efficient, and conversely, where a decentralized model is more efficient. This relationship is examined analytically with a queuing model to determine the most influential factors and then with simulation to fine-tune the results. The tradeoffs between economies of scale and economies of focus measured by these models are used to derive general management guidelines.     

A characterization of independence for competing Markov chains withapplications to stochastic Petri nets

This paper shows that some of the recently obtained product form results for stochastic Petri nets can be obtained as a special case of a simple exclusion mechanism for the product process of a collection of Markov chains     

Analytical models to determine room requirements in outpatient clinics

Outpatient clinics traditionally organize processes such that the doctor remains in a consultation room while patients visit for consultation, we call this the Patient-to-Doctor policy (PtD-policy). A different approach is the Doctor-to-Patient policy (DtP-policy), whereby the doctor travels between multiple consultation rooms, in which patients prepare for their consultation. In the latter approach, the doctor saves time by consulting fully prepared patients. We use a queueing theoretic and a discrete-event simulation approach to provide generic models that enable performance evaluations of the two policies for different parameter settings. These models can be used by managers of outpatient clinics to compare the two policies and choose a particular policy when redesigning the patient process. We use the models to analytically show that the DtP-policy is superior to the PtD-policy under the condition that the doctor’s travel time between rooms is lower than the patient’s preparation time. In addition, to calculate the required number of consultation rooms in the DtP-policy, we provide an expression for the fraction of consultations that are in immediate succession; or, in other words, the fraction of time the next patient is prepared and ready, immediately after a doctor finishes a consultation. We apply our methods for a range of distributions and parameters and to a case study in a medium-sized general hospital that inspired this research.     

Transient product from distributions in queueing networks

In this paper it is shown that a necessary and sufficient condition for a Markovian queueing network to have a particular type of closed form transient distribution which is a natural extension of an equilibrium produc-form distribution is that all queues have infinitely many servers.     

Two-Dimensional protein map of Saccharomyces cerevisiae: Construction of a gene–protein index

This publication marks the beginning of the construction of a gene–protein index that relates proteins which are resolved on the two-dimensional protein map of Saccharomyces cerevisiae with their corresponding genes. We report the identification of 36 novel polypeptide spots on the yeast protein map. They correspond to the products of 26 genes. Together with the polypeptide spots previously identified, this raises to 41 the number of genes whose products have been identified on the protein map. The proteins identified here are concerned with four major areas of yeast cellular physiology: carbon metabolism, heat shock, amino acid biosynthesis and purine biosynthesis. Given the molecular weight and isoelectric point of the identified proteins, and the codon-usage bias of the corresponding genes, it can be estimated that 25 to 35% of all the soluble yeast proteins are detectable under the labelling and running gel conditions used in this study.     

Analysis of flow transfer times in IEEE 802.11 wireless LANs

In this paper we present an integrated packet/flow level modelling approach for analysing flow throughputs and transfer times inieee 802.11wlans. It captures the statistical characteristics of the transmission of individual packets at themac layer and takes into account the system dynamics due to the initiation and completion of data flow transfers. In particular, at the flow level the system is modelled by a processor sharing type of queue, reflecting theieee 802.11mac design principle of distributing the transmission capacity fairly among the active flows. The integrated packet/flow level model is analytically tractable and yields a simple approximation for the throughput and flow transfer time. Extensive simulations show that the approximation is very accurate for a wide range of parameter settings. In addition, the simulation study confirms the attractive property following from our approximation that the expected flow transfer delay is insensitive to the flow size distribution (apart from its mean).     

Identification of proteins of the yeast protein map using genetically manipulated strains and peptide-mass fingerprinting

In this study we used genetically manipulated strains in order to identify polypeptide spots of the protein map of Saccharomyces cerevisiae. Thirty-two novel polypeptide spots were identified using this strategy. They corresponded to the product of 23 different genes. We also explored the possibilities of using peptide-mass fingerprinting for the identification of proteins separated on our gels. According to this strategy, proteins contained in spots are digested with trypsin and the masses of generated peptides are determined by matrix-assisted laser desorption-ionization mass spectrometry (MALDI-MS). The peptide masses are then used to search a yeast protein database for proteins that match the experimental data. Application of this strategy to previously identified polypeptide spots gave evidence of the feasibility of this approach. We also report predictions on the identities of nine unknown spots using MALDI-MS.     

Bottlenecks and stability in networks with contending nodes

This paper considers a class of queueing network models where nodes have to contend with each other to serve their customers. In each time slot, a node with a non-empty queue either serves a customer or is blocked by a node in its vicinity. The focus of our study is on analyzing the throughput and identifying bottleneck nodes in such networks. Our modeling and analysis approach consists of two steps. First, considering the slotted model on a longer timescale, the behavior is described by a continuous time Markov chain with state dependent service rates. In the second step, the state dependent service rates are replaced by their long run averages resulting in an approximate product form network. This enables us to determine the bottleneck nodes and the stability condition of the system. Numerical results show that our approximation approach provides very accurate results with respect to the maximum throughput a network can support. It also reveals a surprising effect regarding the location of bottlenecks in the network when the offered load is further increased.     

Performance Analysis of Fair Channel Sharing Policies in an Integrated Cellular Voice/Data Network

We study channel sharing in an integrated cellular voice/data network with a finite queue for data call requests that cannot be served immediately upon arrival. Using analytical techniques, a comparison of different fair channel sharing policies is made. As a main result, a closed-form expression is derived for the expected sojourn time (waiting time plus transfer time) of a data call, conditional on its size, indicating that the sojourn time is proportional to the call size. This attractive proportionality result establishes an additional fairness property for the channel sharing policies proposed in the paper. Additionally, as a valuable intermediate result, the conditional expected sojourn time of an admitted data call is obtained, given the system state at arrival, which may serve as an appreciated feedback information service to the data source. An extensive numerical study is included to compare the proposed policies and to obtain insight in the performance effects of the various system and policy parameters.     

Induction of a heat-shock-type response in Saccharomyces cerevisiae following glucose limitation

The protein pattern of yeast cells which have arrested proliferation in response to glucose exhaustion is drastically different from that of exponentially growing cells (Boucherie, 1985). In this study, we used two-dimensional gel electrophoresis to characterize the protein events responsible for these alterations. We found that the induction of heat-shock proteins is one of the major events responsible for these changes. This induction accounts for the synthesis of 18 of the 35 novel polypeptides observed in glucose-limited cells. It was shown to occur in combination with two other protein events: the derepression of carbon catabolite repressed proteins, which accounts for the synthesis of the other novel polypeptides, and an arrest of the synthesis of almost all the proteins present in exponentially growing cells. The time course of each of these events was determined by carrying out a detailed analysis of the pattern of proteins synthesized at various stages of a culture exhausting its glucose supply, and by the measurement of the rate of synthesis of individual polypeptides. The results showed in particular that the synthesis of most of the heat-shock proteins synthesized in glucose-limited cells was induced closely before glucose exhaustion, and that this synthesis was transient, climaxing by the time glucose was exhausted. Under the culture condition investigated, the entry into stationary phase associated with glucose limitation began several hours before glucose exhaustion. It was thus concluded that the observed induction of heat-shock proteins is directly related to the nutritional limitation and is independent from the arrest of cell proliferation.