Value management of diagnostic equipment with cancelation,no‐show,and emergency patients

Magnetic resonance imaging and other multifunctional diagnostic facilities, which are considered as scarce resources of hospitals, typically provide services to patients with different medical needs. This article examines the admission policies during the appointment management of such facilities. We consider two categories of patients: regular patients who are scheduled in advance through an appointment system and emergency patients with randomly generated demands during the workday that must be served as soon as possible. According to the actual medical needs of patients, regular patients are segmented into multiple classes with different cancelation rates, no‐show probabilities, unit value contributions, and average service times. Management makes admission decisions on whether or not to accept a service request from a regular patient during the booking horizon to improve the overall value that could be generated during the workday. The decisions should be made by considering the cancelation and no‐show behavior of booked patients as well as the emergency patients that would have to be served because any overtime service would lead to higher costs. We studied the optimal admission decision using a continuous‐time discrete‐state dynamic programming model. Identifying an optimal policy for this discrete model is analytically intractable and numerically inefficient because the state is multidimensional and infinite. We propose to study a deterministic counterpart of the problem (i.e., the fluid control problem) and to develop a time‐based fluid policy that is shown to be asymptotically optimal for large‐scale problems. Furthermore, we propose to adopt a mixed fluid policy that is developed based on the information obtained from the fluid control problem. Numerical experiments demonstrate that this improved policy works effectively for small‐scale problems. © 2016 Wiley Periodicals, Inc. Naval Research Logistics 63: 287–304, 2016     

Analysis of an Alternative Military Healthcare Benefit Design

Abstract

The Military Compensation and Retirement Modernization Commission was established by the Congress in 2013 to perform a systematic review of military compensation to address rising costs and other trends. Their recommendation for reforming the TRICARE health care program was sweeping, and differed greatly from earlier proposals that focused on increasing beneficiary cost shares. Specifically, the commission proposed overhauling the current benefit delivery model and replacing it with a premium-based insurance model offering a menu of DoD-sponsored private health plans. The analysis presented here is based on work that supported the commission by estimating the budgetary impact of its proposed reforms. Results indicate that movement towards the premium-based model would produce an annual budgetary cost savings in the $2 billion to $4 billion range, with a best savings estimate of $3.2 billion.     

装备故障诊断和预测技术综述

结合故障诊断与预测技术的国内外研究现状,综述了故障诊断和预测的完整性认知模型,并以此对蓬勃发展的故障诊断和故障预测技术进行了分类与综合分析。同时针对故障的不确定性特征,对故障诊断和预测技术的性能要求、定量评价与验证方法进行了分析。最后,分别从实际应用及扩展的四个方面提出了故障诊断、预测,以及PHM技术未来发展的几个问题。     

Do Military Expenditures Crowd-out Health Expenditures? Evidence from around the World, 2000–2013

Abstract

The paper examines the relationship between health and military expenditures using pooled cross-sectional (197 countries) and time series (2000–2013) data. Simultaneous equation models were employed to estimate the relationship between an array of public sector expenditures in order to address potential endogeneity. Our empirical findings strongly support the crowding-out hypothesis whereby increased military expenditures reduce the capacity of government to direct expenditures to health expenditures. These findings were robust to alternative specifications explored in the sensitivity analyses. Compared with upper-middle-income countries, the crowding-out effect became more pronounced among lower-middle-income countries. Consequently, this study shows that increased military expenditures negatively impacts health expenditures, and therefore poses as an important risk factor for population health and individual well-being. Moreover, it is the poorest of nations that are most sensitive to the negative effects of increased military expenditures.     

Health Insurance,Health Conditions,and Veteran Health Care Utilization

Abstract

The utilization of health care services by veterans has received much attention in recent years. However, the impact of the large array of factors affecting the veterans’ demand for health care services remains understudied. These factors include individual socio-demographic and economic characteristics, the availability of various sources of health insurance, and the prevalence of medical conditions. We use public data to analyze how veterans’ utilization of health care services varies with these factors. We also analyze how the reliance on VA services varies when alternative sources of health insurance are available to veterans. Based on the estimated relationships, we use a micro-simulation model to forecast future health care utilization, both inside and outside of VA.     

变工况下轴承健康监测的相关向量机与自适应阈值模型方法

工况在旋转机械运行过程中通常是变化的。变化的工况和故障一样,也会引起机械振动特征发生改变,从而引起诊断误差。为此,提出一种用于变工况下轴承健康监测的新方法。该方法使用相关向量机拟合振动特征的统计量随工况参数的变化,得到特征统计量与工况参数之间的连续函数关系;基于不同工况下的特征统计,构建自适应阈值模型。将该方法用于不同转速下的轴承健康监测,结果表明,当转速超过某一个较小的值时,该方法有效。     

Budgetary Trade-Offs Between Defense,Education and Health Expenditures: The Case of Turkey

The main objective of this paper is to evaluate empirically the existence of a budgetary trade-off between military, education and health expenditures in Turkey for the time period 1925-1998. Development economists, peace and defense economists and political economists have extensively investigated the existence of a trade-off between military, education and health spending since the 1970s. However, the literature review reveals that it is hard to establish a general theory of budgetary trade-off between military, education and health spending and make this applicable for all cases. This is mostly due to economic, social, political, and historical differences among the countries Moreover, it is likely that different research techniques, different time periods analyzed may produce different results. As a result of this, researchers have found a variety of outcomes regarding the trade-off between defense-education and health expenditures. This study presents a brief literature review within the framework of trade-offs between defense-education and health expenditures and also concentrates on theoretical model development. The discussion will center on developing a multi-variable single equation regression model and presenting estimable forms of equations.     

关于设置高校学生辅导员专业的思考

新时期党的思想政治工作对高校学生辅导员工作提出更高的要求。设立辅导员专业 ,实现辅导员职业化 ,建立一支高素质的辅导员队伍 ,是高校改革与发展的必然趋势。     

Scheduling patients in an ambulatory surgical center

This paper presents a deterministic approach to schedule patients in an ambulatory surgical center (ASC) such that the number of postanesthesia care unit nurses at the center is minimized. We formulate the patient scheduling problem as new variants of the no‐wait, two‐stage process shop scheduling problem and present computational complexity results for the new scheduling models. Also, we develop a tabu search‐based heuristic algorithm to solve the patient scheduling problem. Our algorithm is shown to be very effective in finding near optimal schedules on a set of real data from a university hospital's ASC. © 2003 Wiley Periodicals, Inc. Naval Research Logistics, 2003     

从德育的人文关怀角度谈高校生命道德教育的建构

道德教育的出发点，应建立在对个体生命的理解与尊重的基础上，这是以人为本的教育价值观的体现。但是我国的德育缺乏了对生命主题的关注。本文试图从德育的人文关怀角度来反思高校的生命道德教育，并提出了相应的对策和建议。