Evaluating appointment postponement in scheduling patients at a diagnostic clinic

Diagnostic clinics are among healthcare facilities that suffer from long waiting times which can worsen medical outcomes and increase patient no-shows. Reducing waiting times without significant capital investments is a challenging task. We tackle this challenge by proposing a new appointment scheduling policy that does not require significant investments for diagnostic clinics. The clinic in our study serves outpatients, inpatients, and emergency patients. Emergency patients must be seen on arrival, and inpatients must be given next day appointments. Outpatients, however, can be given later appointments. The proposed policy takes advantage of this by allowing the postponement of the acceptance of appointment requests from outpatients. The appointment scheduling process is modeled as a two-stage stochastic programming problem where a portion of the clinic capacity is allocated to inpatients and emergency patients in the first stage. In the second stage, outpatients are scheduled based on their priority classes. After a detailed analysis of the solutions obtained from the two-stage stochastic model, we develop a simple, non-anticipative policy for patient scheduling. We evaluate the performance of this proposed, easy-to-implement policy in a simulation study which shows significant improvements in outpatient indirect waiting times.     

Fitting Lanchester equations to the battles of Kursk and Ardennes

Lanchester equations and their extensions are widely used to calculate attrition in models of warfare. This paper examines how Lanchester models fit detailed daily data on the battles of Kursk and Ardennes. The data on Kursk, often called the greatest tank battle in history, was only recently made available. A new approach is used to find the optimal parameter values and gain an understanding of how well various parameter combinations explain the battles. It turns out that a variety of Lanchester models fit the data about as well. This explains why previous studies on Ardennes, using different minimization techniques and data formulations, have found disparate optimal fits. We also find that none of the basic Lanchester laws (i.e., square, linear, and logarithmic) fit the data particularly well or consistently perform better than the others. This means that it does not matter which of these laws you use, for with the right coefficients you will get about the same result. Furthermore, no constant attrition coefficient Lanchester law fits very well. The failure to find a good‐fitting Lanchester model suggests that it may be beneficial to look for new ways to model highly aggregated attrition. © 2003 Wiley Periodicals, Inc. Naval Research Logistics, 2004.     

Geopolitics over Proliferation: the Origins of US Grand Strategy and Their Implications for the Spread of Nuclear Weapons in South Asia

How much does the United States care about nonproliferation? Recent scholarship suggests that the fear of spreading nuclear weapons was central to the US grand strategy in the Cold War. In one important case, however, this argument does not hold. This article draws on theoretical debates and newly declassified archives to demonstrate the primacy of geopolitics over nonproliferation in Washington’s policy toward India and Pakistan. Despite their rhetoric, Democratic and Republican leaders consistently relegated nonproliferation to the backburner whenever it conflicted with other strategic goals. Moreover, they inadvertently encouraged proliferation in South Asia at three inter-connected levels: technology, security, and identity.     

Resource efficiency in aircraft production

This article examines measures of economic efficiency in aircraft production. In particular, a type of nonlinear frontier estimation is contrasted with more traditional methods for estimating a dynamic cost function. This cost function is grounded in economic theory, and it is consistent with knowledge of the aircraft-production process. The model includes the effects of both learning and production rate on total program costs. The usefulness of the model is demonstrated with an example that relates to the acquisition of military equipment. It is shown through various sensitivity analyses that an alternative procurement policy for an aircraft program could have resulted in increased efficiency and hence a lower total program cost to the government.     

Spaghetti: systems thinking and the US Army

In the mid-2000s, the United States Army was embroiled in counterinsurgency missions in Iraq and Afghanistan that required deeper understanding of local social systems. The Army turned to systems thinking and design thinking to model and understand the world, define problems, and develop approaches to strategic and operational challenges. However, the Army’s approach as expressed in publications and doctrine encourages the development of complicated, unsupported, and unfalsifiable hypotheses. The risk is that the Army will act on incorrect assumptions and develop plans that are fragile.     

Impediments to Fighting the Islamic State: Private Contractors and US Strategy

The United States has returned to Iraq, this time to combat the Islamic State. President Barack Obama’s strategy to ‘degrade, and ultimately destroy the terrorist group’ faces serious problems due to political obstacles in obtaining Congressional Authorization for the Use of Military Force (AUMF) and more importantly because of neglect of the crucial role of private contractors. Although the narrative has changed, and there is no public mention of contractors, they remain central to all that the Department of Defense does in the US and abroad. Suggestions are offered on how their performance can be improved to support President Obama’s strategy.     

Simultaneous determination of production and maintenance schedules using in‐line equipment condition and yield information

In many manufacturing environments, equipment condition has a significant impact on product quality, or yield. This paper presents a semi‐Markov decision process model of a single‐stage production system with multiple products and multiple maintenance actions. The model simultaneously determines maintenance and production schedules, accounting for the fact that equipment condition affects the yield of each product differently. It extends earlier work by allowing the expected time between decision epochs to vary by both action and machine state, by allowing multiple maintenance actions, and by treating the outcome of maintenance as less than certain. Sufficient conditions are developed that ensure the monotonicity of both the optimal production and maintenance actions. While the maintenance conditions closely resemble previously studied conditions for this type of problem, the production conditions represent a significant departure from earlier results. The simultaneous solution method is compared to an approach commonly used in industry, where the maintenance and production problems are treated independently. Solving more than one thousand test problems confirms that the combination of both features of the model—accounting for product differences and solving the problems simultaneously—has a significant impact on performance. © 2007 Wiley Periodicals, Inc. Naval Research Logistics, 2008     

Damage functions and estimates of fratricide and collateral damage

There are multiple damage functions in the literature to estimate the probability that a single weapon detonation destroys a point target. This paper addresses differences in the tails of four of the more popular damage functions. These four cover the asymptotic tail behaviors of all monotonically decreasing damage functions with well‐behaved hazard functions. The differences in estimates of probability of kill are quite dramatic for large aim‐point offsets. This is particularly important when balancing the number of threats that can be engaged with the chances of fratricide and collateral damage. In general, analysts substituting one damage function for another may badly estimate kill probabilities in offset‐aiming, which could result in poor doctrine. © 2003 Wiley Periodicals, Inc. Naval Research Logistics 50: 306–321, 2003.