The Effect of Integrated Scheduling and Capacity Policies on Clinical Efficiency

In outpatient healthcare clinics, capacity, patient flow, and scheduling are rarely managed in an integrated fashion, so a question of interest is whether clinic performance can be improved if the policies that guide these decisions are set jointly. Despite the potential importance of this issue, we find surprisingly few studies that look at how the allocation of capacity, paired with various appointment scheduling policies and different patient flow configurations, affects patient flow and clinical efficiency. In this paper, we develop an empirically based discrete‐event simulation to examine the interactions between patient appointment policies and capacity allocation policies (i.e., the number of available examination rooms) and how they jointly affect various performance measures, such as resource utilization and patient waiting time. Findings suggest that scheduling lower‐variance, shorter appointments earlier in the clinic (and, conversely, higher‐variance, longer appointments later) results in less overall patient waiting without reducing physician utilization or increasing clinic duration. Additionally, exam rooms exhibited classic bottleneck behavior: there was no effect on physician utilization by adding exam rooms beyond a certain threshold, but too few exam rooms were devastating to clinic throughput. Some significant interactions between these variables were observed, but were not influential to the level of managerial concern. Clinicians' intuition about managing capacity in healthcare settings may differ substantially from best policies.     

Metropole and Colony: Irish Networks and Patronage in the Eighteenth-Century Empire

This study examines how social networks helped to overcome problems of physical distance in the British Empire during the eighteenth century. In particular, it explores the relationships between ethnicity, patronage and place by focusing on a group of Irish professionals. By piecing together connections between lawyers, merchants and medical doctors in various places including Ireland, London, Jamaica and Senegambia, this essay suggests that Irish networks were flexible enough to allow for dialogue, disagreement and change, but were also durable enough to transcend time and space. These qualities were crucial for sustaining the obligations of patronage that characterised the 'Old Society' of eighteenth-century Britain and generated the means to overcome some practical problems of imperialism.     

Rape in nonhuman animal species: Definitions,evidence, and implications

This paper examines the controversial issue of rape in nonhuman animal species. Many existing studies on nonhuman rape appear to suffer from inappropriate definitions and questionable interpretations. Many existing critiques of these studies are limited by their own misunderstandings of evolutionary theory. An attempt is made to reduce the resulting controversy by defining rape in a way that can be applied to nonhuman animals, without provoking unwarranted implications about human rape. Applying this definition to existing studies indicates that behavior meeting the definition of rape does exist in several nonhuman species. However, comparisons of these species do not provide clear implications for either proximate or ultimate explanations of human rape.     

Mass-mediated information effects on testicular self-examination among college students

The author assessed the effects of a youth-targeted national cable broadcast that promoted testicular self-examination (TSE). A telephone survey of 524 college men included variables from the theory of reasoned action, as well as measures of self-exam compliance, message exposure, knowledge, attention, and the effects of humor and fear. Exposure to the show, with attitudes and norms controlled for, demonstrated a statistically significant but very weak effect on viewers' behavioral intentions. Although also statistically significant, the effect of the show on awareness, knowledge, and facilitating interpersonal communication was as weak or weaker than its effect on intention. Furthermore, dose measures failed to demonstrate any significant effect among those who saw the show. It is conceivable that the show might be integrated into a broader effort toward TSE education, but the results of this study do not argue that it could be effectively used as a media-only TSE promotion.     

Professionalizing youth development: the role of higher education

Certificates, credentials, and degrees offered through institutions of higher education allow youth development professionals to acquire educational experiences that are recognized in a formal manner.     

Expert Informants and Relative Risk: A Methodology for Modeling Waterways

This project describes a methodology for assessing relative risk along a transportation corridor utilizing waterborne transportation on the busiest port area in the world, the lower Mississippi River (from the mouth of Southwest Pass up through Baton Rouge, Louisiana). The paper calculates a relative risk scale, using data obtained from maritime experts, previous research, and existing databases. The research aggregates the vessel traffic data and geographic risk location data to produce relative risk scores for each mile along the River from the mouth of Southwest Pass to the termination of shipping at the U.S. 190 bridge across the River at Baton Rouge. This is done in a very simple and practical way for this initial model: (1) each vessel traveling the Mississippi is classified according to its risk potential for those miles that it passes in route to where it docks, and (2) points along the river are assigned a relative risk score based upon risk variables identified by expérts identified through a standard sampling procedure. The relative risk scores for river miles are combinations of these two factors.     

Two perspectives on sustainable development

This paper applies the Perspectivist conception to the issue of sustainable development in such a way as to make perspicuous two competing views on the issue. These views, here termed theeconomic and theecological, are respectively that of the United Nation's Brundtland Commission, which favours economic growth as a means of overcoming the world's environmental problems, and an alternative view, according to which environmental problems must be dealt with directly, and economic growth may well be a hindrance to their solution. The paper concludes with a theory of human development based on thevicious circle principle, which shows theeconomic perspective on sustainable development to be incoherent, and theecological perspective to remain a viable alternative.This paper, here published with permission, is an expansion of Appendix VI of the author's book,Scientific Progress.Funding for research has been provided by the Swedish Environmental Protection Agency.