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Two different systems for streaming patients were considered to improve efficiency measures such as waiting times (WTs) and length of stay (LOS) for a current emergency department (ED). A typical fast track area (FTA) and a fast track with a wait time threshold (FTW) were designed and compared effectiveness measures from the perspective of total opportunity cost of all patients’ WTs in the ED. The paper aims to discuss these issues.

This retrospective case study used computerized ED patient arrival to discharge time logs (between July 1, 2009 and June 30, 2010) to build computer simulation models for the FTA and fast track with wait time threshold systems. Various wait time thresholds were applied to stream different acuity-level patients. National average wait time for each acuity level was considered as a threshold to stream patients.

The fast track with a wait time threshold (FTW) showed a statistically significant shorter total wait time than the current system or a typical FTA system. The patient streaming management would improve the service quality of the ED as well as patients’ opportunity costs by reducing the total LOS in the ED.

The results of this study were based on computer simulation models with some assumptions such as no transfer times between processes, an arrival distribution of patients, and no deviation of flow pattern.

When the streaming of patient flow can be managed based on the wait time before being seen by a physician, it is possible for patients to see a physician within a tolerable wait time, which would result in less crowded in the ED.

A new streaming scheme of patients’ flow may improve the performance of fast track system.

Overcrowding in emergency departments (EDs) leads to longer waiting times and results in higher number of patients leaving the ED without being seen by a physician. EDs need to improve quality for patients’ waiting time and length of stay (LoS) from the perspective of process and flow control management. The paper aims to discuss these issues.

The retrospective case study was performed using the computerized ED patient time logs from arrival to discharge between July 1, 2009 and June 30, 2010. Patients were divided into two groups either adult or pediatric with a cutoff age of 18. Patients’ characteristics were measured by arrival time periods, waiting times before being seen by a physician, total LoS and acuity levels. A discrete event simulation was applied to the comparison of quality performance measures.

Statistically significant differences were found between the two groups in terms of arrival times, acuity levels, waiting time stratified for various arrival times and acuity levels. The process quality for pediatric patients could be improved by redesign of patient flow management and medical resource.

The results are limited to a case of one community and ED. This study did not analyze the characteristic of leaving the ED without being seen by a physician.

Separation of pediatric patients from adult patients in an ED can reduce the waiting time before being seen by a physician and the total staying time in the ED for pediatric patients. It can also lessen the chances for pediatric patients to leave the ED without being seen by a physician.

A process and flow control management scheme based on patient group characteristics may improve service quality and lead to a better patient satisfaction in ED.

This chapter addresses the perceptions versus facts divide as the United States experiences an eruption of facts, opinions, and untruths in web-facilitated environments. It addresses how traditional and newer media undermine social justice and political inclusion in ways lingering beyond Donald Trump’s presidency. A competitive environment encouraging journalists to publicize rumor and gossip is addressed. The reliance of individuals on the personal experience of mental models, heuristics, and perceptions to separate fact from fiction is examined. Powerful influences of self-interest and political allegiance are explored. In the context of a deeply divided nation, libraries are seen as having the capability of implementing confidence-building measures to bridge the rift in their communities and organizations. The roles of information educators in advancing democracy through promoting useful theories and effective interlanguages are considered. The value of pragmatism, a philosophy promoting engagement in reformist projects possibly acceptable in conservative and mixed ideological environments is addressed. Economically advanced nations committed to equality and inclusion may find the US experience to be both a warning of potential roadblocks and a guide as to how such obstacles may sometimes be positively addressed.

Environmental and social problems are tightly linked in coupled social–ecological systems in the Arctic. This chapter will discuss the importance of equity as a factor in the adaptive capacity of a region undergoing relatively rapid climate change and simultaneous land-use change (petroleum development) in the northwest Russian Arctic. Relative to North America, attempts to implement some kind of economic or legal equity with regard to massive industrial development are token at best. Unfortunately, in the current situation, legal rights to land and resources are neither likely to materialize nor, even if they did, to facilitate adaptive capacity on the part of Nenets herders. As such, herders lack power over important decisions pertaining to the manner in which development proceeds on their traditional territories.

Russia's northern lands have been developed along starkly different lines than those of Europe and North America. Yet the limited literature of resilience in northern social–ecological systems is derived almost exclusively from North American experiences with co-management. Recent work on the Yamal Peninsula indicates that even with a sustained commitment to active engagement, only incremental change is expected. Western-style legislative campaigns and overnight blanket solutions are far less likely to bear fruit and may, in fact, be counterproductive. The prescriptive approaches from four different analyses of the Yamal situation are compared, with special attention devoted to their respective assessments of resilience. Fortunately, the retention of youth within the nomadic population of tundra Nenets appears to be high, providing a positive indicator of overall resilience in this particular social–ecological system.

SEPTEMBER sees most librarians again at the daily round, although some, including those of the universities and schools, are still scattered on mountains, golf‐courses, beaches and oceans for a short while yet. To older men there is a curious feeling aroused by the knowledge that there is no Library Association Conference this month. They may, in a measure, find compensation in attending the annual meeting of the London and Home Counties Branch of the Association, which will be at St. Albans, or that of A.S.L.I.B., which has Gonville and Caius College, Cambridge, as its venue. Both, by some lack of care which might have been avoided, occur on the same week‐end, September 24–26. Quite clearly the special problems of librarianship technique, such as processes, book‐selection and purchase, classification, catalogues, fines, publicity, salaries, hours, and so on almost infinitely, can no longer be discussed profitably at the Annual Meeting of the Library Association; smaller gatherings, such as these, are their fitting place. We make a suggestion to the L.A. Council, for what it is worth and without pretence to being original. It is that it should indicate to all its branches and sections the main questions to which they should devote attention, and that in due course they should produce their conclusions on them. These, being pooled, would form the basis of the L.A. Annual Meeting. This would make a purposeful programme for all, and the results of the Conference might then be considered definite and practical.

The author argues that we must stop and take a look at what our insistence on human labour as the basis of our society is doing to us, and begin to search for possible alternatives. We need the vision and the courage to aim for the highest level of technology attainable for the widest possible use in both industry and services. We need financial arrangements that will encourage people to invent themselves out of work. Our goal, the article argues, must be the reduction of human labour to the greatest extent possible, to free people for more enjoyable, creative, human activities.

We issue a double Souvenir number of The Library World in connection with the Library Association Conference at Birmingham, in which we have pleasure in including a special article, “Libraries in Birmingham,” by Mr. Walter Powell, Chief Librarian of Birmingham Public Libraries. He has endeavoured to combine in it the subject of Special Library collections, and libraries other than the Municipal Libraries in the City. Another article entitled “Some Memories of Birmingham” is by Mr. Richard W. Mould, Chief Librarian and Curator of Southwark Public Libraries and Cuming Museum. We understand that a very full programme has been arranged for the Conference, and we have already published such details as are now available in our July number.

WE write on the eve of an Annual Meeting of the Library Association. We expect many interesting things from it, for although it is not the first meeting under the new constitution, it is the first in which all the sections will be actively engaged. From a membership of eight hundred in 1927 we are, in 1930, within measurable distance of a membership of three thousand; and, although we have not reached that figure by a few hundreds—and those few will be the most difficult to obtain quickly—this is a really memorable achievement. There are certain necessary results of the Association's expansion. In the former days it was possible for every member, if he desired, to attend all the meetings; today parallel meetings are necessary in order to represent all interests, and members must make a selection amongst the good things offered. Large meetings are not entirely desirable; discussion of any effective sort is impossible in them; and the speakers are usually those who always speak, and who possess more nerve than the rest of us. This does not mean that they are not worth a hearing. Nevertheless, seeing that at least 1,000 will be at Cambridge, small sectional meetings in which no one who has anything to say need be afraid of saying it, are an ideal to which we are forced by the growth of our numbers.