Description: Background: Hospital-based Emergency Departments are struggling to provide timely care to a steadily increasingnumber of unscheduled ED visits. Dwindling compensation and rising ED closures dictate thatmeeting this challenge demands greater operational efficiency. Methods: Using techniques from operations research theory, as well as a novel event-driven algorithm for processingpriority queues, we developed a flexible simulation platform for hospital-based EDs. Wetuned the parameters of the system to mimic U.S. nationally average and average academic hospitalbasedED performance metrics and are able to assess a variety of patient flow outcomes includingpatient door-to-event times, propensity to leave without being seen, ED occupancy level, and dynamicstaffing and resource use. Results: The causes of ED crowding are variable and require site-specific solutions. For example, in a nationally average ED environment, provider availability is a surprising, but persistent bottleneck in patient flow. As a result, resources expended in reducing boarding times may not have the expected impact on patient throughput. On the other hand, reallocating resources into alternate care pathways can dramatically expedite care for lower acuity patients without delaying care for higher acuity patients. In an average academic ED environment, bed availability is the primary bottleneck in patient flow. Consequently, adjustments to provider scheduling have a limited effect on the timeliness of care delivery, while shorter boarding times significantly reduce crowding. An online version of the simulation platform is available at http://spark.rstudio.com/klopiano/EDsimulation/. Conclusion: In building this robust simulation framework, we have created a novel decision-support tool that EDand hospital managers can use to quantify the impact of proposed changes to patient flow prior toImplementation

Description: Background: Childhood obesity is a major public health issue in many countries, including China. The importance of parenting relative to the healthy development of children requires the development of instruments for assessing parental influence on child dietary pattern. This study aimed to confirm the internal reliability and validity of a self-report measure on parental feeding styles, including emotional feeding, instrumental feeding, prompting or encouragement to eat, and control over eating. Methods: A 27-item parental feeding style questionnaire (PFSQ) was translated into Chinese and then translated back into English to verify consistency. The questionnaire was then used to conduct a cross-sectional survey on the parents of Hong Kong preschoolers. The internal reliability and validity of the questionnaire were examined by Cronbach's alpha and exploratory factor analysis, respectively. Results: 4,553 completed questionnaires were received. Cronbach's alpha of subscales ranged from 0.63 to 0.81, and the overall reliability was good (alpha =0.75). The factor structure of this questionnaire was similar to that of the original and Turkish versions. One-factor structure was identified for emotional feeding, instrumental feeding (four items), and prompting or encouragement to eat, whereas a two-factor structure was revealed for control over eating. Conclusion: The Chinese version of the PFSQ has good reliability and validity in assessing parental feeding styles in Hong Kong. Researchers can use this instrument to improve their understanding on how parental feeding styles may affect the dietary patterns and ultimately the weight statuses of children among Chinese-speaking populations across different countries.