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Chunmei Qin,1– 3 Yiting Wang,1,2 Lijun Zhao,1,2 Junlin Zhang,1,2 Honghong Ren,1,2 Yutong Zou,1,2 Yucheng Wu,1,2 Tingli Wang,1,2 Yuancheng Zhao,1,2 Rui Zhang,1,2 Huan Xu,4 Jie Zhang,5 Mark E Cooper,6 Fang Liu1,2 1Division of Nephrology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China; 2Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, People’s Republic of China; 3Department of Nephrology, Luzhou People’s Hospital, Luzhou, People’s Republic of China; 4Division of Pathology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China; 5Key Laboratory of Transplant Engineering and Immunology, Chengdu, People’s Republic of China; 6Department of Diabetes, Central Clinical School, Monash University, Melbourne, AustraliaCorrespondence: Fang Liu, Division of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People’s Republic of China, Tel +86-28-18980601214, Fax +86-28-85422335, Email liufangfh@163.comObjective: The rate of kidney function decline in patients with diabetic kidney disease (DKD) is known to differ. This study analyzed the clinicopathologic features and related risk factors affecting long-term renal survival in Chinese type 2 diabetic patients with rapid estimated glomerular filtration rate (eGFR) decline.Methods: In this retrospective descriptive study, 191 DKD patients were first classified as rapid eGFR decliners and slow eGFR decliners on the basis of the median eGFR slope value (− 8.0 mL/min/1.73 m2/year). In total, 96 patients with rapid eGFR decline were included in the analyses and subsequently allocated to end-stage renal disease (ESRD) and non-ESRD groups. Baseline clinicopathological data of rapid eGFR decliners were collected. Cox proportional hazard analysis was performed to calculate the hazard ratios (HRs) for progression to ESRD.Results: Durin

Emergency department(ED) is one of the busiest clinical units in Winnipeg Victoria Gen-eral Hospital (VGH) which faces the challenge of patients’ long waiting-time as increas-ing healthcare demand and limited resources. This research investigates the critical factors of the ED operation to enhance the operational efficiency using simulation modeling and optimization. The contribution of this research is the integration of simulation and optimization for the performance improvement of ED operations. Discrete-events simula-tion (DES) methodology provides a cost-effective tool to analyse the performance of the ED operations and evaluates the potential alternatives. Design of experiments (DOE) and Scatter search (SS) of model optimization are proposed to search the ED potential capaci-ty for waiting-time reduction. The patient-flow is accelerated along with the waiting-time reduction, which results in better efficient patient throughput in the ED. A specific strate-gy is suggested to improve the ED operation based on the simulation model.

Emergency department(ED) is one of the busiest clinical units in Winnipeg Victoria Gen-eral Hospital (VGH) which faces the challenge of patients’ long waiting-time as increas-ing healthcare demand and limited resources. This research investigates the critical factors of the ED operation to enhance the operational efficiency using simulation modeling and optimization. The contribution of this research is the integration of simulation and optimization for the performance improvement of ED operations. Discrete-events simula-tion (DES) methodology provides a cost-effective tool to analyse the performance of the ED operations and evaluates the potential alternatives. Design of experiments (DOE) and Scatter search (SS) of model optimization are proposed to search the ED potential capaci-ty for waiting-time reduction. The patient-flow is accelerated along with the waiting-time reduction, which results in better efficient patient throughput in the ED. A specific strate-gy is suggested to improve the ED operation based on the simulation model.

Emergency department(ED) is one of the busiest clinical units in Winnipeg Victoria Gen-eral Hospital (VGH) which faces the challenge of patients’ long waiting-time as increas-ing healthcare demand and limited resources. This research investigates the critical factors of the ED operation to enhance the operational efficiency using simulation modeling and optimization. The contribution of this research is the integration of simulation and optimization for the performance improvement of ED operations. Discrete-events simula-tion (DES) methodology provides a cost-effective tool to analyse the performance of the ED operations and evaluates the potential alternatives. Design of experiments (DOE) and Scatter search (SS) of model optimization are proposed to search the ED potential capaci-ty for waiting-time reduction. The patient-flow is accelerated along with the waiting-time reduction, which results in better efficient patient throughput in the ED. A specific strate-gy is suggested to improve the ED operation based on the simulation model.

Emergency department(ED) is one of the busiest clinical units in Winnipeg Victoria Gen-eral Hospital (VGH) which faces the challenge of patients’ long waiting-time as increas-ing healthcare demand and limited resources. This research investigates the critical factors of the ED operation to enhance the operational efficiency using simulation modeling and optimization. The contribution of this research is the integration of simulation and optimization for the performance improvement of ED operations. Discrete-events simula-tion (DES) methodology provides a cost-effective tool to analyse the performance of the ED operations and evaluates the potential alternatives. Design of experiments (DOE) and Scatter search (SS) of model optimization are proposed to search the ED potential capaci-ty for waiting-time reduction. The patient-flow is accelerated along with the waiting-time reduction, which results in better efficient patient throughput in the ED. A specific strate-gy is suggested to improve the ED operation based on the simulation model.