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Sionnadh Mairi McLean,1 Andrew Booth,2 Melanie Gee,3 Sarah Salway,2 Mark Cobb,4 Sadiq Bhanbhro,3 Susan A Nancarrow5 1Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK; 2School of Health and Related Research, University of Sheffield, Sheffield, UK; 3Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK; 4Therapeutics & Palliative Care, Sheffield Teaching Hospitals, Sheffield, UK; 5School of Health and Human Science, Southern Cross University, East Lismore, NSW, Australia Abstract: Missed appointments are an avoidable cost and resource inefficiency which impact upon the health of the patient and treatment outcomes. Health care services are increasingly utilizing reminder systems to manage these negative effects. This study explores the effectiveness of reminder systems for promoting attendance, cancellations, and rescheduling of appointments across all health care settings and for particular patient groups and the contextual factors which indicate that reminders are being employed sub-optimally. We used three inter-related reviews of quantitative and qualitative evidence. Firstly, using pre-existing models and theories, we developed a conceptual framework to inform our understanding of the contexts and mechanisms which influence reminder effectiveness. Secondly, we performed a review following Centre for Reviews and Dissemination guidelines to investigate the effectiveness of different methods of reminding patients to attend health service appointments. Finally, to supplement the effectiveness information, we completed a review informed by realist principles to identify factors likely to influence non-attendance behaviors and the effectiveness of reminders. We found consistent evidence that all types of reminder systems are effective at improving appointment attendance across a range of health care settings and patient populations. Reminder systems may also increase cancellation and rescheduling of unwanted appointments. “Reminder plus”, which provides additional information beyond the reminder function may be more effective than simple reminders (ie, date, time, place) at reducing non-attendance at appointments in particular circumstances. We identified six areas of inefficiency which indicate that reminder systems are being used sub-optimally. Unless otherwise indicated, all patients should receive a reminder to facilitate attendance at their health care appointment. The choice of reminder system should be tailored to the individual service. To optimize appointment and reminder systems, health care services need supportive administrative processes to enhance attendance, cancellation, rescheduling, and re-allocation of appointments to other patients. Keywords: attendance, cancellation, rescheduling, TURNUP

Level 3 probabilistic safety assessment (PSA) is performed to calculate radionuclide concentrations and exposure dose resulting from nuclear power plant accidents. To calculate the external exposure dose from the released radioactive materials, the radionuclide concentrations are multiplied by two factors of dose coefficient and a finite cloud dose correction factor (FCDCF), and the obtained values are summed. This indicates that a standard set of FCDCFs is required for external exposure dose calculations.To calculate a standard set of FCDCFs, the effective distance from the release point to the receptor along the wind direction should be predetermined. The TID-24190 document published in 1968 provides equations to calculate FCDCFs and the resultant standard set of FCDCFs. However, it does not provide any explanation on the effective distance required to calculate the standard set of FCDCFs. In 2021, Sandia National Laboratories (SNLs) proposed a method to predetermine finite effective distances depending on the atmospheric stability classes A to F, which results in six standard sets of FCDCFs. Meanwhile, independently of the SNLs, the authors of this paper discovered that an infinite effective distance assumption is a very reasonable approach to calculate one standard set of FCDCFs, and they implemented it into the multi-unit radiological consequence calculator (MURCC) code, which is a post-processor of the level 3 PSA codes.This paper calculates and compares short- and long-range FCDCFs calculated using the TID-24190, SNLs method, and MURCC method, and explains the strength of the MURCC method over the SNLs method. Although six standard sets of FCDCFs are required by the SNLs method, one standard sets of FCDCFs are sufficient by the MURCC method. Additionally, the use of the MURCC method and its resultant FCDCFs for level 3 PSA was strongly recommended.