Planificación del flujo de caja de proyectos de construcción basada en BIM y dinámica de sistemas / Cash flow planning of construction projects based on BIM and system dynamics / Planeamento do fluxo de caixa de projectos de construção baseados em BIM e System Dynamics

RESUMEN La planificación del flujo de caja de un proyecto de construcción es una actividad decisiva para garantizar los recursos financieros que son necesarios para el desarrollo de las actividades de obra. Debido a la importancia, en la industria de la construcción se observa la necesidad de metodologías de análisis de flujo caja de adaptación fácil a las modificaciones, y con altos niveles de detalle, las cuales propicien mejoras en la precisión de las estimaciones y en la anticipación de situaciones problemáticas. Considerando esta necesidad, en este artículo se propone un nuevo esquema metodológico para la planificación del flujo de caja de proyectos de construcción, el cual está basado en la integración de modelos del proceso constructivo BIM 5D (Building Information Modeling 5D), y dinámica de sistemas. El esquema que es propuesto consta de seis etapas principales: 1) modelo BIM 3D, cantidades y rendimientos, 2) estructura desglosada del trabajo, 3) estimación de costos, 4) modelado y simulación digital BIM 5D, 5) análisis del flujo de caja, y 6) implementación de la alternativa. La aplicación del esquema indica que la rapidez, visualización y automatización, con la que se desarrolla la planificación del flujo de caja, propicia el análisis de varias alternativas; lo cual fortalece los procesos de toma de decisiones, y mejora los resultados de la planificación.

ABSTRACT Cash flow planning of a construction project is a crucial activity to guarantee the financial resources necessary for construction activities development. Due to the importance, there is a need for cash flow analysis methodologies that are easy to adapt to modifications and involve high levels of detail, which allow improving precision in estimations and anticipating possible problematic events. Considering this need, this paper proposes a new methodological scheme for cash flow planning of construction projects, which is based on construction process models BIM 5D (Building Information Modeling 5D), and system dynamics. The proposed scheme consists of six main stages: 1) BIM 3D model and quantities, 2) work breakdown structure, 3) cost estimation, 4) BIM 5D digital modeling and simulation, 5) cash flow analysis, and 6) implementation. The application of the proposed scheme indicates that the speed, visualization, and automation, with which the cash flow planning is developed, favors the analysis of several alternatives, which strengthens decision-making processes, and improves planning results.

RESUMO O planeamento do fluxo de caixa de um projecto de construção é uma actividade decisiva para garantir os recursos financeiros necessários para o desenvolvimento das actividades de trabalho. Devido à sua importância, na indústria da construção há necessidade de metodologias de análise de fluxo de caixa que sejam facilmente adaptáveis às mudanças e com elevados níveis de detalhe, que permitam melhorar a precisão das estimativas e a antecipação de situações problemáticas. Considerando esta necessidade, este documento propõe um novo esquema metodológico para o planeamento do fluxo de caixa dos projectos de construção, que se baseia na integração do BIM 5D (Building Information Modeling 5D) e modelos de dinâmica do sistema do processo de construção. O esquema proposto consiste em seis fases principais: 1) modelo BIM 3D, quantidades e desempenhos, 2) estrutura de repartição do trabalho, 3) estimativa de custos, 4) modelação e simulação digital BIM 5D, 5) análise do fluxo de caixa, e 6) implementação da alternativa. A aplicação do esquema indica que a rapidez, visualização e automatização, com a qual o planeamento do fluxo de caixa é desenvolvido, é conducente à análise de várias alternativas; o que reforça os processos de tomada de decisão, e melhora os resultados do planeamento.

Exploring early prevention and control of COVID-19 outbreak based on system dynamics model analysis / 浙江大学学报·医学版

To explore early prevention and control of coronavirus disease 2019 （COVID-19） outbreak based on system dynamics model analysis. The data of early outbreak of COVID-19 were collected from the World Health Organization，covering countries of the China，United States，United Kingdom，Australia，Serbia and Italy. The susceptible-exposed-infected-recovered （SEIR） model was generalized and then its parameters were optimized. According to the parameters in the basic infection number expression，the sensitivity in the system dynamics model was used to quantitatively analyze the influence of the protection rate，infection rate and average quarantine time on the early spread of the outbreak. Based on the analysis results，targeted prevention and control measures for the early outbreak of COVID-19 were proposed. The generalized SEIR model had a good fit for the early prediction and evaluation of COVID-19 outbreaks in six countries. The spread of COVID-19 was mainly affected by the protection rate，infection rate and average quarantine time. The improvement of the protection rate in the first ays was the most important:the greater the protection rate，the fewer the number of confirmed cases. The infection rate in the first 5 days was the most critical:the smaller the infection rate，the fewer the number of confirmed cases. The average quarantine time in the first 5 days was very important:the shorter the average quarantine time，the fewer the number of confirmed cases. Through the comparison of key parameters of six countries，Australia and China had implemented strict epidemic prevention policies，which had resulted in good epidemic prevention effects. In the early stage of the outbreak，it is necessary to improve the protection rate，shorten the average quarantine time，and implement strict isolation policies to curb the spread of COVID-19.

Pandemic responses in vulnerable communities: a simulation-oriented approach / Respuestas a la pandemia en comunidades vulnerables: un abordaje de simulación / Respostas à pandemia em comunidades vulneráveis: uma abordagem de simulação

Abstract Populations living in favelas are facing even more vulnerabilities with the sudden escalation of the COVID-19 pandemic, as social distancing is challenging in such settings. Furthermore, these populations typically lack proper sanitation and hygiene conditions, which are requirements to adequately control the outbreak. This paper proposes the use of System Dynamics modeling to support the public policy-making process in order to avert negative effects of the pandemic in the Brazilian favelas based on measures elicited from the social movement named "Favelas Contra o Corona." The simulation model assessed the effectiveness of strategies and policy bundles encompassing temporary transfer of the favela population, supply of hygiene products, emergency sanitation structures, and expansion of Intensive Care Units. Results indicate that a suitable combination of strategies can bring significant effects to the number of avoidable deaths and the availability of Intensive Care Units for the population.

Resumen Las poblaciones que viven en barrios de bajos recursos enfrentan aún más vulnerabilidades con el surgimiento de la pandemia de COVID-19, ya que para ellos el aislamiento social es una tarea difícil. Además, carecen de condiciones adecuadas de saneamiento e higiene, que son requisitos para controlar la pandemia. Este estudio propone el uso de la Dinámica de Sistemas para apoyar las decisiones de políticas públicas que leen las medidas que se tomarán para aliviar los efectos negativos de la propagación del virus basado en medidas obtenidas del trabajo del movimiento social "Favelas Contra o Corona". Se desarrolla un modelo considerando estrategias y conjunto de políticas basado en: transferencia temporal de la población de barrios de bajos recurso, suministro de productos de higiene, estructuras de saneamiento de emergencia y expansión de la Unidade de Cuidados Intensivos. Se concluye que la solamente por la combinación de políticas efectos significativos serán alcanzados en el número de muertes evitadas y en el logro de la disponibilidad de Unidade de Cuidados Intensivos en el sistema de salud.

Resumo Populações vivendo em favelas no Brasil enfrentam ainda mais vulnerabilidade com o advento da COVID-19, já que para elas o isolamento social é uma tarefa difícil. Além disso, esses locais carecem de saneamento e condições de higiene, que são requisitos importantes para controlar a pandemia. Este artigo propõe o uso de Dinâmica de Sistemas para apoiar decisões de políticas públicas relativas a medidas para aliviar os efeitos negativos da disseminação do vírus baseado em medidas definidas a partir do trabalho do movimento social "Favelas Contra o Corona". O modelo proposto avalia a efetividade de estratégias e conjuntos de políticas que envolvem: transferência temporária da população da favela, suprimento de produtos de higiene, estruturas emergenciais de saneamento e expansão de Unidades de Terapia Intensiva. Os resultados apresentam o impacto de cada uma das estratégias. Entretanto, somente a combinação adequada de medida traz resultados significativos sobre o número de mortes evitadas e à disponibilidade de leitos de Unidades de Terapia Intensiva para a população.

Estrategias de manejo de Senecio vulgaris L. asociado al cultivo de Daucus carota L. a partir de los principios de la modelación biológica / Management strategies of Senecio vulgaris L. associated to Daucus carota L. from the principles of biological modeling

RESUMEN Senecio vulgaris L. es una maleza, considerada de difícil control cuando se asocia a la zanahoria, debido a que compite por recursos con el cultivo, siendo importante su control, ya que tiene un impacto negativo en la productividad. La modelación biológica es una herramienta que permite prever los posibles efectos del control de la especie, ya que identifica las diferentes variables de un sistema y los factores que las afecta, para de este modo, predecir los resultados en diversos ambientes. Con base en la dinámica de sistemas y los aspectos morfo-fisiológicos de la especie, se planteó la modelación del banco de semillas de S. vulgaris, basado en las ecuaciones planteadas por Fernández-Quintanilla, donde se construyó el diagrama Forrester, al que se le incorporaron las diferentes ecuaciones y valores del modelo, para proyectar la dinámica de la especie en el banco de semillas, dependiendo del manejo. Se propusieron tres escenarios: (1) control con herbicidas en post-emergencia, (2) rotación de cultivos y (3) incorporar los métodos culturales de control, con un testigo en pre siembra y rotación de cultivos. Los resultados del modelo muestran que cuando se realiza rotación de cultivos y se incorporan manejos en pre-siembra al proceso convencional de la especie, se presenta una menor cantidad de semillas en el banco.

ABSTRACT Senecio vulgaris L. is a weed, considered difficult to control, when it is associated with carrot, because it competes for resources with the crop, its control being important, since it has a negative impact on crop productivity. Biological modeling is a tool that allows predicting the possible effects of the species control, since it identifies the different variables of a system and the factors that affect them, in order to predict the results in different environments. Based on the dynamics of systems and the morphophysiological aspects of the species, the modeling of the S. vulgaris seed bank was suggested, based on the equations proposed by Fernández-Quintanilla, the Forrester diagram was constructed, which was incorporated the different equations and values of the model, to project the dynamics of the species in the seed bank, depending on the management. Three scenarios were proposed, (1) post-emergence herbicide control, (2) crop rotation (3) incorporate traditional control methods with a control in presowing and crop rotation. The model results show that when crop rotation is performed and pre-sowing management is incorporated into the conventional process of the species, a smaller quantity of seeds is presented in the bank.

Analysis of public-private-partnership projects in hospital energy stations based on system dynamics model / 中华医院管理杂志

By promoting the socialization of hospital logistics professional skill services, the logistics support ability and safety production supervision level can be improved. By using the theory and method of system dynamics, the income decision model of public-private-partnership projects in the energy station of Nankai hospital is established. Then, the qualitative factors in the decision-making model are transformed into calculable quantitative factors by using the mathematical method of fuzzy logic, and the reasonable charging interval negotiated between Nankai Hospital and the project company is given. According to the income range and in consideration of the balance of interests of all stakeholders, the concession period and the concession price are adjusted to provide decision-making and analysis reference for energy station construction projects.

Analysis of public-private-partnership projects in hospital energy stations based on system dynamics model / 中华医院管理杂志

By promoting the socialization of hospital logistics professional skill services,the logistics support ability and safety production supervision level can be improved.By using the theory and method of system dynamics,the income decision model of public-private-partnership projects in the energy station of Nankai hospital is established.Then,the qualitative factors in the decision-making model are transformed into calculable quantitative factors by using the mathematical method of fuzzy logic,and the reasonable charging interval negotiated between Nankai Hospital and the project company is given.According to the income range and in consideration of the balance of interests of all stakeholders,the concession period and the concession price are adjusted to provide decision-making and analysis reference for energy station construction projects.

Study on the Construction of Reverse Supply Chain for Expired Drugs under Block Chain Perspective / 中国药房

OBJECTIVE： To provide reference for reducing the harm of expired drugs to public health， improving the technical level of drug recovery， and realizing the green recycling economy of drugs. METHODS： The literatures analysis and field investigation is conducted to analyze the development status and the main problems in the construction of the reverse supply chain of expired drugs. According to the technical characteristics of block chain， the feasibility of building the reverse supply chain of expired drugs is analyzed. In order to verify the feasibility of the application of block chain technology in the construction of the expired drug reverse supply chain， this paper attempts to build the expired drug reverse supply chain from the perspective of block chain， and uses the system dynamics method to build a simulation model for each participant in the drug reverse supply chain and its operationing efficiency. RESULTS & CONCLUSIONS： The reverse supply chain of expired drugs constructed by the block chain technology could effectively solve the main problems of the reverse supply chain of expired drugs in China， such as many levels of participants， high logistics cost， low level of information. The simulation results showed when using block chain technology， the recovery efficiency and recovery quantity of each participant in the supply chain were significantly increased. The recovery efficiency of consumers and retailers increased from 20％ to 83％， and those of distributors and manufacturers increased from 40％ and 50％ to 83％， respectively. The recovery quantity of each participant also increased significantly with the increase of recovery efficiency. In the actual construction of the reverse supply chain of expired drugs， the enterprises involved in the drug supply chain should be taken as the leading role， and the multi-party participation of government agencies， industry platforms and consumers should be emphasized. Drug supply chain participating enterprises should use block chain technology to strengthen information communication between enterprises， establish an efficient information platform， and promote and guide consumers to actively participate in the construction of the reverse supply chain of expired drugs. The government should give full play to the guiding role of policy and strengthen the policy guarantee； the industry platform should learn from international advanced cases to form industry standards for the recovery process of expired drugs； consumers should fully understand the hazards of expired drugs and actively participate in the recovery of expired drugs.

METODOLOGÍA BASADA EN SIG Y MODELAMIENTO PARA LA RECOLECCIÓN DE LLANTAS USADAS EN BOGOTÁ / METHODOLOGY BASED ON GEOGRAPHICAL INFORMATION SYSTEM -GIS- AND MODELING FOR THE COLLECTION OF USED TIRES IN BOGOTÁ

En este artículo se presenta una metodología para el estudio del incremento de llantas usadas y su recolección. Se comienza desde el modelamiento con dinámica de sistemas para visualizar el crecimiento del parque automotor y estimar la generación de llantas usadas en la ciudad de Bogotá. Posteriormente se diseña un Sistema de Información Geográfica ­SIG­ con los puntos críticos de generación de llantas usadas, en donde se georreferencia también la malla vial de la ciudad y una ruta de recolección de estos residuos especiales. El SIG muestra los puntos críticos, los puntos de recolección y los potenciales puntos para ampliar la cobertura de rutas en diferentes localidades de la ciudad. Finalmente se determinan las rutas de recolección en las zonas donde se presenta la mayor cantidad de puntos críticos sin atender, siendo estos: Engativá, Bosa y Barrios Unidos. De esta forma se pretende aportar al diseño de rutas para la recolección y manejo de llantas usadas en Bogotá y otras ciudades con similar problemática.

This paper presents a methodology for the study of the increase of used tires generation and their collection. It starts from the modeling with systems dynamics to visualize the growth of the vehicle fleet and estimate the generation of used tires in the city of Bogotá. Subsequently, a Geographic Information System -GIS- was designed with the critical points of generation of used tires, where the city vehicle fleet and a collection route for this special waste were georeferenced. The GIS shows the critical points, the collection points and the potential points to expand the collection routes in different locations in the city of Bogota. Finally, the collection routes are determined in the areas where the greatest number of critical points without attention are present which are Engativá, Bosa and Barrios Unidos. In this way the intention is to contribute to the design of routes for the collection and management of used tires in Bogotá and other cities with similar problems.

Saturación en los servicios de urgencias: Análisis de cuatro hospitales de Medellín y simulación de estrategias / Emergency Department Overcrowding: A Four-Hospital Analysis in Medellín and a Strategy Simulation / Saturação nos serviços de urgência: Análise de quatro hospitais de Medellín e simulação de estratégias

Resumen Las urgencias médicas pueden saturarse debido a factores externos e internos al servicio. Esto se refleja en congestión, tiempos de espera elevados e insatisfacción de los usuarios. Identificar y simular estrategias para gestionar las urgencias médicas, procurando atenuar la saturación. Investigación exploratoria y analítica, con trabajo de campo en cuatro unidades de urgencias de Medellín y simulación de estrategias contra la saturación mediante dinámica de sistemas. Las estrategias utilizadas son: reorganizar el registro, remitir los pacientes que no requieren atención urgente, implementar consultorio fast-track e incrementar el traslado a pisos. Esta última es la estrategia más efectiva en la simulación. Aunque las estrategias de flujo pueden ayudar a resolver la saturación a partir de sus causas internas, como lo sugiere la literatura, su alcance es limitado. Se requieren estrategias de entrada, que no están al alcance del servicio, y estrategias de salida del sistema hospitalario. Es posible disminuir la saturación, concibiendo las urgencias y el hospital como dos elementos de un mismo sistema, de modo que se agilice el flujo de pacientes y se cuente con oferta adecuada de camas hospitalarias sin sobredimensionar la capacidad instalada.

Abstract Medical emergency services can be overcrowded due to both external and internal service factors. This is evinced in the congestion, longer waits, and dissatisfaction by the users. To identify and simulate strategies for processing medical emergency requests in order to mitigate the overcrowding. An exploratory and analytical research was conducted based on the field work at four emergency rooms in hospitals of Medellín; simulation strategies were then proposed against the overcrowded service with system dynamics. The strategies included: to reorganize the sign-in, refer to other places those patient not requiring emergency services, implement fast-track services, and increase the inpatient capacity. The last one becomes the most effective strategy in the simulation. While the flow strategies can help to solve the service overcrowding due to internal causes as suggested in the literature, these strategies are limited in their scope. The required patient sign-in strategies as well as the patient discharge strategies are not easy-to-do in these emergency rooms. Overcrowding can be reduced by thinking of the hospital and the emergency room as two elements in a single system, so that the patient flow can be speeded up; the bed number for inpatients must be improved without overflowing the hospital capacity.

Resumo As urgências médicas podem se saturar devido a fatores externos e internos ao serviço. Isso se reflete em congestão, tempos de espera elevados e insatisfação dos usuários. Identificar e simular estratégias para gerir as urgências médicas, procurando atenuar a saturação. Pesquisa exploratória e analítica, com trabalho de campo em quatro unidades de urgências de Medellín e simulação de estratégias contra a saturação mediante dinâmica de sistemas. As estratégias utilizadas são: reorganizar o cadastro, reencaminhar os pacientes que não precisam atendimento urgente, implementar clínica ambulatória fast-track e facilitar o traslado aos quartos. Esta última é a estratégia mais efetiva na simulação. Ainda que as estratégias de fluxo possam ajudar a resolver a saturação a partir de suas causas internas, como sugere a literatura, seu escopo é limitado. Precisam-se estratégias de entrada, que no estão dentro do escopo do serviço e estratégias de saída do sistema hospitalar. Conclusões: é possível diminuir a saturação, concebendo as urgências e o hospital como dois elementos de um mesmo sistema, de jeito de agilitar o fluxo de pacientes e contar com oferta adequada de leitos hospitalares sem superdimensionar a capacidade instalada.

Modelamiento del control de población de palomas (Columba-livia) en la Plaza de Bolívar de Bogotá / Control Modeling for the Pigeon Population (Columba-livia) at the Plaza de Bolívar in Bogotá / Modelagem de controle da população de pombos (Columba-livia) na Praça de Bolívar em Bogotá

Resumen Introducción: Las palomas (Columba livia) son parte cultural de los centros históricos de las grandes ciudades del mundo -entre ellos la Plaza de Bolívar de la ciudad de Bogotá, Colombia-, sin embargo, son una especie invasora que puede llegar a ser una amenaza para la salud pública de los visitantes de la Plaza, razón por la cual es necesario controlar el incremento neto de estas aves sin buscar su extinción. Objetivo: En este trabajo se construyó un modelo matemático del crecimiento de la población de palomas, bajo una serie de pulsos de control a través del tiempo, para observar el comportamiento de desarrollo controlado de estas aves. Materiales y métodos: Como herramienta principal se utilizó la metodología de modelamiento conocida como Dinámica de Sistemas, la cual permite obtener un sistema de ecuaciones diferenciales a partir de una representación sistémica de un problema. Resultados: Los resultados indican que la simulación de este tipo de control permite que la población de palomas se mantenga dentro de un rango aceptable para el espacio. Conclusiones: Este trabajo se considera un gran aporte en la simulación y evaluación de escenarios para el control de población de palomas, mediante la evaluación con Dinámica de Sistemas y puede reproducirse para otras especies problema.

Abstract Introduction: The pigeons (Columba livia) are a cultural part of the historical centers of the great cities of the world; however, they are an invasive species that can become a threat to the public health of visitors to the Plaza de Bolívar in Bogotá, which is why it is necessary to control the net increase of these birds, without seeking extinction. Objective: In this work a mathematical model of the population growth of pigeons was constructed, under a series of control pulses through time, to observe the behavior of controlled development of these birds. Materials and Methods: As a main tool we used the modeling methodology known as System Dynamics, which allows us to obtain a system of differential equations from a systemic representation of a problem. Results: The results indicate that the simulation of this type of control allows the population of pigeons to remain within an acceptable range for space. Conclusions: This work is considered a great contribution in the simulation and evaluation ofscenarios for the population control of pigeons, through the evaluation with Systems Dynamics and can be reproduced for other problem species.

Resumo Introdução: As pombos (Columba livia) são parte cultural dos centros históricos das grandes cidades no mundo, incluindo a Praça Bolívar na cidade de Bogotá, Colômbia, no entanto, são uma espécie invasora que podem se tornar uma ameaça para a saúde pública dos visitantes da Praça, é por isso que é necessário controlar o aumento líquido dessas aves sem buscar a extinção. Objetivo: Neste trabalho construiu-se um modelo matemático do crescimento da população de pombos, sob uma série de pulsos de controle no tempo, para observar o comportamento de desenvolvimento controlado dessas aves. Materiais e métodos: Como ferramenta principal, utilizou-se a metodologia de modelagem conhecida como Dinâmica de Sistemas, que permite obter um sistema de equações diferenciais a partir de uma representação sistémica de um problema. Resultados: Os resultados indicam que a simulação deste tipo de controle permite que a população de pombos permaneça dentro de um intervalo aceitável para o espaço. Conclusões: Este trabalho é considerado uma grande contribuição na simulação e avaliação de cenários para o controle da população de pombos, através da avaliação com a Dinâmica de Sistemas e pode se reproduzir para outras espécies problema.

A simulation research on casualty prediction based on system dynamics and agent-based modeling / 第二军医大学学报

Objective To simulate, predict and analyze the total number, spatial and temporal distribution, and proportion and composition distribution of combat casualties. Methods System dynamics was used to construct an combat process simulation and casualty prediction model. Agent-based modeling was used to import macro casualty data from the prediction model, split the casualty data and assign the combat injury information in a specific proportion. Results The casualty prediction model based on system dynamics could integrate with specific operational mission and analyze the combat influencing factors, weapon destruction performance, and level of protection in both Red and Blue sides. The casual-effect loop and the stock-flow model were constructed on combat process. The degree of damage to the target of the two sides in the battle was transformed to casualty data. We extracted the macro casualty data from the combat casualty prediction model. Through constructing the corresponding relationship between the destruction degree of operational objectives and war wound information of all kinds, we assigned and simulated the traumatic condition of each individual casualty and completed the conversion from casualty to wounded flow. Conclusion Constructed casualty prediction model based on system dynamics and the casualty generating model based on agent can scientifically calculate the spatial, temporal distribution and proportion and composition of casualties.

Analysis on the hierarchical medical system of regional longitudinal medical consortium based on system dynamics / 中国卫生政策研究

Objective: To analyze the change in community first diagnosis and two-way referral rate under the condition of the regional longitudinal medical consortium implementation in the country at large. According to the simulation results,some suggestions for hierarchical medical system were put forward. Methods : The community first diagnosis and two-way referral rates were determined using the literature meta-analysis, and were simulated under different conditions by means of the system dynamics. Results :The analysis results confirmed that simply increasing the financial subsidies can increase the community first diagnosis rate within a range from 0.08％ to 0. 17％. For in case increases are made by the government in technical financial input to enhance the technical level of the community health service centers and in compensatory financial input to reduce the higher hospitals dependence on the light disease, results showed that the lower conversion rate increased within the range of 0.33％～0.45％ in terms of the two-way referral rating. On the contrary, when technical financial input is increased to improve the technical level of community health service centers, the rate of change was in the range of 7.52％ '- 12.61％ - Conclusions : Firstly, the diversified strategy should be used to promote the achievement of graded diagnosis and treatment. Secondly, the Health Commission plays a key role in the promotion of themedical consortiumconstruction. Thirdly, medical insurance reimbursement differential strategy should be implemented and the supply-side reform should be strengthened. At last,attention should be paid to the rational development of existing referrals, especially the upper and lower ones.

System dynamics model for balance rate in military hospitals during new healthcare reform / 军事医学

Objective To analyze the impact of the declining balance rate in military hospitals during new healthcare reform.Methods A military medical expense model was established,the parameters of the model were changed and the impact of the declining balance rate was analyzed.Results and Conclusion Military hospitals have to face up to the negative influence caused by the declining balance rate,actively promote expenditure compensation mechanism reforms,increase funding,enhance supervision,and separate revenues from expenditures.

"Effect of policy intervention of the ""Healthcare Talents Project"" in Zhejiang Province: Based on system dynamics modeling" / 中国卫生政策研究

In China's new healthcare reform, the pilot local governments explore the practice of establishing a new model of hierarchical diagnosis and treatment system.Zhejiang Province has adopted a special policy of effectively allocating hospital resources and human resources, and efficiently improving primary healthcare institution capability and patient satisfaction(hereinafter referred to as double allocation, double improvement), focusing on the implementation of the 'Healthcare Talents Project', in order to fill a vacancy of human resources in primary healthcare institutions.This paper uses system dynamics modeling and the WISN method of WHO to estimate the gap in physician supply in primary healthcare institutions.After building the system dynamics model of 'Healthcare Talents Project', this paper simulates the influence of the policy on the vacancy of doctors in primary healthcare institutions and analyzes the sensitivity of regulatory factors.The simulation results show that, there are a big gap in physician supply of about 14,000 to build the hierarchical diagnosis and treatment system.The project can gradually increase the number of primary doctors, and the policy may fill the vacancy by 2021.However, if the efficiency of the hospital doctors who give assistance to primary institutions is increased by 10%, the targeted training and recruitment 100% achieve the policy plans and objectives, the project goal may be achieved by 2020.Therefore, this project can effectively adjust the human resources structure quickly and reasonably, and it can be used as reference for the reform of hierarchical diagnosis and treatment system.

Predicting the Development Trend of Health Expenditure Based on Methods of System Dynamics Simulation / 中国卫生经济

Objective:To explore the usage of system dynamics analyzing the influencing factors of total health expenditure(THE),forecast the trends of total health expenditure based on the method of System Dynamics and put forward relative countermeasures.Methods:According to the literature and expert consultation,the population,elderly,GDP,government health expenditures,drug costs and the number of health workers per thousand population were the important factors for THE.These factors were incorporated into system dynamics model for total health expenditure and conducted the simulation.Results:Based on the examination,the simulation results highly corresponded to historical data (2002-2014) and the official forecast (2015-2020),which showed that the model had good stability and reliability.The simulation results showed that steadily increasing total health expenditure would reach 7 457.12 billion yuan in 2025.Conclusion:The system dynamics approach had superior characteristics to other projection methods in terms of stability and reliability.In order to control the irrational growth of total health expenditure,it needed to increase the prevention investment,decrease the incidence of chronic diseases;sustainably improve the reform of public hospitals,implement the basic drug system;change the income-oriented performance appraisal to realize the labor value of medical staffs.

Whether tiered medical care system is effective in saving costs?Cost savings estimation of the medical care system after tiered optimization in Zhejiang Province based on system dynamics model / 中国卫生政策研究

The experience of various countries proves that the hierarchical diagnosis and treatment model can lead to reasonable resources allocation and utilization, however, the waste of China''s disordered treatment model has not been estimated.Nowadays, it is very important to establish a hierarchical diagnosis and treatment system during China''s healthcare system reform.Therefore, it is necessary to estimate the benefit the reform may bring.We take Zhejiang Province as an example, and adopted the system dynamics model to build the health delivery system, to emulate the hierarchical diagnosis and treatment model and the disordered model, and to evaluate the benefit.Results showed that if first option at the primary health institutions increased 10%, it could save 0.251 billion yuan, and if increased 15%, it could save 0.39 billion yuan.If the first option at the primary health institution reached 72.35% and the treatment in county reached 90%, the outpatient in tertiary hospital could reduce by 13 million, and those in primary healthcare institutions could increase by 74 million yuan.The direct healthcare cost could reduce 3.016 billion Yuan.

Simulation analysis of dynamics modeling of long-distance medical evacuation system on the high seas / 第二军医大学学报

Objective To explore the factors influencing the rescuing efficiency of the Navy by dynamics modeling and simulation analysis of long-distance medical evacuation system on the high seas. Methods We established a long-distance medical evacuation system dynamics model on the high seas using system dynamics modeling, including the main circuit analysis and causal analysis. Carrying capacity of the Overseas Friendship Hospital was set at 100 persons per day; the single peak type inflow system of the wounded was selected, with the system peaks being 500, 200, and 100 persons per day, and then the system was simulated. Results The simulating results showed that when the number of the wounded was beyond the carrying capacity of the Overseas Friendship Hospital, more wounded were unable to get medical treatment or the treatment tended to be delayed; when the number was in the range of carrying capacity, the wounded could obtain a comfortable treatment and leave the system quickly. Conclusion The carrying capacity of Overseas Friendship Hospital is a key factor of determining the number of the wounded in this system.

A system dynamics model for study of military medical expenses in PLA hospitals / 军事医学

Objective To explore the application of a system dynamics(SD) model to military medical expenses in PLA hospitals.Methods According to relevant theories of SD, the study has selected some important variables and defined the primary function relations in order to establish a military medical expenses SD model.Results and Conclusion The SD model is suited to modeling the PLA medical expenses and can serve as a theoretical basis for the policy innovation of the PLA medical system.

DINÁMICA DE SISTEMAS, UNA HERRAMIENTA PARA LA EDUCACIÓN AMBIENTAL EN INGENIERÍA / SYSTEM DYNAMICS, A TOOL FOR ENVIRONMENTAL EDUCATION IN ENGINEERING

Este trabajo presenta parte de la experiencia acumulada en la utilización de la Dinámica de Sistemas, como herramienta para la educación ambiental de estudiantes de ingeniería de la Universidad Sergio Arboleda. A partir de la Dinámica de Sistemas, se recrean diversos escenarios que permiten al estudiante tener una percepción sistémica del mundo real y visualizar su dinámica. Dado que el medio ambiente es un sistema complejo, la utilización de la Dinámica de Sistemas favorece la identificación de relaciones no lineales entre los atributos ambientales, la modelización y la extensión a otras técnicas de comprensión como lo es la teoría matemática de los sistemas dinámicos, favoreciendo así la inclusión de lo ambiental de forma transversal en el currículo, pero además, permitiendo la apropiación de elementos indispensables en el ejercicio profesional de un ingeniero. De este modo, presentamos tres ejemplos de trabajos con Dinámica de Sistemas que se pueden implementar con estudiantes de ingeniería para introducir conceptos ambientales, que fueron desarrollados en la línea de investigación de Ciencias de la Complejidad y Medio Ambiente de la Universidad Sergio Arboleda, con algunos de sus estudiantes de ingeniería. Se concluye que la utilización de la Dinámica de Sistemas en la enseñanza de conceptos ambientales, actúa como pauta que conecta diferentes campos del conocimiento requeridos para la comprensión de la situación ambiental actual del planeta, convirtiéndose así en una herramienta para la transdisciplinariedad en ingenierías.

This paper presents part of the experience gained in using system dynamics as a tool for environmental education of engineering students from Universidad Sergio Arboleda. From, diverse scenarios that allow students to have a systemic view of the real world and visualize its dynamics, System Dynamics are recreated. Since the environment is a complex system, using System Dynamics favors the identification of nonlinear relationships between the environmental attributes, modeling and extension to other techniques such as understanding the mathematical theory of systems dynamic, thus contributing to the inclusion of environmental issues in a cross-curricular manner, but also allowing the appropriation of the necessary elements in the professional exercise as an engineer. This way, three examples of work with system dynamics are presented which can be implemented with engineering students to introduce environmental concepts that were developed by the research line of Sciences of Complexity and Environment of Universidad Sergio Arboleda, with some of their engineering students. It is concluded that the use of System Dynamics in the teaching of environmental concepts acts as a guideline that connects different fields of knowledge required for understanding the planet's current environmental situation, thus becoming a transdisciplinary tool in engineering.

Carrying Capacity and Sustainability Appraisals on Regional Water Supply Systems under Climate Change.

This study aims to appraise the carrying capacity and sustainability of four water supply systems which are in the same watershed under climate change. An integrated assessment tool, TaiWAP, which integrates the common procedures of impact assessment of climate change, i.e., downscaling, weather generation, hydrological model, and interface for linking system dynamics model, is used to evaluate the sustainability of regional water resources systems. The GWLF physical model is used to simulate surface water processes and Vensim (a specialized software tool) is used in a system dynamics approach to simulate Taiwan’s Danshuei river watershed supply system to analyze climate impact on sustainable water resource utilization, which are both included in TaiWAP. To understand the sustainability of water supply systems, definition of a sustainable index are necessary to reveal the effects of response strategy and climate change. The results of this study could support making governmental strategies to enhance adaptive capacity, mitigate the impact of climate changes on water supplies and achieve sustainable and resilient water supply systems for the future.