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A fast food restaurant has two drive-thru lanes and windows staffed by a single server each.  The average customer interarrival time is 2 minutes, while the average customer service time is 3 minutes.  (4 pts.)  Experience shows that even though the average processing time (1.5 minutes/customer since there are two servers) is less than the average customer interarrival time (2 minutes) customers will sometimes experience significant waiting times.  Explain why a queue can form under these conditions. (4 pts.) Recent data shows that the two servers have an average utilization of 48%.  An assistant manager has suggested that the restaurant could save money by having only one drive-thru open instead of two.  Do you agree or disagree with this suggestion?  Explain your reasoning. (4 pts.) Currently customers arriving at the drive-thru must choose one of two lanes/servers and, due to traffic patterns, cannot switch lanes later.  The operations manager suggests that the two lanes should be pooled into a single lane and then when a server is free he will take the order from the next customer.  Do you think this is a good idea?  Why or why not? (4 pts.) The restaurant has set a target wait time (TWT) for customers waiting to order of 1.5 minutes.  Reports show that currently 15% of customers wait more than 1.5 minutes or less. What is the TWT service level for this process? (4 pts.) The manager thinks that the current service level is too low and wonders if she should add another drive-thru lane.  Explain for her the primary tradeoff to be considered in making this decision. (4 pts.) Simulation might be a tool to help the restaurant manager determine the correct number of drive-thru lanes and the best configuration of the waiting line(s). Give one advantage of using simulation as a tool for process design rather than experimenting in the actual process. Give one difficulty the manager might face in modeling the system through simulation.  

It is important for the clinician to discuss the long-term effects of sexual assault with survivors. Which of the following is the most common long-term effect of sexual assault?

Which pharm agent works by inhibiting glucose reabsorptions in the kidneys?

A 21-year-old woman reports recurrent abdominal pain relieved by defecation and alternating constipation and diarrhea. No fever or weight loss. What is the most likely diagnosis?

which symptoms is least likely to be present in a patient with GERD?

A 67-year-old man with a history of hypertension and chronic back pain presents to the clinic with complaints of infrequent bowel movements and straining during defecation. He reports starting a new pain management regimen that includes opioids and a calcium channel blocker for blood pressure control. Physical examination is unremarkable, and there are no signs of obstruction. What type of constipation is most likely the diagnosis with this patient presentation?

The most significant precipitating event leading to otitis media with effusion is:

With which drug therapy should Prostate specific antigen (PSA) values be doubled to estimate a more accurate PSA level?

An 80 year old man with type 2 DM comes in for an evaluation.  He reports at his last visit 2 months ago he received new medication and he feels shaky and sweaty some times and he occasionally checks his blood sugar and it is 60-70 mg/dl.  Which of the following medications is most likely responsible for these symptoms?

A 22-year-old nursing student presents with acute nausea, vomiting, and watery diarrhea after eating fried chicken. His roommate has similar symptoms. What is the most likely diagnosis?