Riboflavin and thiamine exacerbate the anti-inflammatory activity of dexamethasone and reduce production of TNF-α and IL-6.

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This is the peer reviewed version of the following article: F. Rodrigues, G.S. Zaric, D.A. Stanford, Discrete event simulation model for planning Level 2 "step-down" bed needs using NEMS, In Operations Research for Health Care, 2017, which has been published in final form at https://doi. AbstractIn highly congested hospitals it may be common for patients to overstay at Intensive Care Units (ICU) due to blockages and imbalances in capacity. This is inadequate clinically, as patients occupy a service they no longer need; operationally, as it disrupts ow from upstream units; and nancially as ICU beds are more expensive than ward beds.Step-down beds, also known as Level 2 beds, have become an increasingly popular and less expensive alternative to ICU beds to deal with this issue. We developed a discrete event simulation model that estimates Level 2 bed needs for a large university hospital. The model innovates by simulating the entirety of the hospital's inpatient ow and most importantly, the ICU's daily stochastic ows based on a nursing workload scoring metrics called "Nine Equivalents of Nursing Manpower Use Score" (NEMS). Using data from a large academic hospital, the model shows the benets of Level 2 beds in improving both patient ow and costs.