Passenger Flows in Underground Railway Stations and Platforms, MTI Report 12-43

Urban rail systems are designed to carry large volumes of people into and out of major activity centers. As a result, the stations at these major activity centers are often crowded with boarding and alighting passengers, resulting in passenger inconvenience, delays, and at times danger. This study examines the planning and analysis of station passenger queuing and flows to offer rail transit station designers and transit system operators guidance on how to best accommodate and manage their rail passengers. The objectives of the study are to: 1) Understand the particular infrastructural, operational, behavioral, and spatial factors that affect and may constrain passenger queuing and flows in different types of rail transit stations; 2) Identify, compare, and evaluate practices for efficient, expedient, and safe passenger flows in different types of station environments and during typical (rush hour) and atypical (evacuations, station maintenance/ refurbishment) situations; and 3) Compile short-, medium-, and long-term recommendations for optimizing passenger flows in different station environments

Extended scope of nursing practice: a multicentre randomised controlled trial of appropriately trained nurses and pre-registration house officers in pre-operative assessment in elective general surgery

Aim/ Principal Research Question:1) To determine whether pre-operative assessment carried out by an appropriately trained nurse (ATN) is equivalent in quality to that carried out by a pre-registration house officer (PRHO).2) To assess whether pre-assessments carried out by ATNs and PRHOs are equivalent in terms of cost.3) To determine whether assessments carried out by ATNs are acceptable to patients.4) To investigate the quality of communication between senior medical staff and ATNs.Factors of Interest:The extended role of appropriately trained nurses and pre-registration house officers in pre-operative assessment in elective general surgery.Methods:The study design was principally a prospective randomised equivalence trial but was accompanied by additional qualitative assessment of patient and staff perceptions, and an economic evaluation.The intervention consisted of a pre-operative assessment carried out by either an ATN or a PRHO. Of the patients who completed the study with a full evaluation, 926 patients were randomised to the PRHO arm of the trial and 948 to the ATN arm. Three ATNs took part in the study, one from each centre, together with a total of 87 PRHOs.Immediately following the initial assessment of a patient by a PRHO or an ATN, one of a number of clinical research fellows, all specialist registrars in anaesthetics, repeated the assessment and recorded it on a study form, together with a list of investigations required. The clinical research fellow then evaluated the competency of the initial assessor by comparing the quality of their assessment with their own. Any deficiencies in ordering of investigations and referral to other specialities were met in order to maximise patient care.Sample groups:All patients attending at one site for assessment prior to general anaesthetic for elective general, vascular, urological or breast surgery were potentially included in the study. Of 1907 patients who were randomised, 1874 completed the study with a full evaluation.The study was carried out at four NHS hospitals, three of which were teaching hospitals, in three NHS Trusts in Southampton, Sheffield and Doncaster.Outcome measures:Three areas of ATN and PRHO performance were judged separately, history taking, examination and ordering of tests, and each was graded into one of four categories, the most important of which was under-assessment, which would possibly have affected peri-operative management. In the case of ordering of tests, it was possible to have both over- and under-assessed a patient on different tests.Findings:The pre-operative assessments carried out by the ATNs were essentially equivalent to those performed by the PRHOs in terms of under-assessment that might possibly have affected peri-operative management, although there was variation between the ATNs in terms of the quality of history taking. This may be related to the low number of patients seen at one study site.PRHOs ordered significantly more unnecessary tests than the ATNs. The substitution of ATNs for PRHOs was calculated to be cost neutral.The results of the qualitative assessment showed that the use of ATNs for pre-operative assessment was acceptable to patients; however, there was no evidence that communication between senior medical staff and those carrying out pre-operative assessments was improved by their introduction.Conclusions:This study demonstrated no reason to inhibit the development of fully nurse-led pre-operative assessment, provided that the nurses are appropriately trained and maintain sufficient workload to retain skills.Implications for Further Research:Further research is needed in the following areas:1) the extent and type of training needed for nurses undertaking the pre-operative assessment role2) the use, costs and benefits of routine pre-operative testing.<br/

Design of experiments for non-manufacturing processes : benefits, challenges and some examples

Design of Experiments (DoE) is a powerful technique for process optimization that has been widely deployed in almost all types of manufacturing processes and is used extensively in product and process design and development. There have not been as many efforts to apply powerful quality improvement techniques such as DoE to improve non-manufacturing processes. Factor levels often involve changing the way people work and so have to be handled carefully. It is even more important to get everyone working as a team. This paper explores the benefits and challenges in the application of DoE in non-manufacturing contexts. The viewpoints regarding the benefits and challenges of DoE in the non-manufacturing arena are gathered from a number of leading academics and practitioners in the field. The paper also makes an attempt to demystify the fact that DoE is not just applicable to manufacturing industries; rather it is equally applicable to non-manufacturing processes within manufacturing companies. The last part of the paper illustrates some case examples showing the power of the technique in non-manufacturing environments

The Differences in Antibiotic Decision-making Between Acute Surgical and Acute Medical Teams: An Ethnographic Study of Culture and Team Dynamics

Background Cultural and social determinants influence antibiotic decision-making in hospitals. We investigated and compared cultural determinants of antibiotic decision-making in acute medical and surgical specialties. Methods An ethnographic observational study of antibiotic decision-making in acute medical and surgical teams at a London teaching hospital was conducted (August 2015–May 2017). Data collection included 500 hours of direct observations, and face-to-face interviews with 23 key informants. A grounded theory approach, aided by Nvivo 11 software, analyzed the emerging themes. An iterative and recursive process of analysis ensured saturation of the themes. The multiple modes of enquiry enabled cross-validation and triangulation of the findings. Results In medicine, accepted norms of the decision-making process are characterized as collectivist (input from pharmacists, infectious disease, and medical microbiology teams), rationalized, and policy-informed, with emphasis on de-escalation of therapy. The gaps in antibiotic decision-making in acute medicine occur chiefly in the transition between the emergency department and inpatient teams, where ownership of the antibiotic prescription is lost. In surgery, team priorities are split between 3 settings: operating room, outpatient clinic, and ward. Senior surgeons are often absent from the ward, leaving junior staff to make complex medical decisions. This results in defensive antibiotic decision-making, leading to prolonged and inappropriate antibiotic use. Conclusions In medicine, the legacy of infection diagnosis made in the emergency department determines antibiotic decision-making. In surgery, antibiotic decision-making is perceived as a nonsurgical intervention that can be delegated to junior staff or other specialties. Different, bespoke approaches to optimize antibiotic prescribing are therefore needed to address these specific challenges

Collaborative model development increases trust in and use of scientific information in environmental decision-making

While science matters for environmental management, creating science that is credible, salient to decision-makers, and deemed legitimate by stakeholders is challenging. Collaborative modeling is an increasingly-used approach to enable effective science-based decision-making. This work evaluates the modeling process conducted for two hydropower dam licensing negotiations, to explore how differences in the collaborative development of hydrological models affected differences in their use in subsequent decision-making. In one case, the model was developed iteratively through deliberation with stakeholders. Consequently, stakeholders understood the model and its limitations and trusted the model and modelers; the model itself was also better designed to evaluate resource managers’ questions. The collaboratively-developed model became the focal point for subsequent negotiations and enabled creative group problem-solving. Conversely, in the case with less engagement during model development, the model was not used subsequently by decision-makers. These differences are argued to result from trust built during the modeling process, applicability of the model to test real management scenarios, and the broader social context in which the models were used

Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital

Objective: Healthcare faces the continual challenge of improving outcome whilst aiming to reduce cost. The aim of this study was to determine the micro cost differences of the Glasgow non-operative trauma virtual pathway in comparison to a traditional pathway. Design:  Discrete event simulation was used to model and analyse cost and resource utilisation with an activity based costing approach. Data for a full comparison before the process change was unavailable so we utilised a modelling approach, comparing a Virtual Fracture Clinic (VFC) to a simulated Traditional Fracture Clinic (TFC). Setting:  The orthopaedic unit VFC pathway pioneered at Glasgow Royal Infirmary has attracted significant attention and interest and is the focus of this cost study. Outcome measures: Our study focused exclusively on non-operative trauma patients attending Emergency Department or the minor injuries unit and the subsequent step in the patient pathway. Retrospective studies of patient outcomes as a result of the protocol introductions for specific injuries in association with activity costs from the models.ResultsPatients are satisfied with the new pathway, the information provided and the outcome of their injuries (Evidence Level IV). There was a 65% reduction in the number of first outpatient face-to-face attendances in orthopaedics. In the VFC pathway, the resources required per day were significantly lower for all staff groups (p=<0.001). The overall cost per patient of the VFC pathway was £22.84 (95% CI: 21.74, 23.92) per patient compared with £36.81 (95% CI: 35.65, 37.97) for the TFC pathway.  Conclusions:  Our results give a clearer picture of the cost comparison of the virtual pathway over a wholly traditional face-to-face clinic system. The use of simulation-based stochastic costings in healthcare economic analysis has been limited to date, but this study provides evidence for adoption of this method as a basis for its application in other healthcare settings

Entropy? Honest!

Here we deconstruct, and then in a reasoned way reconstruct, the concept of "entropy of a system," paying particular attention to where the randomness may be coming from. We start with the core concept of entropy as a COUNT associated with a DESCRIPTION; this count (traditionally expressed in logarithmic form for a number of good reasons) is in essence the number of possibilities---specific instances or "scenarios," that MATCH that description. Very natural (and virtually inescapable) generalizations of the idea of description are the probability distribution and of its quantum mechanical counterpart, the density operator. We track the process of dynamically updating entropy as a system evolves. Three factors may cause entropy to change: (1) the system's INTERNAL DYNAMICS; (2) unsolicited EXTERNAL INFLUENCES on it; and (3) the approximations one has to make when one tries to predict the system's future state. The latter task is usually hampered by hard-to-quantify aspects of the original description, limited data storage and processing resource, and possibly algorithmic inadequacy. Factors 2 and 3 introduce randomness into one's predictions and accordingly degrade them. When forecasting, as long as the entropy bookkeping is conducted in an HONEST fashion, this degradation will ALWAYS lead to an entropy increase. To clarify the above point we introduce the notion of HONEST ENTROPY, which coalesces much of what is of course already done, often tacitly, in responsible entropy-bookkeping practice. This notion, we believe, will help to fill an expressivity gap in scientific discourse. With its help we shall prove that ANY dynamical system---not just our physical universe---strictly obeys Clausius's original formulation of the second law of thermodynamics IF AND ONLY IF it is invertible. Thus this law is a TAUTOLOGICAL PROPERTY of invertible systems!Comment: 27 pages, 11 figures. Published in the journal "Entropy" in June 2016. Abstracts from referee's reports quoted right after the abstrac

BIM and its impact upon project success outcomes from a Facilities Management perspective

The uptake of Building Information Modelling (BIM) has been increasing, but some of its promoted potential benefits have been slow to materialise. In particular, claims that BIM will revolutionise facilities management (FM) creating efficiencies in the whole-life of building operations have yet to be achieved on a wide scale, certainly in comparison to tangible progress made for the prior design and construction phases. To attempt to unravel the factors at play in the adoption of BIM during the operational phase, and in particular, understand if adoption by facilities managers (FMs) is lagging behind other disciplines, this study aims to understand if current BIM processes can ease the challenges in this area faced by facilities management project stakeholders. To do this, success from a facilities management viewpoint is considered and barriers to facilities management success are explored, with focused BIM use proposed as a solution to these barriers. Qualitative research was undertaken, using semi structured interviews to collect data from a non-probability sample of 7 project- and facilities- management practitioners. Key results from this study show that the main barrier to BIM adoption by facilities managers is software interoperability, with reports that facilities management systems are unable to easily import BIM data produced during the design and construction stages. Additionally, facilities managers were not treated as salient stakeholders by Project Managers, further negatively affecting facilities management project success outcomes. A µresistance to change was identified as another barrier, as facilities managers were sceptical of the ability of current BIMenabled systems promoted as being FM compatible to be able to replicate their existing Computer Aided Facility Management (CAFM) legacy software and its user required capabilities. The results of this study highlight that more work is needed to ensure that BIM benefits the end user, as there was no reported use of BIM data for dedicated facilities management purposes. Further investigation into the challenges of interoperability could add significant value to this developing research area.The uptake of Building Information Modelling (BIM) has been increasing, but some of its promoted potential benefits have been slow to materialise. In particular, claims that BIM will revolutionise facilities management (FM) creating efficiencies in the whole-life of building operations have yet to be achieved on a wide scale, certainly in comparison to tangible progress made for the prior design and construction phases. To attempt to unravel the factors at play in the adoption of BIM during the operational phase, and in particular, understand if adoption by facilities managers (FMs) is lagging behind other disciplines, this study aims to understand if current BIM processes can ease the challenges in this area faced by facilities management project stakeholders. To do this, success from a facilities management viewpoint is considered and barriers to facilities management success are explored, with focused BIM use proposed as a solution to these barriers. Qualitative research was undertaken, using semi structured interviews to collect data from a non-probability sample of 7 project- and facilities- management practitioners. Key results from this study show that the main barrier to BIM adoption by facilities managers is software interoperability, with reports that facilities management systems are unable to easily import BIM data produced during the design and construction stages. Additionally, facilities managers were not treated as salient stakeholders by Project Managers, further negatively affecting facilities management project success outcomes. A µresistance to change was identified as another barrier, as facilities managers were sceptical of the ability of current BIMenabled systems promoted as being FM compatible to be able to replicate their existing Computer Aided Facility Management (CAFM) legacy software and its user required capabilities. The results of this study highlight that more work is needed to ensure that BIM benefits the end user, as there was no reported use of BIM data for dedicated facilities management purposes. Further investigation into the challenges of interoperability could add significant value to this developing research area

Simulation in clinical education: a reflective and critical account

Simulation. A complex tool employed to immerse learners in a reality created specifically to elicit actions, behaviours and thought processes which can then be discussed with peers and reflected upon by the learner immediately and at leisure. This was my understanding of what simulation has to offer as an educational intervention. I viewed simulation through the lens of Honey and Mumford's (1986) experiential learning typology, seeing it satisfy all four learning styles - activist and reflector most obviously so, but theorist because of the observational element and pragmatist as the scenario unravels. It externalises what is often the internal parts of the cycle – reflection and abstract conceptualisation – through the debriefing process. I also believed that high fidelity environments offered the greatest return in terms of learning – being rather dismissive of lower fidelity tools. However, through active observation of simulation – both in a setting I am familiar with (mannequin based scenarios) and in one I am not (dental student lab-based simulation) – I am recognising that this view may be only a small aspect of what simulation has to offer and that fidelity is not everything