Boarding is Associated with Reduced Emergency Department Efficiency that is not Mitigated by a Provider in Triage

Introduction: Boarding of patients in the emergency department (ED) is associated with decreased ED efficiency. The provider-in-triage (PIT) model has been shown to improve ED throughput, but it is unclear how these improvements are affected by boarding. We sought to assess the effects of boarding on ED throughput and whether implementation of a PIT model mitigated those effects.Methods: We performed a multi-site retrospective review of 955 days of ED operations data at a tertiary care academic ED (AED) and a high-volume community ED (CED) before and after implementation of PIT. Key outcome variables were door to provider time (D2P), total length of stay of discharged patients (LOSD), and boarding time (admit request to ED departure [A2D]).Results: Implementation of PIT was associated with a decrease in median D2P by 22 minutes or 43% at the AED (p < 0.01), and 18 minutes (31%) at the CED (p < 0.01). LOSD also decreased by 19 minutes (5.9%) at the AED and 8 minutes (3.3%) at the CED (p<0.01). After adjusting for variations in daily census, the effect of boarding (A2D) on D2P and LOSD was unchanged, despite the implementation of PIT. At the AED, 7.7 minutes of boarding increased median D2P by one additional minute (p < 0.01), and every four minutes of boarding increased median LOSD by one minute (p < 0.01). At the CED, 7.1 minutes of boarding added one additional minute to D2P (p < 0.01), and 4.8 minutes of boarding added one minute to median LOSD (p < 0.01).Conclusion: In this retrospective, observational multicenter study, ED operational efficiency was improved with the implementation of a PIT model but worsened with boarding. The PIT model was unable to mitigate any of the effects of boarding. This suggests that PIT is associated with increased efficiency of ED intake and throughput, but boarding continues to have the same effect on ED efficiency regardless of upstream efficiency measures that may be designed to minimize its impact

New methodology for the prediction of motor starting effect on bus voltages of interconnected power systems

A new methodology is proposed in this paper capable of predicting the impact of induction motor load starting on the bus voltages of an interconnected power system. The profile of the voltage sag is predicted for each bus, which is used to improve the power quality of a system. The methodology is investigated with the use of a four bus, as well as fourteen bus IEEE interconnected system. Mathematical and simulation results demonstrate the effectiveness and applicability of the proposed methodology for the application

A Targeted Genetic Screen to Identify Meiotic Cohesin Regulators

During oogenesis in animals deficient for REC-8, a cohesin subunit required for sister chromatids cohesin (SCC), Co recombination fails and sister chromatids segregate away from one another prematurely in meiosis I. Consequently, zygotes inherit two copies of each chromosome. Chromosome segregation in meiosis II fails and the progeny of rec-8 mutant mothers usually survive as viable polyploids. In contrast, homologs segregate randomly during meiosis I in oocytes produced by spo-11 mutants, which lack the transesterase required for crossover recombination. This results in aneuploidy, and nearly all the embryos die. We have shown that mutations disrupting SCC mediated by REC-8 cohesion, but not the related COH-3/4 cohesion complex, dramatically suppress the lethality of spo-11 mutants (88% vs 8% viable). Thus, a screen for spo-11 suppressors can identify kleisin-specific regulators critical for the formation of healthy gametes, including factors required for loading of REC-8 cohesion, for stepwise release of SCC mediated by REC-8 cohesion and for establishment of SCC by REC-8 cohesion, for example, mutations within subunits of REC-8 cohesion or in factors that couple premeiotic DNA replication to SCC establishment. A pilot screen of 4000 haploid genomes identified three suppressors. The first cloned was a null allele of htp-3, which encodes a component of the synaptonemal complex. This mutation revealed differential loading mechanisms of REC-8 and COH-3/4 and demonstrated the first evidence that HTP-3 regulates cohesin. We will continue this screen to identify additional regulators. Our analysis will provide insight into how cohesion and SCC are regulated during C.elegans meiosis. We expect our results will be relevant to plants andhttps://engagedscholarship.csuohio.edu/u_poster_2018/1023/thumbnail.jp

A Targeted Genetic Screen to Identify Meiotic Cohesin Regulators

During oogenesis in animals deficient for REC-8, a cohesin subunit required for sister chromatids cohesin (SCC), Co recombination fails and sister chromatids segregate away from one another prematurely in meiosis I. Consequently, zygotes inherit two copies of each chromosome. Chromosome segregation in meiosis II fails and the progeny of rec-8 mutant mothers usually survive as viable polyploids. In contrast, homologs segregate randomly during meiosis I in oocytes produced by spo-11 mutants, which lack the transesterase required for crossover recombination. This results in aneuploidy, and nearly all the embryos die. We have shown that mutations disrupting SCC mediated by REC-8 cohesion, but not the related COH-3/4 cohesion complex, dramatically suppress the lethality of spo-11 mutants (88% vs 8% viable). Thus, a screen for spo-11 suppressors can identify kleisin-specific regulators critical for the formation of healthy gametes, including factors required for loading of REC-8 cohesion, for stepwise release of SCC mediated by REC-8 cohesion and for establishment of SCC by REC-8 cohesion, for example, mutations within subunits of REC-8 cohesion or in factors that couple premeiotic DNA replication to SCC establishment. A pilot screen of 4000 haploid genomes identified three suppressors. The first cloned was a null allele of htp-3, which encodes a component of the synaptonemal complex. This mutation revealed differential loading mechanisms of REC-8 and COH-3/4 and demonstrated the first evidence that HTP-3 regulates cohesin. We will continue this screen to identify additional regulators. Our analysis will provide insight into how cohesion and SCC are regulated during C.elegans meiosis. We expect our results will be relevant to plants andhttps://engagedscholarship.csuohio.edu/u_poster_2018/1023/thumbnail.jp

Micro-scale modeling of carbon-fiber reinforced thermoplastic materials

Thin-walled textile-reinforced composite parts possess excellent properties, including lightweight, high specific strength, internal torque and moment resistance which offer opportunities for applications in mass transit and ground transportation. In particular the composite material is widely used in aerospace and aircraft structure. In order to estimate accurately the parameters of the constitutive law of woven fabric composite, it is recommended to canvass multi-scale modeling approaches: meso, micro and macro. In the present investigation, based on the experimental results established by carrying out observations by Scanning electron microscope (SEM), we developed a micro-scale FEM model of carbon-fiber reinforced thermoplastic using a commercial software ABAQUS. From the SEM cartography, one identified two types of representative volume elementary (RVE): periodic and random distribution of micro-fibers in the yarn. Referring to homogenization method and by applying the limits conditions to the RVE, we have extracted the coefficients of the rigidity matrix of the studied composites. In the last part of this work, we compare the results obtained by random and periodic RVE model of carbon/PPS and we compute the relative error assuming that random model gives the right value

Localisation of a Reactive Transport Zone in a Saturated Karstic Conduit Deduced from Natural and Artificial Tracer Tests

International audienceFor groundwater resources managers, flow modeling is a useful tool to investigate sustainable scenarios of water use. However, in karstic aquifers, the quality of scenarios is limited by the difficulties of locating and describing the position, geometry and possible time evolution of conduits. The location of conduits in the karstic aquifer of the "Val d'Orléans" (France) were defined using 200 boreholes, surface collapses and 24 artificial tracer tests, which facilitated the development of a simplified conceptual model of flow in the saturated conduits and the surrounding rocks. 68 logs present voids > 50 cm and locate a highly porous zone around 80 m a.s.l. with voids that average 3.5 meter in diameter. In this saturated conduit, 1D quantitative interpretation of artificial tracer tests validate the proposed conceptual model of a saturated conduit under pressure, with an efficient section about 10 m2 an input flow about 3.1 m3/s with 2.9 m3/s flowing from the conduit toward the surrounding rock before arriving at the Loiret Spring. The conceptual model of flow and the previous water chemical analysis show that the transported elements in the groundwater react and dissolve carbonate rocks, mainly inside the conduit, and that this may increase the diameter of the conduit zone by an estimated 40 cm in 100 year

Micro-Scale Modeling of Carbon-Fiber Reinforced Thermoplastic Materials

Thin-walled textile-reinforced composite parts possess excellent properties, including lightweight, high specific strength, internal torque and moment resistance which offer opportunities for applications in mass transit and ground transportation. In particular, the composite material is widely used in aerospace and aircraft structure. In order to estimate accurately the parameters of the constitutive law of woven fabric composite, it is recommended to canvass multi-scale modeling approaches: meso, micro and macro. In the present investigation, based on the experimental results established by carrying out observations by Scanning electron microscope (SEM), we developed a micro-scale FEM model of carbon-fiber reinforced thermoplastic using a commercial software ABAQUS. From the SEM cartography, one identified two types of representative volume elementary (RVE): periodic and random distribution of micro-fibers in the yarn. Referring to homogenization method and by applying the limits conditions to the RVE, we have extracted the coefficients of the rigidity matrix of the studied composites. In the last part of this work, we compare the results obtained by random and periodic RVE model of carbon/PPS and we compute the relative error assuming that random model gives the right value

A Multi-scale Approach for Simulations of Kelvin Probe Force Microscopy with Atomic Resolution

The distance dependence and atomic-scale contrast observed in nominal contact potential difference (CPD) signals recorded by KPFM on surfaces of insulating and semiconducting samples, have stimulated theoretical attempts to explain such effects. We attack this problem in two steps. First, the electrostatics of the macroscopic tip-cantilever-sample system is treated by a finite-difference method on an adjustable nonuniform mesh. Then the resulting electric field under the tip apex is inserted into a series of atomistic wavelet-based density functional theory (DFT) calculations. Results are shown for a realistic neutral but reactive silicon nano-scale tip interacting with a NaCl(001) sample. Bias-dependent forces and resulting atomic displacements are computed to within an unprecedented accuracy. Theoretical expressions for amplitude modulation (AM) and frequency modulation (FM) KPFM signals and for the corresponding local contact potential differences (LCPD) are obtained by combining the macroscopic and atomistic contributions to the electrostatic force component generated at the voltage modulation frequency, and evaluated for several tip oscillation amplitudes A up to 10 nm. Being essentially constant over a few Volts, the slope of atomistic force versus bias is the basic quantity which determines variations of the atomic-scale LCPD contrast. Already above A = 0.1 nm, the LCPD contrasts in both modes exhibit almost the same spatial dependence as the slope. In the AM mode, this contrast is approximately proportional to $A^{-1/2}$, but remains much weaker than the contrast in the FM mode, which drops somewhat faster as A is increased. These trends are a consequence of the macroscopic contributions to the KPFM signal, which are stronger in the AM-mode and especially important if the sample is an insulator even at sub-nanometer separations where atomic-scale contrast appears.Comment: 19 pages, 13 figure

Underwater robot navigation around a sphere using electrolocation sense and Kalman filter

International audienceThe aim of this paper is to perform the navigation of an underwater robot equipped with a sensor using the electric sense. The robot navigates in an unbounded environment in presence of spheres. This sensor is inspired of some species of electric fish. A model of this sensor composed of n spherical electrodes is established. The variations of the current due to the presence of the sphere is related to the model of Rasnow [3]. Unscented Kalman Filter is used to localize the robot with respect to the sphere and to estimate the size of the sphere. We show that bio-inspired motions improve the detection of the spheres. We illustrate the efficiency of the method in two cases: a two electrodes sensor and a four electrodes sensor