Flexible nurse staffing based on hourly bed census predictions

Workload on nursing wards depends highly on patient arrivals and patient lengths of stay, which are both inherently variable. Predicting this workload and staffing nurses accordingly is essential for guaranteeing quality of care in a cost effective manner. This paper introduces a stochastic method that uses hourly census predictions to derive efficient nurse staffing policies. The generic analytic approach minimizes staffing levels while satisfying so-called nurse-to-patient ratios. In particular, we explore the potential of flexible staffing policies which allow hospitals to dynamically respond to their fluctuating patient population by employing float nurses. The method is applied to a case study of the surgical inpatient clinic of the Academic Medical Center (AMC) Amsterdam. This case study demonstrates the method's potential to study the complex interaction between staffing requirements and several interrelated planning issues such as case mix, care unit partitioning and size, and surgical block planning. Inspired by the numerical results, the AMC decided that this flexible nurse staffing methodology will be incorporated in the redesign of the inpatient care operations during the upcoming years

Integral resource capacity planning for inpatient care services based on hourly bed census predictions

The design and operations of inpatient care facilities are typically largely historically shaped. A better match with the changing environment is often possible, and even inevitable due to the pressure on hospital budgets. Effectively organizing inpatient care requires simultaneous consideration of several interrelated planning issues. Also, coordination with upstream departments like the operating theater and the emergency department is much-needed. We present a generic analytical approach to predict bed census on nursing wards by hour, as a function of the Master Surgical Schedule (MSS) and arrival patterns of emergency patients. Along these predictions, insight is gained on the impact of strategic (i.e., case mix, care unit size, care unit partitioning), tactical (i.e., allocation of operating room time, misplacement rules), and operational decisions (i.e., time of admission/discharge). The method is used in the Academic Medical Center Amsterdam as a decision support tool in a complete redesign of the inpatient care operations

Topology of Boundary Surfaces in 3D Simplicial Gravity

A model of simplicial quantum gravity in three dimensions(3D) was investigated numerically based on the technique of dynamical triangulation (DT). We are concerned with the genus of surfaces appearing on boundaries (i.e., sections) of a 3D DT manifold with $S^{3}$ topology. Evidence of a scaling behavior of the genus distributions of boundary surfaces has been found.Comment: 3 pages, latex, 4 ps figures, uses espcrc2.sty. Talk presented at LATTICE'97(gravity

Global surface-ocean pCO2 and sea–air CO2 flux variability from an observation-driven ocean mixed-layer scheme

A temporally and spatially resolved estimate of the global surface-ocean CO₂ partial pressure field and the sea–air CO₂ flux is presented, obtained by fitting a simple data-driven diagnostic model of ocean mixed-layer biogeochemistry to surface-ocean CO₂ partial pressure data from the SOCAT v1.5 database. Results include seasonal, interannual, and short-term (daily) variations. In most regions, estimated seasonality is well constrained from the data, and compares well to the widely used monthly climatology by Takahashi et al. (2009). Comparison to independent data tentatively supports the slightly higher seasonal variations in our estimates in some areas. We also fitted the diagnostic model to atmospheric CO₂ data. The results of this are less robust, but in those areas where atmospheric signals are not strongly influenced by land flux variability, their seasonality is nevertheless consistent with the results based on surface-ocean data. From a comparison with an independent seasonal climatology of surface-ocean nutrient concentration, the diagnostic model is shown to capture relevant surface-ocean biogeochemical processes reasonably well. Estimated interannual variations will be presented and discussed in a companion paper

High-resolution spectroscopy of V854 Cen in decline - Absorption and emission lines of C_2 molecules

High-resolution optical spectra of the R Coronae Borealis (RBC) star V854 Centauri in the early stages of a decline show, in addition to the features reported for other RCBs in decline, narrow absorption lines from the C_2 Phillips system. The low rotational temperature, T_rot = 1150K, of the C_2 ground electronic state suggests the cold gas is associated with the developing shroud of carbon dust. These absorption lines were not seen at a fainter magnitude on the rise from minimum light nor at maximum light. This is the first detection of cold gas around a RCB star.Comment: 5 pages, 5 figures, accepted for publication by Monthly Notices of the Royal Society of Astronom

Scaling Structures in Four-dimensional Simplicial Gravity

Four-dimensional(4D) spacetime structures are investigated using the concept of the geodesic distance in the simplicial quantum gravity. On the analogy of the loop length distribution in 2D case, the scaling relations of the boundary volume distribution in 4D are discussed in various coupling regions i.e. strong-coupling phase, critical point and weak-coupling phase. In each phase the different scaling relations are found.Comment: 4 pages, latex, 4 ps figures, uses espcrc2.sty. Talk presented at LATTICE96(gravity). All figures and its captions have been improve

Phase Transition of 4D Simplicial Quantum Gravity with U(1) Gauge Field

The phase transition of 4D simplicial quantum gravity coupled to U(1) gauge fields is studied using Monte-Carlo simulations. The phase transition of the dynamical triangulation model with vector field ($N_{V}=1$) is smooth as compared with the pure gravity($N_{V}=0$). The node susceptibility ($\chi$) is studied in the finite size scaling method. At the critical point, the node distribution has a sharp peak in contrast to the double peak in the pure gravity. From the numerical results, we expect that 4D simplicial quantum gravity with U(1) vector fields has higher order phase transition than 1st order, which means the possibility to take the continuum limit at the critical point.Comment: 3 pages, latex, 3 eps figures, uses espcrc2.sty. Talk presented at LATTICE99(gravity