Increased Speed Equals Increased Wait: The Impact of a Reduction in Emergency Department Ultrasound Order Processing Time

We exploit an exogenous process change at two emergency departments (EDs) within a health system to test the theory that increasing capacity in a discretionary work setting increases wait times due to additional services being provided to customers as a consequence of reduced marginal costs for a task. We find that an increase in physician’s capacity for ordering ultrasounds (U/S) resulted in an 11.5 percentage point increase in the probability of an U/S being ordered, confirming that resource availability induces demand. Furthermore, we find that the additional U/S demand increased the time to return other radiological tests due to the higher demand placed on radiologists from the additional U/S. Consequently, the average length of stay (LOS) for patients with an abdominal complaint increased by nearly 30 minutes, and the waiting time to enter the ED increased by 26 minutes. We do not find any indications of improved performance on clinical metrics, with no statistical change in the number of admissions to the hospital or readmissions to the ED within 72 hours. Our study highlights an important lesson for process improvement in interdependent service settings: increasing process capacity at one step in the process can increase demand at that step, as well as for a subsequent shared service, and both can result in an overall negative impact on performance

First-Pass Meconium Samples from Healthy Term Vaginally-Delivered Neonates : An Analysis of the Microbiota

Acknowledgments The authors would like to thank the parents who consented to provide samples with limited notice at an emotional and stressful time. This work was supported entirely from personal donations to the neonatal endowments fund at Aberdeen Maternity Hospital and we thank families for their continued generosity, year-on-year. The Rowett Institute of Nutrition and Health receives funding from the Scottish Government (SG-RESAS). Funding: This work was funded from NHS Grampian Neonatal Endowments. The Rowett Institute receives funding from the Rural and Environmental Science and Analytical Services programme of the Scottish Government. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

NMR experiment factors numbers with Gauss sums

We factor the number 157573 using an NMR implementation of Gauss sums.Comment: 4 pages 5 figure

Fractal Noise in Quantum Ballistic and Diffusive Lattice Systems

We demonstrate fractal noise in the quantum evolution of wave packets moving either ballistically or diffusively in periodic and quasiperiodic tight-binding lattices, respectively. For the ballistic case with various initial superpositions we obtain a space-time self-affine fractal $\Psi(x,t)$ which verify the predictions by Berry for "a particle in a box", in addition to quantum revivals. For the diffusive case self-similar fractal evolution is also obtained. These universal fractal features of quantum theory might be useful in the field of quantum information, for creating efficient quantum algorithms, and can possibly be detectable in scattering from nanostructures.Comment: 9 pages, 8 postscript figure

Long-term ice-rich permafrost coast sensitivity to air temperatures and storm influence: lessons from Pullen Island, Northwest Territories, Canada

Response of erosive mechanisms to climate change is of mounting concern on Beaufort Sea coasts, which experience some of the highest erosion rates in the Arctic. Collapse of intact permafrost blocks and slumping within sprawling retrogressive thaw complexes are two predominant mechanisms that manifest as cliff retreat in this region. Using aerial imagery and ground survey data from Pullen Island, Northwest Territories., Canada, from 13 time points between 1947 and 2018, we observe increasing mean retreat rates from 0 ± 4.8 m a−1 in 1947 to 12 ± 0.3 m a−1 in 2018. Mean summer air temperature was positively correlated with cliff retreat over each time step via block failure (r2 = 0.08; p = 0.5) and slumping (r2 = 0.41; p = 0.05), as was mean storm duration with cliff retreat via block failure (r2 = 0.84; p = 0.0002) and slumping (r2 = 0.34; p = 0.08). These data indicate that air temperature has a greater impact in slump-dominated areas, whereas storm duration has greater control in areas of block failure. Increasingly, heterogeneous cliff retreat rates are likely resulting from different magnitudes of response to climate trends depending on mechanism, and on geomorphological variations that prescribe occurrences of retrogressive thaw slumps

Modelling the behaviour of the bonding of fibre reinforced concrete at the plate end

Comunicação apresentada em International Symposium Polymers in Concrete (ISPIC 2006), Guimarães, 2006In this paper, the finite element method is used to analyse the behaviour of concrete externally strengthened by fibre reinforced polymers (FRP). This model aims to analyse the stress distribution in the FRP-concrete interface at the plate end of a bending beam. The behaviour of the concrete-poxy-FRP arrangement is modelled with interface elements with initial zero thickness, using a discrete crack approach. A localized damage model is adopted for the interface and a parametric study is performed to approximate the material parameters adopted. The importance of each parameter is assessed. This model is subsequently verified using experimental data collected from the literature. Finally, a proposal is made concerning the adoption of a relation GF II/GF for the interface behaviour. Mention is also made to some of the main mathematical models found in the literature, which are compared to the present approach

Massive Ice Control on Permafrost Coast Erosion and Sensitivity

High overall rates of permafrost cliff retreat, coupled with spatial variability, have been accompanied by increased uncertainty over future landscape dynamics. We map long‐term (>80 years) retreat of the shoreline and photogrammetrically analyze historic aerial imagery to quantify the processes at a permafrost coast site with massive ground ice. Retreat rates have been relatively constant, but topographic changes show that subsidence is a potentially critical but often ignored component of coastal sensitivity, exceeding landward recession by over three times during the last 24 years. We calibrate novel passive seismic surveys along clear and variable exposures of massive ground ice and then spatially map key subsurface layers. Combining decadal patterns of volumetric change with new ground ice variation maps enables past trends to be interpreted, future volumetric geomorphic behavior to be better constrained, and improves the assessment of permafrost coast sensitivity and the release of carbon‐bearing material

Heisenberg-style bounds for arbitrary estimates of shift parameters including prior information

A rigorous lower bound is obtained for the average resolution of any estimate of a shift parameter, such as an optical phase shift or a spatial translation. The bound has the asymptotic form k_I/ where G is the generator of the shift (with an arbitrary discrete or continuous spectrum), and hence establishes a universally applicable bound of the same form as the usual Heisenberg limit. The scaling constant k_I depends on prior information about the shift parameter. For example, in phase sensing regimes, where the phase shift is confined to some small interval of length L, the relative resolution \delta\hat{\Phi}/L has the strict lower bound (2\pi e^3)^{-1/2}/, where m is the number of probes, each with generator G_1, and entangling joint measurements are permitted. Generalisations using other resource measures and including noise are briefly discussed. The results rely on the derivation of general entropic uncertainty relations for continuous observables, which are of interest in their own right.Comment: v2:new bound added for 'ignorance respecting estimates', some clarification

The Effects of High Volume Aquatic Plyometric Training on Vertical Jump, Muscle Power, and Torque

The purpose of this study was to examine the effects of high volume aquatic-based plyometrics versus lower volume land and aquatic plyometric training on vertical jump (VJ), muscular peak power and torque in the dominant knee. Thirty-nine adult participants were randomly assigned to 1 of 4 groups: aquatic group 1 (APT1), aquatic group 2 (APT2), land group (LPT1), and control group (CON). All groups performed a 6-week plyometric training program. The APT1 and LPT performed the same volume of training where, APT2 doubled the volume. All participants were pre- and post-tested on performance variables. A 4 (group) X 2 (time) ANOVA with repeated measures was used to determine differences between the performance variables. We found no significant differences between groups for all tested variables. However, APT2 showed the greatest increased average in the performance variables. The high volume aquatic plyometric protocol is useful to help increase performance and minimize muscle soreness

Band Distributions for Quantum Chaos on the Torus

Band distributions (BDs) are introduced describing quantization in a toral phase space. A BD is the uniform average of an eigenstate phase-space probability distribution over a band of toral boundary conditions. A general explicit expression for the Wigner BD is obtained. It is shown that the Wigner functions for {\em all} of the band eigenstates can be reproduced from the Wigner BD. Also, BDs are shown to be closer to classical distributions than eigenstate distributions. Generalized BDs, associated with sets of adjacent bands, are used to extend in a natural way the Chern-index characterization of the classical-quantum correspondence on the torus to arbitrary rational values of the scaled Planck constant.Comment: 12 REVTEX page