Health care operations management

Health care operations management has become a major topic for health care service providers and society. Operations research already has and further will make considerable contributions for the effective and efficient delivery of health care services. This special issue collects seven carefully selected papers dealing with optimization and decision analysis problems in the field of health care operations management

Soap Bubbles in Outer Space: Interaction of a Domain Wall with a Black Hole

We discuss the generalized Plateau problem in the 3+1 dimensional Schwarzschild background. This represents the physical situation, which could for instance have appeared in the early universe, where a cosmic membrane (thin domain wall) is located near a black hole. Considering stationary axially symmetric membranes, three different membrane-topologies are possible depending on the boundary conditions at infinity: 2+1 Minkowski topology, 2+1 wormhole topology and 2+1 black hole topology. Interestingly, we find that the different membrane-topologies are connected via phase transitions of the form first discussed by Choptuik in investigations of scalar field collapse. More precisely, we find a first order phase transition (finite mass gap) between wormhole topology and black hole topology; the intermediate membrane being an unstable wormhole collapsing to a black hole. Moreover, we find a second order phase transition (no mass gap) between Minkowski topology and black hole topology; the intermediate membrane being a naked singularity. For the membranes of black hole topology, we find a mass scaling relation analogous to that originally found by Choptuik. However, in our case the parameter $p$ is replaced by a 2-vector $\vec{p}$ parametrizing the solutions. We find that $Mass\propto|\vec{p}-\vec{p}_*|^\gamma$ where $\gamma\approx 0.66$. We also find a periodic wiggle in the scaling relation. Our results show that black hole formation as a critical phenomenon is far more general than expected.Comment: 15 pages, Latex, 4 figures include

Vector bundles on the projective line and finite domination of chain complexes

Finitely dominated chain complexes over a Laurent polynomial ring in one indeterminate are characterised by vanishing of their Novikov homology. We present an algebro-geometric approach to this result, based on extension of chain complexes to sheaves on the projective line. We also discuss the K-theoretical obstruction to extension.Comment: v1: 11 page

Geometric Challenges in Designing Parts for Machining using Wire-fed DED

Wire-fed DED using MIG welding systems allows for high deposition rates above 30lbs/hr, enabling much larger parts to be printed than would be possible on other DED systems. However, a drawback to this high deposition rate is a relatively low bead resolution on the printed part. Post-processing using machining is usually required on any mating surfaces printed using wire-fed DED. Problems such as residual stress in the build plate and printed part, underbuilding, and path interpolations can all lead to insufficient material deposition and deviation from the desired shape. These areas where the printed part varies from the model can leave defects on post-processed surfaces. This paper will cover common geometry issues that can arise from wire-fed DED and design changes that can be made to ensure that the printed design contains the required material to achieve the finished part.Mechanical Engineerin

What lies beneath: predicting seagrass below-ground biomass from above-ground biomass, environmental conditions and seagrass community composition

Seagrass condition, resilience and ecosystem services are affected by the below-ground tissues (BGr) but these are rarely monitored. In this study we compiled historical data across northern Australia to investigate biomass allocation strategies in 13 tropical seagrass species. There was sufficient data to undertake statistical analysis for five species: Cymodocea serrulata, Halophila mutts, Halodule uninervis, Thalassia hemprichii, and Zostera muelleri. The response of below-ground biomass (BGr) to above-ground biomass (AGr) and other environmental and seagrass community composition predictor variables were assessed using Generalized Linear Models. Environmental data included: region, season, sediment type, water depth, proximity to land-based sources of pollution, and a light stress index. Seagrass community data included: species diversity and dominant species class (colonising, opportunistic or persistant) based on biomass. The predictor variables explained 84-97% of variance in BGr on the log-scale depending on the species. Multi-species meadows showed a greater investment into BGr than mono-specific meadows and when dominated by opportunistic or persistent seagrass species. This greater investment into BGr is likely to enhance their resistance to disturbances if carbohydrate storage reserves also increase with biomass. Region was very important for the estimation of BGr from AGr in four species (not in C. serrulata). No temporally changing environmental features were included in the models, therefore, they cannot be used to predict local-scale responses of BGr to environmental change. We used a case study for Cairns Harbour to predict BGr by applying the models to AGr measured at 362 sites in 2017. This case study demonstrates how the model can be used to estimate BGr when only AGr is measured. However, the general approach can be applied broadly with suitable calibration data for model development providing a more complete assessment of seagrass resources and their potential to provide ecosystem services

Polar foliations and isoparametric maps

A singular Riemannian foliation $F$ on a complete Riemannian manifold $M$ is called a polar foliation if, for each regular point $p$, there is an immersed submanifold $\Sigma$, called section, that passes through $p$ and that meets all the leaves and always perpendicularly. A typical example of a polar foliation is the partition of $M$ into the orbits of a polar action, i.e., an isometric action with sections. In this work we prove that the leaves of $F$ coincide with the level sets of a smooth map $H: M\to \Sigma$ if $M$ is simply connected. In particular, we have that the orbits of a polar action on a simply connected space are level sets of an isoparametric map. This result extends previous results due to the author and Gorodski, Heintze, Liu and Olmos, Carter and West, and Terng.Comment: 9 pages; The final publication is available at springerlink.com http://www.springerlink.com/content/c72g4q5350g513n1

Tracking Black Holes in Numerical Relativity

This work addresses and solves the problem of generically tracking black hole event horizons in computational simulation of black hole interactions. Solutions of the hyperbolic eikonal equation, solved on a curved spacetime manifold containing black hole sources, are employed in development of a robust tracking method capable of continuously monitoring arbitrary changes of topology in the event horizon, as well as arbitrary numbers of gravitational sources. The method makes use of continuous families of level set viscosity solutions of the eikonal equation with identification of the black hole event horizon obtained by the signature feature of discontinuity formation in the eikonal's solution. The method is employed in the analysis of the event horizon for the asymmetric merger in a binary black hole system. In this first such three dimensional analysis, we establish both qualitative and quantitative physics for the asymmetric collision; including: 1. Bounds on the topology of the throat connecting the holes following merger, 2. Time of merger, and 3. Continuous accounting for the surface of section areas of the black hole sources.Comment: 14 pages, 16 figure

Gravitational Collapse of Phantom Fluid in (2+1)-Dimensions

This investigation is devoted to the solutions of Einstein's field equations for a circularly symmetric anisotropic fluid, with kinematic self-similarity of the first kind, in $(2+1)$-dimensional spacetimes. In the case where the radial pressure vanishes, we show that there exists a solution of the equations that represents the gravitational collapse of an anisotropic fluid, and this collapse will eventually form a black hole, even when it is constituted by the phantom energy.Comment: 10 page

Betamethasone phosphate reduces the efficacy of antenatal steroid therapy and is associated with lower birth weights when administered to pregnant sheep in combination with betamethasone acetate

Background Antenatal corticosteroid (ACS) therapy is standard of care for women at imminent risk of preterm labour. Despite this, much remains to be understood regarding an optimal (maximum benefit, minimal risk of side effects) ACS dosing strategy. Although conveying overall benefit when given to the right patient at the right time, ACS treatment efficacy is highly variable, and is not risk-free. Building on earlier findings, we hypothesized that when administered in combination with slow-release betamethasone acetate, betamethasone phosphate and the high materno-fetal betamethasone concentrations it generates are redundant for fetal lung maturation. Objective Using an established sheep model of prematurity and post-natal ventilation of the preterm lamb, we aimed to compare the pharmacodynamic effects of a low-dose treatment with betamethasone acetate only against a standard dose of betamethasone phosphate and betamethasone acetate as recommended by the American College of Obstetricians and Gynaecologists for women at risk of imminent preterm delivery between 24 and 35+6 weeks’ gestation. Methods Ewes carrying a single fetus at 122±1 d gestational age (term=150d) were randomized to receive either: i) maternal intramuscular injections of sterile saline (the Saline Negative Control Group, n=12), ii) two maternal intramuscular injections of 0.25 mg/kg betamethasone phosphate + acetate spaced by 24h (the Beta-P+Ac Group, n=12); or iii) two maternal intramuscular injections of 0.125 mg/kg betamethasone acetate spaced by 24h (the Beta-Ac Group, n=11). Fetuses were surgically delivered 48h after treatment initiation and ventilated for 30 minutes to determine functional lung maturation. Fetuses were euthanized after ventilation and lung were collected for analysis using quantitative polymerase chain reaction and western blot assays. Fetal plasma ACTH levels were measured in the cord blood samples taken at delivery. Results Preterm lambs were defined as either ACS treatment responders or non-responders using an arbitrary cut-off, being a PaCO2 level at 30 minutes of ventilation being more extreme than two standard deviations from the mean value of the normally-distributed Saline Control Group values. Relative to Saline Control Group animals, both ACS treatment group animals showed significantly improved lung physiological responses (blood gas and ventilation data) and had a biochemical signature (mRNA and surfactant protein assays) consistent with functional maturation. However, the Beta-Ac Group had a significantly higher treatment response rate than the Beta-P+Ac Group. These physiological results were strongly correlated to the amount of surfactant protein A. Birth weight was lower in Beta-P+Ac Group and the fetal HPA axis was supressed to a greater extent in the Beta-P+Ac Group. Conclusion Low dose ACS therapy solely employing Beta-Ac was sufficient for fetal lung maturation. The elevated materno-fetal betamethasone concentrations associated with the co-administration of betamethasone phosphate did not additionally improve lung maturation, but were associated with greater HPA axis suppression, a lower ACS treatment response rate, and lower birth weight – outcomes not desirable in a clinical setting. These data warrant a clinical investigation of sustained, low-dose ACS treatments that avoid high materno-fetal betamethasone exposures