Design for Improving Hospital Stroke Unit Processes: Reducing Complex Systems Failures Leading to Adverse Patient Outcomes

This paper describes recent research involving a user-focused design analysis of in-hospital residential treatment for stroke patients. The focus of the research was to identify positive and negative design heuristics associated with addressing poor performance, errors and failures of patient care associated with current designs of hospital systems processes being inadequate to address actual levels of system complexity. The research findings are based on an in–depth case study following a single patient through a stroke unit in a medium scale hospital of (approximately 280 acute beds overall) with 26 stroke unit beds. The case study involved over 200 hours of observations over nine weeks and liaison with hospital and family over the four months of the patient’s stay in hospital. The findings suggest an explanation for the lack of effective advantage so far shown for integrated care as compared to conventional multidisciplinary care. In essence, they suggest that integrated stroke care and multidisciplinary care are both subject to similar serious systemic organisational failures that in effect reduce outcomes of both to a similar compromised position. The paper concludes with three design heuristics for improving stroke unit outcomes via improving the design of stroke unit organisational systems. These proposed heuristics may be of benefit more widely in hospital system design for improved outcomes. Keywords: Hospital System Design, Design Strategies, User-Based Assessment, Case Study, Viable System Model</p

Effects of storage temperature and duration on the milling properties of rice

To maximize rice quality, it is essential to quantify the various factors that affect milling properties of rice. Rice aging, a process during which rice undergoes a series of chemical and physicochemical changes, affects head rice yield (HRY) and the rate at which HRY changes with degree of milling (DOM). This study examined effects of storage duration (0, 2, and 4 months) and storage temperature (4, 21, and 35°C) on milling properties of ‘Wells’ (long-grain) and ‘Jupiter’ (medium-grain) rice cultivars. In general, HRY increased with storage duration, most significantly for Wells cultivar. Millability curves were developed by plotting HRY vs. surface lipid content (SLC) of milled rice. Millability curves of Wells had greater slopes, 11.3 pp decrease in HRY for every 1.0 pp decrease in SLC, than those of Jupiter, 8.5 pp decrease in HRY per 1.0 pp decrease in SLC

Phase-feeding Metabolizable Protein for Finishing Steers

A finishing trial was conducted to evaluate phase-feeding of metabolizable protein in order to match requirements. Treatments were: 1) one finishing diet which matched requirements at initial weight; 2) one finishing diet which matched requirements at mid-weight; and 3) six finishing diets fed in sequential order which matched requirements throughout the feeding period. The 1996 Beef NRC was used to determine metabolizable protein requirements. No performance differences were observed. Gains and efficiencies were lower than projected, likely due to mud, causing protein requirements to be over-predicted. Phase-feeding metabolizable protein maintained equal performance and reduced nitrogen excretion compared to treatment 1

Phase-feeding Metabolizable Protein for Finishing Steers

A finishing trial was conducted to evaluate phase-feeding of metabolizable protein in order to match requirements. Treatments were: 1) one finishing diet which matched requirements at initial weight; 2) one finishing diet which matched requirements at mid-weight; and 3) six finishing diets fed in sequential order which matched requirements throughout the feeding period. The 1996 Beef NRC was used to determine metabolizable protein requirements. No performance differences were observed. Gains and efficiencies were lower than projected, likely due to mud, causing protein requirements to be over-predicted. Phase-feeding metabolizable protein maintained equal performance and reduced nitrogen excretion compared to treatment 1

Observations on Acidosis Through Continual Feed Intake and Ruminal pH Monitoring

A system of continual data acquisition of feed intake and ruminal pH has been developed for studying subacute acidosis in finishing steers. Feed intake is monitored with feedbunks which are suspended from weigh cells. Ruminal pH is monitored with submersible pH electrodes suspended in the rumen. Numerous anecdotal observations of subacute acidosis have been made throughout the feeding periods of several steers, providing information unlikely to be recognized during a planned trial. Therefore, this model for studying subacute acidosis offers many unique opportunities for enhancing our understanding of the interactions between feed intake and acidosis

Non-invasive molecular imaging of inflammatory macrophages in allograft rejection.

BackgroundMacrophages represent a critical cell type in host defense, development and homeostasis. The ability to image non-invasively pro-inflammatory macrophage infiltrate into a transplanted organ may provide an additional tool for the monitoring of the immune response of the recipient against the donor graft. We therefore decided to image in vivo sialoadhesin (Sn, Siglec 1 or CD169) using anti-Sn mAb (SER-4) directly radiolabelled with (99m)Tc pertechnetate.MethodsWe used a heterotopic heart transplantation model where allogeneic or syngeneic heart grafts were transplanted into the abdomen of recipients. In vivo nanosingle-photon emission computed tomography (SPECT/CT) imaging was performed 7 days post transplantation followed by biodistribution and histology.ResultsIn wild-type mice, the majority of (99m)Tc-SER-4 monoclonal antibody cleared from the blood with a half-life of 167 min and was located predominantly on Sn(+) tissues in the spleen, liver and bone marrow. The biodistribution in the transplantation experiments confirmed data derived from the non-invasive SPECT/CT images, with significantly higher levels of (99m)Tc-SER-4 observed in allogeneic grafts (9.4 (±2.7) %ID/g) compared to syngeneic grafts (4.3 (±10.3) %ID/g) (p = 0.0022) or in mice which received allogeneic grafts injected with (99m)Tc-IgG isotype control (5.9 (±0.6) %ID/g) (p = 0.0185). The transplanted heart to blood ratio was also significantly higher in recipients with allogeneic grafts receiving (99m)Tc-SER-4 as compared to recipients with syngeneic grafts (p = 0.000004) or recipients with allogeneic grafts receiving (99m)Tc-IgG isotype (p = 0.000002).ConclusionsHere, we demonstrate that imaging of Sn(+) macrophages in inflammation may provide an important additional and non-invasive tool for the monitoring of the pathophysiology of cellular immunity in a transplant model

Corn Bran, Solvent-Extracted Germ Meal, and Steep Liquor Blends for Finishing Yearlings

Finishing performance of yearling steers was used to assess eight treatments containing corn wet milling byproducts. Interactions were encountered for dry matter intake, average daily gain and feed efficiency as level of dietary steep liquor/distillers solubles increased and corn bran and(or) corn bran with solvent- extracted germ meal decreased. Average daily gain and feed efficiency increased as steep liquor/distillers solubles replaced corn bran or a combination of corn bran and solvent-extracted germ meal. Steep liquor with distillers solubles had higher feeding value than corn bran or solvent-extracted germ meal and solvent-extracted germ meal had 19.9 percent higher energy than corn bran

Assessing the environmental and economic efficacy of two integrated constructed wetlands at mitigating eutrophication risk from sewage effluent

The nutrient removal efficiency of two integrated constructed wetlands (ICWs) installed at commercial wastewater treatment plants (WWTPs) in Norfolk, UK, is assessed – the River Ingol ICW (1 year old) and the River Mun ICW (5 years old). Analysing water samples collected across the ICWs between February and September 2019, significant reductions in both effluent nutrient concentration and load were recorded. At the River Mun ICW, mean nitrate and phosphate concentrations were reduced by ~63% across the wetland, whilst nutrient loadings were reduced by ~57%. At the River Ingol ICW, mean nitrate and phosphate concentrations were reduced by ~30%, whilst nutrient loadings were reduced by ~70%. Economically, the total capital cost of both ICWs was comparable at £31-39 per person served. Overall, this study demonstrates ICWs can significantly reduce the eutrophication risk associated with WWTP discharges and can do so whilst providing a cost-effective alternative to conventional tertiary wastewater treatment

Wet Corn Gluten Feed Levels for Steam-flaked Corn Based Finishing Diets

A finishing trial was conducted to evaluate level of wet corn gluten feed in steam-flaked corn based finishing diets. Feed efficiency and daily gain were similar among all levels (10, 20, 25, 30, and 35%, DM basis) of inclusion of Sweet Bran® wet corn gluten feed evaluated in this trial. These data indicate wet corn gluten feed is similar in energy content to steam-flaked corn based on animal performance