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

A quantitative assessment of the amount of prion diverted to category 1 materials and wastewater during processing

In this article the development and parameterization of a quantitative assessment is described that estimates the amount of TSE infectivity that is present in a whole animal carcass (bovine spongiform encephalopathy [BSE] for cattle and classical/atypical scrapie for sheep and lambs) and the amounts that subsequently fall to the floor during processing at facilities that handle specified risk material (SRM). BSE in cattle was found to contain the most oral doses, with a mean of 9864 BO ID50s (310, 38840) in a whole carcass compared to a mean of 1851 OO ID50s (600, 4070) and 614 OO ID50s (155, 1509) for a sheep infected with classical and atypical scrapie, respectively. Lambs contained the least infectivity with a mean of 251 OO ID50s (83, 548) for classical scrapie and 1 OO ID50s (0.2, 2) for atypical scrapie. The highest amounts of infectivity falling to the floor and entering the drains from slaughtering a whole carcass at SRM facilities were found to be from cattle infected with BSE at rendering and large incineration facilities with 7.4 BO ID50s (0.1, 29), intermediate plants and small incinerators with a mean of 4.5 BO ID50s (0.1, 18), and collection centers, 3.6 BO ID50s (0.1, 14). The lowest amounts entering drains are from lambs infected with classical and atypical scrapie at intermediate plants and atypical scrapie at collection centers with a mean of 3 × 10−7 OO ID50s (2 × 10−8, 1 × 10−6) per carcass. The results of this model provide key inputs for the model in the companion paper published here

Passive heat exposure alters perception and executive function

Findings regarding the influence of passive heat exposure on cognitive function remain equivocal due to a number of methodological issues including variation in the domains of cognition examined. In a randomized crossover design, forty-one male participants completed a battery of cognitive function tests [Visual Search, Stroop, Corsi Blocks and Rapid Visual Information Processing (RVIP) tests] prior to and following 1 h of passive rest in either hot (39.6 ± 0.4°C, 50.8 ± 2.3% Rh) or moderate (21.2 ± 1.8°C, 41.9 ± 11.4% Rh) conditions. Subjective feelings of heat exposure, arousal and feeling were assessed alongside physiological measures including core temperature, skin temperature and heart rate, at baseline and throughout the protocol. Response times were slower in the hot trial on the simple (main effect of trial, P 0.05). Subjective feelings of thermal sensation and felt arousal were higher, feeling was lower in the hot trial, whilst skin temperature, core temperature and heart rate were higher (main effects of trial, all P < 0.001). The findings of the present study suggest that response times for perception and executive function tasks are worse in the heat. An improvement in accuracy on perceptual tasks may suggest a compensatory speed-accuracy trade-off effect occurring within this domain, further highlighting the task dependant nature of heat exposure on cognition

Characterization of avian natural killer cells and their intracellular CD3 protein complex

Natural killer (NK) cell activity appears to be conserved throughout vertebrate development but NK cells have only been well characterized in mammals. Candidate NK cells have been identified in the chicken as cytoplasmic CD3+ and surface T cell receptor (TCR)/CD3- (TCRO) lymphocytes that often express CD8. The fact that the TCRO cells are abundant in the embryonic spleen before T cells enter this organ allowed us to cultivate the embryonic TCRO cells using growth factors derived from activated adult lymphocytes. These TCRO cells were cytotoxic for an NK target cell line. They expressed cell surface CD8, a putative interleukin-2 receptor, CD45 and a receptor for IgG, but did not express CD4, major histocompatibility complex class II or immunoglobulin. Biochemical analysis of the cytoplasmic CD3 antigen revealed two of the three CD3 , and homologues, and RNA transcripts for the third. The CD3 monoclonal antibody also precipitated a 32-kDa dimer that may represent a heterodimer of different CD3 constituents. TCR and gene transcripts were not detected in the TCRO cells. These results indicate that the avian TCRO cell is the mammalian NK cell homologue. The shared evolutionary features of T cells and NK cells in birds and mammals support the idea that they derive from a common progenito

Wound infection in clinical practice : principles of best practice

The International Wound Infection Institute (IWII) is an organisation of volunteer interdisciplinary health professionals dedicated to advancing and improving practice relating to prevention and control of wound infection. This includes acute wounds (surgical, traumatic and burns) and chronic wounds of all types, although principally chronic wounds of venous, arterial, diabetic and pressure aetiologies. Wound infection is a common complication of wounds. It leads to delays in wound healing and increases the risk of loss of limb and life. Implementation of effective strategies to prevent, diagnose and manage, is important in reducing mortality and morbidity rates associated with wound infection. This second edition of Wound Infection in Clinical Practice is an update of the first edition published in 2008 by the World Union of Wound Healing Societies (WUWHS). The original document was authored by leading experts in wound management and endorsed by the WUWHS. The intent of this edition is to provide a practical, updated resource that is easy-to-use and understand. For this edition, the IWII collaborative team has undertaken a comprehensive review of contemporary literature, including systematic reviews and meta-analyses when available. In addition, the team conducted a formal Delphi process to reach consensus on wound infection issues for which scientific research is minimal or lacking. This rigorous process provides an update on the science and expert opinion regarding prevention, diagnosis and control of wound infection. This edition outlines new definitions relevant to wound infection, presents new paradigms and advancements in the management and diagnosis of a wound infection, and highlights controversial areas of discussion

Loving to Straighten Out Development: Sexuality and ‘Ethnodevelopment’ in the World Bank’s Ecuadorian Lending

Gender staff in the World Bank -- the world's largest and most influential development institution -- have a policy problem. Having prioritised efforts to get women into paid employment as the "cure-all" for gender inequality they must deal with the work that women already do -- the unpaid labour of caring, socialisation, and human needs fulfilment. This article explores the most prominent policy solution enacted by the Bank to this tension between paid and unpaid work: the restructuring of normative heterosexuality to encourage a two-partner model of love and labour wherein women work more and men care better. Through a case study of Bank gender lending in Ecuador I argue that staff are trying to (re)forge normative arrangements of intimacy, a policy preference that remains invisible unless sexuality is taken seriously as a category of analysis in development studies. Specifically, I focus on four themes that emerge from the attempt to restructure heteronormativity in the loan: (1) the definition of good gender analysis as requiring complementary sharing and dichotomous sex; (2) the Bank's attempt to inculcate limited rationality in women such that they operate as better workers while retaining altruistic attachments to loved ones; (3) the Bank's attempt to inculcate better loving in men, such that they pick up the slack of caring labour when their (partially) rational wives move into productive work, and; (4) the invocation of a racialised hierarchy resting on the extent to which communities approximate ideals of sharing monogamous partnership. Aside from providing clear evidence that the world's largest development institution is involved in micro-processes of sexuality adjustment alongside macro-processes of economic restructuring, I also critique the Bank's sexualised policy interventions and suggest that they warrant contestation

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