Event-based knowledge elicitation of operating room management decision-making using scenarios adapted from information systems data

<p>Abstract</p> <p>Background</p> <p>No systematic process has previously been described for a needs assessment that identifies the operating room (OR) management decisions made by the anesthesiologists and nurse managers at a facility that do not maximize the efficiency of use of OR time. We evaluated whether event-based knowledge elicitation can be used practically for rapid assessment of OR management decision-making at facilities, whether scenarios can be adapted automatically from information systems data, and the usefulness of the approach.</p> <p>Methods</p> <p>A process of event-based knowledge elicitation was developed to assess OR management decision-making that may reduce the efficiency of use of OR time. Hypothetical scenarios addressing every OR management decision influencing OR efficiency were created from published examples. Scenarios are adapted, so that cues about conditions are accurate and appropriate for each facility (e.g., if OR 1 is used as an example in a scenario, the listed procedure is a type of procedure performed at the facility in OR 1). Adaptation is performed automatically using the facility's OR information system or anesthesia information management system (AIMS) data for most scenarios (43 of 45). Performing the needs assessment takes approximately 1 hour of local managers' time while they decide if their decisions are consistent with the described scenarios. A table of contents of the indexed scenarios is created automatically, providing a simple version of problem solving using case-based reasoning. For example, a new OR manager wanting to know the best way to decide whether to move a case can look in the chapter on "Moving Cases on the Day of Surgery" to find a scenario that describes the situation being encountered.</p> <p>Results</p> <p>Scenarios have been adapted and used at 22 hospitals. Few changes in decisions were needed to increase the efficiency of use of OR time. The few changes were heterogeneous among hospitals, showing the usefulness of individualized assessments.</p> <p>Conclusions</p> <p>Our technical advance is the development and use of automated event-based knowledge elicitation to identify suboptimal OR management decisions that decrease the efficiency of use of OR time. The adapted scenarios can be used in future decision-making.</p

Effect of Agronomic Practices on Apparent Sucrose and Invert Sugar Levels During Storage of Sugarbeets (Beta Vulgaris L.)

The quality of sugar beet (Beta vulgaris L. ~ roots stored in open piles deteriorates due to a buildup of impurities t6). Sucrose is lost because of respiration and inversion to glucose and fructose. Invert sugar (glucose and fructose) constitutes a major portion of the increase of impurities during storage. Storage temperatures affect invert sugar buildup (4). Other variables affecting sucrose loss and invert sugar accumulation are variety, date of harvest and various chemicals. The objectives of this study were to determine the effects of chemicals, supplemental irrigation, nitrogen, and cultivars on invert sugar accumulation and apparent sucrose loss in sugar beet roots stored for 150 days at 5 C. The data indicate the importance of controlling several agronomic practices that affect quality of sugar beet roots during storage. Sucros levels were higher in those sugar beets roots which were treated with three herbicides and a growth regulator when averaged over all sampling dates during storage of the roots

Radiative Models of Sagittarius A* and M87 from Relativistic MHD Simulations

Ongoing millimeter VLBI observations with the Event Horizon Telescope allow unprecedented study of the innermost portion of black hole accretion flows. Interpreting the observations requires relativistic, time-dependent physical modeling. We discuss the comparison of radiative transfer calculations from general relativistic MHD simulations of Sagittarius A* and M87 with current and future mm-VLBI observations. This comparison allows estimates of the viewing geometry and physical conditions of the Sgr A* accretion flow. The viewing geometry for M87 is already constrained from observations of its large-scale jet, but, unlike Sgr A*, there is no consensus for its millimeter emission geometry or electron population. Despite this uncertainty, as long as the emission region is compact, robust predictions for the size of its jet launching region can be made. For both sources, the black hole shadow may be detected with future observations including ALMA and/or the LMT, which would constitute the first direct evidence for a black hole event horizon.Comment: 8 pages, 2 figures, submitted to the proceedings of AHAR 2011: The Central Kiloparse

Dissecting X-ray-emitting Gas around the Center of our Galaxy

Most supermassive black holes (SMBHs) are accreting at very low levels and are difficult to distinguish from the galaxy centers where they reside. Our own Galaxy's SMBH provides a uniquely instructive exception, and we present a close-up view of its quiescent X-ray emission based on 3 mega-second of Chandra observations. Although the X-ray emission is elongated and aligns well with a surrounding disk of massive stars, we can rule out a concentration of low-mass coronally active stars as the origin of the emission based on the lack of predicted Fe Kalpha emission. The extremely weak H-like Fe Kalpha line further suggests the presence of an outflow from the accretion flow onto the SMBH. These results provide important constraints for models of the prevalent radiatively inefficient accretion state.Comment: 18 pages, 5 PDF figures, pdflatex format; Final version, published in Scienc

Sustainable Water Infrastructure:Visions and Options for Sub-Saharan Africa

Developing a sustainable water infrastructure entails the planning and management of water systems to ensure the availability, access, quality, and affordability of water resources in the face of social, environmental, and economic challenges. Sub-Saharan Africa (SSA) is currently in an era where it must make significant changes to improve the sustainability of its water infrastructure. This paper reviews the factors affecting water infrastructure sustainability and the interventions taken globally to address these challenges. In parallel, it reflects on the relevance of these interventions to the context of Sub-Saharan Africa through the lens of the STEEP (societal, technological, economic, environmental, political) framework. The paper goes on to recommend an extended analysis that captures additional critical dimensions when applying the concept of sustainability. Furthermore, this paper sheds light on the practice of sustainable development and fosters a deeper understanding of the issues, thereby forming the basis for further research and the development of sustainable and resilient solutions for water infrastructure and water asset management more generally

Coherent control of indirect excitonic qubits in optically driven quantum dot molecules

We propose an optoelectronic scheme to define and manipulate an indirect neutral exciton qubit within a quantum dot molecule. We demonstrate coherent dynamics of indirect excitons resilient against decoherence effects, including direct exciton spontaneous recombination. For molecules with large interdot separation, the exciton dressed spectrum yields an often overlooked avoided crossing between spatially indirect exciton states. Effective two level system Hamiltonians are extracted by Feshbach projection over the multilevel exciton configurations. An adiabatic manipulation of the qubit states is devised using time dependent electric field sweeps. The exciton dynamics yields the necessary conditions for qubit initialization and near unitary rotations in the picosecond time scale, driven by the system internal dynamics. Despite the strong influence of laser excitation, charge tunneling, and interdot dipole-dipole interactions, the effective relaxation time of indirect excitons is much longer than the direct exciton spontaneous recombination time, rendering indirect excitons as potential elemental qubits in more complex schemes.Comment: Submitted to PRB, 11 pages and 6 figure

Hiring expert consultants in e-healthcare: an analytics-based two sided matching approach

Very often in some censorious healthcare scenario, there may be a need to have some expert consultancies (especially by doctors) that are not available in-house to the hospitals. Earlier, this interesting healthcare scenario of hiring the expert consultants (mainly doctors) from outside of the hospitals had been studied with the robust concepts of mechanism design with money and mechanism design without money. In this paper, we explore the more realistic two sided matching market in our healthcare set-up. In this, the members of the two participating communities, namely the patients and the doctors are revealing the strict preference ordering over the members of the opposite community for a stipulated amount of time. We assume that the patients and doctors are strategic in nature. With the theoretical analysis, we demonstrate that the TOMHECs, that results in the stable allocation of doctors to the patients, satisfies the several economic properties such as strategy-proof-ness (or truthfulness) and optimality. Further, the analytically based analysis of our proposed mechanisms i.e. RAMHECs and TOMHECs are carried out on the ground of the expected distance of the allocation done by the mechanisms from the top most preference. The proposed mechanisms are also validated with the help of exhaustive experiments.Peer ReviewedPostprint (author's final draft