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

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

The Post-Pericenter Evolution of the Galactic Center Source G2

In early 2014 the fast-moving near-infrared source G2 reached its closest approach to the supermassive black hole Sgr A* in the Galactic Center. We report on the evolution of the ionized gaseous component and the dusty component of G2 immediately after this event, revealed by new observations obtained in 2015 and 2016 with the SINFONI integral field spectrograph and the NACO imager at the ESO VLT. The spatially resolved dynamics of the Br$\gamma$ line emission can be accounted for by the ballistic motion and tidal shearing of a test-particle cloud that has followed a highly eccentric Keplerian orbit around the black hole for the last 12 years. The non-detection of a drag force or any strong hydrodynamic interaction with the hot gas in the inner accretion zone limits the ambient density to less than a few 10$^3$ cm$^{-3}$ at the distance of closest approach (1500 $R_s$), assuming G2 is a spherical cloud moving through a stationary and homogeneous atmosphere. The dust continuum emission is unresolved in L'-band, but stays consistent with the location of the Br$\gamma$ emission. The total luminosity of the Br$\gamma$ and L' emission has remained constant to within the measurement uncertainty. The nature and origin of G2 are likely related to that of the precursor source G1, since their orbital evolution is similar, though not identical. Both object are also likely related to a trailing tail structure, which is continuously connected to G2 over a large range in position and radial velocity.Comment: 17 pages, 12 figures; accepted for publication in Ap

Accumulation and dissemination of prion protein in experimental sheep scrapie in the natural host

<p>Abstract</p> <p>Background</p> <p>In order to study the sites of uptake and mechanisms of dissemination of scrapie prions in the natural host under controlled conditions, lambs aged 14 days and homozygous for the VRQ allele of the PrP gene were infected by the oral route. Infection occurred in all lambs with a remarkably short and highly consistent incubation period of approximately 6 months. Challenge of lambs at approximately eight months of age resulted in disease in all animals, but with more variable incubation periods averaging significantly longer than those challenged at 14 days.</p> <p>This model provides an excellent system in which to study the disease in the natural host by virtue of the relatively short incubation period and close resemblance to natural infection.</p> <p>Results</p> <p>Multiple sites of prion uptake were identified, of which the most important was the Peyer's patch of the distal ileum.</p> <p>Neuroinvasion was detected initially in the enteric nervous system prior to infection of the central nervous system. At end stage disease prion accumulation was widespread throughout the entire neuraxis, but vacuolar pathology was absent in most animals that developed disease at 6–7 months of age.</p> <p>Conclusion</p> <p>Initial spread of detectable PrP was consistent with drainage in afferent lymph to dependent lymph nodes. Subsequent accumulation of prions in lymphoid tissue not associated with the gut is consistent with haematogenous spread. In addition to macrophages and follicular dendritic cells, prion containing cells consistent with afferent lymph dendritic cells were identified and are suggested as a likely vehicle for carriage of prions from initial site of uptake to the lymphoreticular system, and as potential carriers of prion protein in blood. It is apparent that spongiform change, the characteristic lesion of scrapie and other prion diseases, is not responsible for the clinical signs in sheep, but may develop in an age dependent manner.</p

Rotary atomizer drop size distribution database

Wind tunnel measurements of drop Size distributions from Micronair A U4000 and A U5000 rotary atomizers were collected to develop a database for model use. The measurements varied tank mix, flow rate, air speed, and blade angle conditions, which were correlated by multiple regressions (average R-2 = 0.995 for A U4000 and 0.988 for AU5000). This database replaces an outdated set of rotary atomizer data measured in the 1980s by the USDA Forest Service and fills in a gap in data measured in the 1990s by the Spray Drift Task Force. Since current USDA Forest Service spray projects rely on rotary atomizers, the creation of the database (and its multiple regression interpolation) satisfies a need seen for ten years

Environmental effects of James River sewage treatment plant outfall construction

In the spring of 1975 the Institute began a program to determine whether significant environmental changes would occur in the area of the new James River Plant outfall that might be related to its construction and/or initial operation. Parameters measured in the study were benthic animal and oyster populations, coliform levels and chlorine residuals. The primary emphasis of the study centered on the estimation of the impact of the construction activity on shellfish beds in the area. The results of the investigation are presented in three segments, the first dealing with shellfish populations, the second with other benthic animals and the third with coliforms and chlorine. Section I. Environmental Effects of James River Sewage Treatment Plant Outfall Construction on Oyster Beds in the James River by Dexter S. Haven and Paul C . Kendall Section II. Environmental Effects of the James River Sewage Treatment Plant Outfall Construction: Soft Bottom Macrobenthos by Robert J. Diaz and Donald F. Boesch Section III. Water Quality in the Vicinity of James River Sewage Treatment Plant Outfall by Michael E. Bende