Meeting the four-hour deadline in an A&E department

This is the print version of the Article. The official published version can be obtained from the link below - Copyright @ 2011 EmeraldPurpose – Accident and emergency (A&E) departments experience a secondary peak in patient length of stay (LoS) at around four hours, caused by the coping strategies used to meet the operational standards imposed by government. The aim of this paper is to build a discrete-event simulation model that captures the coping strategies and more accurately reflects the processes that occur within an A&E department. Design/methodology/approach – A discrete-event simulation (DES) model was used to capture the A&E process at a UK hospital and record the LoS for each patient. Input data on 4,150 arrivals over three one-week periods and staffing levels was obtained from hospital records, while output data were compared with the corresponding records. Expert opinion was used to generate the pathways and model the decision-making processes. Findings – The authors were able to replicate accurately the LoS distribution for the hospital. The model was then applied to a second configuration that had been trialled there; again, the results also reflected the experiences of the hospital. Practical implications – This demonstrates that the coping strategies, such as re-prioritising patients based on current length of time in the department, employed in A&E departments have an impact on LoS of patients and therefore need to be considered when building predictive models if confidence in the results is to be justified. Originality/value – As far as the authors are aware this is the first time that these coping strategies have been included within a simulation model, and therefore the first time that the peak around the four hours has been analysed so accurately using a model

Self-tuning to the Hopf bifurcation in fluctuating systems

The problem of self-tuning a system to the Hopf bifurcation in the presence of noise and periodic external forcing is discussed. We find that the response of the system has a non-monotonic dependence on the noise-strength, and displays an amplified response which is more pronounced for weaker signals. The observed effect is to be distinguished from stochastic resonance. For the feedback we have studied, the unforced self-tuned Hopf oscillator in the presence of fluctuations exhibits sharp peaks in its spectrum. The implications of our general results are briefly discussed in the context of sound detection by the inner ear.Comment: 37 pages, 7 figures (8 figure files

Experimental observation of a near-motion trapped mode: free motion in heave with negligible radiation

A simple geometry which exhibits near-motion-trapping is tested experimentally, along with perturbed versions of the structure. The motion of the freely floating structure and the surrounding wave field is tracked and the near-motion-trapped mode is found, characterised by a slowly decaying heave motion with very small linear radiation of energy. It is found that the latter property is a better discriminator of the perturbed geometries as viscous damping masks fine differences in radiation damping as far the motion of the structure is concerned. The magnitude of this viscous damping is reasonably well predicted by a simple Stokes oscillatory boundary layer analysis

Linear Wave Interaction with a Vertical Cylinder of Arbitrary Cross Section: An Asymptotic Approach

An asymptotic approach to the linear problem of regular water waves interacting with a vertical cylinder of an arbitrary cross section is presented. The incident regular wave was one-dimensional, water was of finite depth, and the rigid cylinder extended from the bottom to the water surface. The nondimensional maximum deviation of the cylinder cross section from a circular one plays the role of a small parameter of the problem. A fifth-order asymptotic solution of the problem was obtained. The problems at each order were solved by the Fourier method. It is shown that the first-order velocity potential is a linear function of the Fourier coefficients of the shape function of the cylinder, the second-order velocity potential is a quadratic function of these coefficients, and so on. The hydrodynamic forces acting on the cylinder and the water surface elevations on the cylinder are presented. The present asymptotic results show good agreement with numerical and experimental results of previous investigations. Long-wave approximation of the hydrodynamic forces was derived and used for validation of the asymptotic solutions. The obtained values of the forces are exact in the limit of zero wave numbers within the linear wave theory. An advantage of the present approach compared with the numerical solution of the problem by an integral equation method is that it provides the forces and the diffracted wave field in terms of the coefficients of the Fourier series of the deviation of the cylinder shape from the circular one. The resulting asymptotic formula can be used for optimization of the cylinder shape in terms of the wave loads and diffracted wave fields

Retinoic acid degradation shapes zonal development of vestibular organs and sensitivity to transient linear accelerations

Each vestibular sensory epithelium in the inner ear is divided morphologically and physio- logically into two zones, called the striola and extrastriola in otolith organ maculae, and the central and peripheral zones in semicircular canal cristae. We found that formation of striolar/central zones during embryogenesis requires Cytochrome P450 26b1 (Cyp26b1)- mediated degradation of retinoic acid (RA). In Cyp26b1 conditional knockout mice, formation of striolar/central zones is compromised, such that they resemble extrastriolar/peripheral zones in multiple features. Mutants have deficient vestibular evoked potential (VsEP) responses to jerk stimuli, head tremor and deficits in balance beam tests that are consistent with abnormal vestibular input, but normal vestibulo-ocular reflexes and apparently normal motor performance during swimming. Thus, degradation of RA during embryogenesis is required for formation of highly specialized regions of the vestibular sensory epithelia with specific functions in detecting head motions

Manual / Issue 11 / Repair

Manual, a journal about art and its making. Repair. Can we find in the detail, in the stitch and the weave, an ecology of care, a model for activating new forms of life, ones that might reject or reimagine an economic and cultural order based on novelty, disposability, and the monadic self? Can they help us learn to live together in a broken world? —Brian Goldberg and Kate Irvin, from the preface to Issue 11 This volume complemented the exhibition Repair and Design Futures, on view at the RISD Museum October 5, 2018 through June 30, 2019. Softcover, 96 pages. Published 2018 by the RISD Museum. Manual 11 (Repair) contributors include Markus Berger, Gina Borromeo, Linda Catano, Thomas Denenberg, Daniel Eatock, Brian Goldberg, Ramiro Gomez, Kate Irvin, Anna Rose Keefe, Olivia Laing, Steven Lubar, Roberto Lugo, Lisa Z. Morgan, Maureen C. O’Brien, Barry Schwabsky, Sharma Shields, Jessica Urick, and Liliane Wong.https://digitalcommons.risd.edu/risdmuseum_journals/1037/thumbnail.jp

Functional Changes in the Snail Statocyst System Elicited by Microgravity

BACKGROUND: The mollusk statocyst is a mechanosensing organ detecting the animal's orientation with respect to gravity. This system has clear similarities to its vertebrate counterparts: a weight-lending mass, an epithelial layer containing small supporting cells and the large sensory hair cells, and an output eliciting compensatory body reflexes to perturbations. METHODOLOGY/PRINCIPAL FINDINGS: In terrestrial gastropod snail we studied the impact of 16- (Foton M-2) and 12-day (Foton M-3) exposure to microgravity in unmanned orbital missions on: (i) the whole animal behavior (Helix lucorum L.), (ii) the statoreceptor responses to tilt in an isolated neural preparation (Helix lucorum L.), and (iii) the differential expression of the Helix pedal peptide (HPep) and the tetrapeptide FMRFamide genes in neural structures (Helix aspersa L.). Experiments were performed 13-42 hours after return to Earth. Latency of body re-orientation to sudden 90° head-down pitch was significantly reduced in postflight snails indicating an enhanced negative gravitaxis response. Statoreceptor responses to tilt in postflight snails were independent of motion direction, in contrast to a directional preference observed in control animals. Positive relation between tilt velocity and firing rate was observed in both control and postflight snails, but the response magnitude was significantly larger in postflight snails indicating an enhanced sensitivity to acceleration. A significant increase in mRNA expression of the gene encoding HPep, a peptide linked to ciliary beating, in statoreceptors was observed in postflight snails; no differential expression of the gene encoding FMRFamide, a possible neurotransmission modulator, was observed. CONCLUSIONS/SIGNIFICANCE: Upregulation of statocyst function in snails following microgravity exposure parallels that observed in vertebrates suggesting fundamental principles underlie gravi-sensing and the organism's ability to adapt to gravity changes. This simple animal model offers the possibility to describe general subcellular mechanisms of nervous system's response to conditions on Earth and in space

Coupling and Elastic Loading Affect the Active Response by the Inner Ear Hair Cell Bundles

Active hair bundle motility has been proposed to underlie the amplification mechanism in the auditory endorgans of non-mammals and in the vestibular systems of all vertebrates, and to constitute a crucial component of cochlear amplification in mammals. We used semi-intact in vitro preparations of the bullfrog sacculus to study the effects of elastic mechanical loading on both natively coupled and freely oscillating hair bundles. For the latter, we attached glass fibers of different stiffness to the stereocilia and observed the induced changes in the spontaneous bundle movement. When driven with sinusoidal deflections, hair bundles displayed phase-locked response indicative of an Arnold Tongue, with the frequency selectivity highest at low amplitudes and decreasing under stronger stimulation. A striking broadening of the mode-locked response was seen with increasing stiffness of the load, until approximate impedance matching, where the phase-locked response remained flat over the physiological range of frequencies. When the otolithic membrane was left intact atop the preparation, the natural loading of the bundles likewise decreased their frequency selectivity with respect to that observed in freely oscillating bundles. To probe for signatures of the active process under natural loading and coupling conditions, we applied transient mechanical stimuli to the otolithic membrane. Following the pulses, the underlying bundles displayed active movement in the opposite direction, analogous to the twitches observed in individual cells. Tracking features in the otolithic membrane indicated that it moved in phase with the bundles. Hence, synchronous active motility evoked in the system of coupled hair bundles by external input is sufficient to displace large overlying structures

The Ocean Decade - opportunities for oceans and human health programs to contribute to public health.

This is the final version. Available from the American Public Health Association via the DOI in this record. The COVID-19 pandemic reminds us that our health is vulnerable to immediate threats emerging from the ecosystems we inhabit. More insidious global threats include the increasingly overt consequences of climate change, biodiversity loss, and pollution. As the largest connected ecosystem on Earth, the global ocean exerts a greater influence than any other on our climate and weather, affecting global food production and international trade. Much more importantly, human health is intricately linked to “ocean health.” The United Nations has announced the Decade of Ocean Science for Sustainable Development from 2021 to 2030 (http://bit.ly/3kePT9f). Public health and medical professionals should embrace this timely opportunity to transform the way we interact with our seas. We call for a revitalized, inclusive endeavor to repair the damage we have done during our careless past and to protect the myriad benefits available in the future. Making amends will necessitate bringing together ocean researchers, health professionals, coastal communities, policymakers, and other stakeholders to work on delivering a resilient, sustainable ocean that fosters improvements in public health.European Union’s Horizon 2020European Union’s Horizon 2020Natural Environment Research CouncilUKR