Purpose-orientated stocking of procedure trolleys saves time in busy emergency centres

Background. Inefficient storage and sourcing of routinely required consumables located on procedure trolleys result in time wasted when preparing for common procedures in emergency centres (ECs), contributing to poor efficiency and quality of care.Objectives. We designed a novel purpose-orientated procedure trolley and evaluated its impact on time spent on procedure preparation and efficiency.Methods. In an urban EC, eight participants were measured each day over 24 days, once using the standard setup and once using the modified procedure setup. During each simulation, efficiency markers were assessed (time spent on procedure preparation, steps taken, stops made, and time spent opening drawers to locate required items).Results. The mean (standard deviation) time required to collect the required items for intravenous cannulation and blood sampling from the purpose-orientated trolley was 22.7 (3.66) seconds, compared with 49.2 (15.45) seconds using the standard trolley. There was a significant difference between the two trolleys in mean collection time (p<0.0005) and in all the other categories: steps taken, stops made and drawer opening (p<0.0005).Conclusions. In our setting, stocking procedure trolleys in a purpose-orientated manner has the potential to improve efficiency by reducing time spent on procedure preparation

Emergency centre reorganization in preparation to the COVID-19 pandemic: A district hospital’s dynamic adaptation response

Furstenburg PP, Mukonkole SN, Kibamba CN, et al. Emergency centre reorganization in preparation to the COVID-19 pandemic: A district hospital’s dynamic adaptation response. Afr J Prm Health Care Fam Med. 2020;12(1), a2514. https://doi. org/10.4102/phcfm.v12i1.2514CITATION:Furstenburg PP, Mukonkole SN, Kibamba CN, et al. Emergency centre reorganization in preparation to the COVID-19 pandemic: A district hospital’s dynamic adaptation response. Afr J Prm Health Care Fam Med. 2020;12(1), a2514. https://doi. org/10.4102/phcfm.v12i1.2514The original publication is available at http://www.phcfm.orgThe COVID-19 global pandemic forced healthcare facilities to put special isolation measures in place to limit nosocomial transmission. Cohorting is such a measure and refers to placing infected patients (or under investigation) together in a designated area. This report describes the physical reorganisation of the emergency centre at Khayelitsha Hospital, a district level hospital in Cape Town, South Africa in preparation to the COVID-19 pandemic. The preparation included the identification of a person under investigation (PUI) room, converting short stay wards into COVID-19 isolation areas, and relocating the paediatric section to an area outside the emergency centre. Finally, we had to divide the emergency centre into a respiratory and non-respiratory side by utilising part of the hospital's main reception. We are positive that the preparation and reorganization of the emergency centre will limit nosocomial transmission during the expected COVID-19 surge. Our experience in adapting to COVID-19 may have useful implications for ECs throughout South Africa and in low-and-middle income countries that are preparing for this pandemic

On the uniqueness and global dynamics of AdS spacetimes

We study global aspects of complete, non-singular asymptotically locally AdS spacetimes solving the vacuum Einstein equations whose conformal infinity is an arbitrary globally stationary spacetime. It is proved that any such solution which is asymptotically stationary to the past and future is itself globally stationary. This gives certain rigidity or uniqueness results for exact AdS and related spacetimes.Comment: 18pp, significant revision of v

Purpose-orientated stocking of procedure trolleys saves time in busy emergency centres

Background. Inefficient storage and sourcing of routinely required consumables located on procedure trolleys result in time wasted when preparing for common procedures in emergency centres (ECs), contributing to poor efficiency and quality of care.Objectives. We designed a novel purpose-orientated procedure trolley and evaluated its impact on time spent on procedure preparation and efficiency.Methods. In an urban EC, eight participants were measured each day over 24 days, once using the standard setup and once using the modified procedure setup. During each simulation, efficiency markers were assessed (time spent on procedure preparation, steps taken, stops made, and time spent opening drawers to locate required items).Results. The mean (standard deviation) time required to collect the required items for intravenous cannulation and blood sampling from the purpose-orientated trolley was 22.7 (3.66) seconds, compared with 49.2 (15.45) seconds using the standard trolley. There was a significant difference between the two trolleys in mean collection time (p<0.0005) and in all the other categories: steps taken, stops made and drawer opening (p<0.0005).Conclusions. In our setting, stocking procedure trolleys in a purpose-orientated manner has the potential to improve efficiency by reducing time spent on procedure preparation

Pricing Private Mortgage Insurance

Issues involved in an evaluation of the price of private mortgage insurance are discussed. Cost considerations are emphasized as long-run equilibrium competitive market prices equal long-run marginal and average cost. An empirical evaluation of current insurance premiums vis-a-vis competitive market norms requires more empirical information on the determinants of foreclosures, especially the links between micro and macro determinants. Option pricing models suggest other data comparisons that also may shed light on an evaluation of insurance premiums. Copyright American Real Estate and Urban Economics Association.

Correlations between physical and chemical defences in plants: tradeoffs, syndromes, or just many different ways to skin a herbivorous cat?

� Most plant species have a range of traits that deter herbivores. However, understanding of how different defences are related to one another is surprisingly weak. Many authors argue that defence traits trade off against one another, while others argue that they form coordinated defence syndromes. � We collected a dataset of unprecedented taxonomic and geographic scope (261 species spanning 80 families, from 75 sites across the globe) to investigate relationships among four chemical and six physical defences. � Five of the 45 pairwise correlations between defence traits were significant and three of these were tradeoffs. The relationship between species’ overall chemical and physical defence levels was marginally nonsignificant (P = 0.08), and remained nonsignificant after accounting for phylogeny, growth form and abundance. Neither categorical principal component analysis (PCA) nor hierarchical cluster analysis supported the idea that species displayed defence syndromes. � Our results do not support arguments for tradeoffs or for coordinated defence syndromes. Rather, plants display a range of combinations of defence traits. We suggest this lack of consistent defence syndromes may be adaptive, resulting from selective pressure to deploy a different combination of defences to coexisting species