The cost of trauma operating theatre inefficiency.

The National Health Service (NHS) is currently facing a financial crisis with a projected deficit of £2billion by the end of financial year 2015/16. As operating rooms (OR) are one of the costliest components in secondary care, improving theatre efficiency should be at the forefront of efforts to improve health service efficiency. The objectives of this study were to characterize the causes of trauma OR delays and to estimate the cost of this inefficiency. A 1-month prospective single-centre study in St. Marys Hospital. Turnaround time (TT) was used as the surrogate parameter to measure theatre efficiency. Factors including patient age, ASA score and presence of surgical and anaesthetic consultant were evaluated to identify positive or negative associations with theatre delays. Inefficiency cost was calculated by multiplying the time wasted with staff capacity costs and opportunity costs, found to be £24.77/minute. The commonest causes for increased TT were delays in sending for patients (50%) and problems with patient transport to the OR (31%). 461 min of delay was observed in 12 days, equivalent to loss of £951.58/theatre/day. Non-statistically significant trends were seen between length of delays and advancing patient age, ASA score and absence of either a senior clinician or an anaesthetic consultant. Interestingly, the trend was not as strong for absence of an anaesthetic consultant. This study found delays in operating TT to represent a sizable cost, with potential efficiency savings based on TT of £347,327/theatre/year. Further study of a larger sample is warranted to better evaluate the identified trends

Identity and Alliance: Iceland’s Role in International Defence Cooperation 2006 - 2023

Summary This thesis outlines and discusses the development of the defence strategy and military alliances of Iceland, a small Nordic nation in the North Atlantic, between 2006 and 2023. Iceland is a founding member of NATO since 1949, yet without a standing army. This makes Iceland’s situation quite unique. The chosen timespan starts with the U.S. departure from the Keflavik airbase in 2006. It ends in April 2023 when Finland has just joined NATO, Sweden aspires to NATO membership, and visions for Nordic defence cooperation, including a vision for a Nordic Air Force, attract considerable interest. Basic knowledge of Iceland’s history, culture and mentality can greatly help to gain insight into the past, present and future of Iceland’s role and ambitions regarding defence matters and international alliances. Therefore, the thesis starts with historical and cultural background notes relevant to these topics. Sammendrag Målet med denne bacheloroppgaven er å beskrive og diskutere utviklingen av Islands forsvars-strategi og militære allianser i tidsperioden 2006-2023. Island har vært NATO-medlem siden organisasjonen ble etablert i 1949, samtidig som landet ikke har noe eget forsvar. Dette gjør landets situasjon unik. Tidsspennet denne oppgaven dekker starter i 2006 da USA formelt forlot den militære flybasen i Keflavik. Det ender i april 2023 idet Finland nettopp har blitt medlem av NATO, Sverige has sendt søknad om inngang i NATO og det er raskt økende interesse for å realisere visjonene om et samlet nordisk luftforsvar. Grunnleggende innsikt i Islands historie, kultur og mentalitet kan gjøre det lettere å forstå både utviklingen og framtidsmulighetene for Islands forsvarsstrategi og allianser. Oppgavens første del omtaler derfor relevante aspekter ved landets historie og kultur.publishedVersio

Exploiting technological synergies for future launch vehicles

Two launch vehicle concepts based on technologies available today or in a short term future in Western Europe are presented. The design of both launchers has the goal of exploiting synergies with current European programs to limit development and operational costs. Technologies of particular interest here are the high performance solid rocket motors with carbon-epoxy filament wound monolithic motor cases and the future high performance cryogenic expander cycle engine Vinci. The first concept dubbed ANGELA (A New GEneration LAuncher) is a study financed with funds of the German Ministry of Economics and managed by the DLR Space Administration. The project, which started in the summer of 2012 aims at designing a low cost versatile launcher able to place payloads between 2 and 5 tons into GTO. Three architectures have been considered during the first phase of the study. This phase was concluded in March 2013 with the preliminary stagings, which will be the starting point of more detailed analyses. The first architecture is made out of an H110 (stage with 110 tons of LOx/LH2) equipped with two Vulcain 2 engines with shortened nozzles and an H29 propelled by a Vinci engine. In addition the variation of the number of P36 solid rocket boosters allow to reach the entire range of payload performance. The second architecture differs from the first one only by the use of a new staged-combustion engine instead of two Vulcain 2 engines. The new engine, which should deliver 1800 kN in vacuum, allows a reduction of the size of the stages to H90-H24, enhanced with P34 boosters. The third and last architecture is a so called Multi PPH. The first stage is a bundle of 2 or 3 P120 solid rocket motors. The second stage is made out of one single P120, strictly similar to those used for the first stage. Finally the upper stage is an H23 equipped with a Vinci engine, the same as the two other architectures. The second launcher concept described in this paper is the small TSTO launch vehicle. It consists of a large solid rocket motor first stage P175 and a cryogenic upper stage propelled by the Vinci engine, H26. The preliminary design performed at DLR-SART considers two target performances. The light version of the small TSTO shall perform Galileo satellite replacement single launch missions to MTO corresponding to a payload performance of about 1400 kg in GTO. A heavy version of the launch vehicle shall be able to launch payloads up to 3000 kg in GTO. The performance increase for the heavy version is made possible by the addition of two pairs of P23 boosters, the second pair being ignited with a delay

The Role of Perceived Competence in Determining Teacher Support in Upper Secondary School Physical Education

Physical education remains one of the most liked school subjects, irrespective of grade level or geography. Nevertheless, sections of the student body dislike the subject immensely and even more think it should be organized differently. Students who are less competent have long claimed that physical education teachers and the curriculum favor the competent. Despite clear refusals of any conscious favoritism from the teachers, perceived competence is one of the premier predictors of students liking and being motivated to participate in the subject, the other being participation in organized sport. The purpose of this study was therefore to refute or confirm the veracity of the aforementioned claims through an investigation of the relationship between perceived competence and teacher-dependent support in upper secondary school physical education. One thousand one hundred thirty-three upper secondary school students (Mage = 17.2, SD = 0.86) from Norway (n = 554) and Iceland (n = 579) participated in a cross-sectional survey. Four teacher-dependent support variables were measured via self-reporting: perceived competence support, perceived relatedness support, perceived autonomy support, and perceived teacher learning support. To simplify comparison between groups, we divided the sample into three units: highly competent students, moderately competent students, and less competent students. A one-way multivariate analysis of covariance (MANCOVA), with gender as a covariate, found indications of biased teacher behavior, thus supporting the aforementioned accusations. Even though some discrepancies may exist between the reported and actual support levels, students respond and react in accordance with their perceptions, which is why their perceptions are of concern. These findings are incongruent with the aims of the subject and indicate that modified practices are needed if a more equal learning environment for all students is desired. To reverse the current trend, we provide three measures that we believe can reduce the aforementioned discrepancy. First, PE teachers must become more aware of their own biases, recognizing their tendency to treat the competent more favorably. Second, challenges related to the students who show less appreciation for the subject should become more prominent in physical education teacher education. Finally, the advantage of those who participate in leisuretime sporting activities, over those who do not, should be reduced through a reevaluation of the current curricular implementation.acceptedVersio

Efficient scene simulation for robust monte carlo localization using an RGB-D camera

This paper presents Kinect Monte Carlo Localization (KMCL), a new method for localization in three dimensional indoor environments using RGB-D cameras, such as the Microsoft Kinect. The approach makes use of a low fidelity a priori 3-D model of the area of operation composed of large planar segments, such as walls and ceilings, which are assumed to remain static. Using this map as input, the KMCL algorithm employs feature-based visual odometry as the particle propagation mechanism and utilizes the 3-D map and the underlying sensor image formation model to efficiently simulate RGB-D camera views at the location of particle poses, using a graphical processing unit (GPU). The generated 3D views of the scene are then used to evaluate the likelihood of the particle poses. This GPU implementation provides a factor of ten speedup over a pure distance-based method, yet provides comparable accuracy. Experimental results are presented for five different configurations, including: (1) a robotic wheelchair, (2) a sensor mounted on a person, (3) an Ascending Technologies quadrotor, (4) a Willow Garage PR2, and (5) an RWI B21 wheeled mobile robot platform. The results demonstrate that the system can perform robust localization with 3D information for motions as fast as 1.5 meters per second. The approach is designed to be applicable not just for robotics but other applications such as wearable computing

Toward lifelong visual localization and mapping

Thesis (Ph.D.)--Joint Program in Applied Ocean Science and Engineering (Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science; and the Woods Hole Oceanographic Institution), 2013.Cataloged from PDF version of thesis.Includes bibliographical references (p. 171-181).Mobile robotic systems operating over long durations require algorithms that are robust and scale efficiently over time as sensor information is continually collected. For mobile robots one of the fundamental problems is navigation; which requires the robot to have a map of its environment, so it can plan its path and execute it. Having the robot use its perception sensors to do simultaneous localization and mapping (SLAM) is beneficial for a fully autonomous system. Extending the time horizon of operations poses problems to current SLAM algorithms, both in terms of robustness and temporal scalability. To address this problem we propose a reduced pose graph model that significantly reduces the complexity of the full pose graph model. Additionally we develop a SLAM system using two different sensor modalities: imaging sonars for underwater navigation and vision based SLAM for terrestrial applications. Underwater navigation is one application domain that benefits from SLAM, where access to a global positioning system (GPS) is not possible. In this thesis we present SLAM systems for two underwater applications. First, we describe our implementation of real-time imaging-sonar aided navigation applied to in-situ autonomous ship hull inspection using the hovering autonomous underwater vehicle (HAUV). In addition we present an architecture that enables the fusion of information from both a sonar and a camera system. The system is evaluated using data collected during experiments on SS Curtiss and USCGC Seneca. Second, we develop a feature-based navigation system supporting multi-session mapping, and provide an algorithm for re-localizing the vehicle between missions. In addition we present a method for managing the complexity of the estimation problem as new information is received. The system is demonstrated using data collected with a REMUS vehicle equipped with a BlueView forward-looking sonar. The model we use for mapping builds on the pose graph representation which has been shown to be an efficient and accurate approach to SLAM. One of the problems with the pose graph formulation is that the state space continuously grows as more information is acquired. To address this problem we propose the reduced pose graph (RPG) model which partitions the space to be mapped and uses the partitions to reduce the number of poses used for estimation. To evaluate our approach, we present results using an online binocular and RGB-Depth visual SLAM system that uses place recognition both for robustness and multi-session operation. Additionally, to enable large-scale indoor mapping, our system automatically detects elevator rides based on accelerometer data. We demonstrate long-term mapping using approximately nine hours of data collected in the MIT Stata Center over the course of six months. Ground truth, derived by aligning laser scans to existing floor plans, is used to evaluate the global accuracy of the system. Our results illustrate the capability of our visual SLAM system to map a large scale environment over an extended period of time.by Hordur Johannsson.Ph.D

Toward autonomous harbor surveillance

Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2010.Includes bibliographical references (p. 105-113).In this thesis we address the problem of drift-free navigation for underwater vehicles performing harbor surveillance and ship hull inspection. Maintaining accurate localization for the duration of a mission is important for a variety of tasks, such as planning the vehicle trajectory and ensuring coverage of the area to be inspected. Our approach uses only onboard sensors in a simultaneous localization and mapping setting and removes the need for any external infrastructure like acoustic beacons. We extract dense features from a forward-looking imaging sonar and apply pair-wise registration between sonar frames. The registrations are combined with onboard velocity, attitude and acceleration sensors to obtain an improved estimate of the vehicle trajectory. In addition, an architecture for a persistent mapping is proposed. With the intention of handling long term operations and repetitive surveillance tasks. The proposed architecture is flexible and supports different types of vehicles and mapping methods. The design of the system is demonstrated with an implementation of some of the key features of the system. In addition, methods for re-localization are considered. Finally, results from several experiments that demonstrate drift-free navigation in various underwater environments are presented.by Hordur Johannsson.S.M