How many operating rooms are needed to manage non-elective surgical cases? A Monte Carlo simulation study.

BackgroundPatients often wait to have urgent or emergency surgery. The number of operating rooms (ORs) needed to minimize waiting time while optimizing resources can be determined using queuing theory and computer simulation. We developed a computer program using Monte Carlo simulation to determine the number of ORs needed to minimize patient wait times while optimizing resources.MethodsWe used patient arrival data and surgical procedure length from our institution, a tertiary-care academic medical center that serves a large diverse population. With ~4800 patients/year requiring non-elective surgery, and mean procedure length 185 min (median 150 min) we determined the number of ORs needed during the day and evening (0600-2200) and during the night (2200-0600) that resulted in acceptable wait times.ResultsSimulation of 4 ORs at day/evening and 3 ORs at night resulted in median wait time = 0 min (mean = 19 min) for emergency cases requiring surgery within 2 h, with wait time at the 95th percentile = 109 min. Median wait time for urgent cases needing surgery within 8-12 h was 34 min (mean = 136 min), with wait time at the 95th percentile = 474 min. The effect of changes in surgical length and volume on wait times was determined with sensitivity analysis.ConclusionsMonte Carlo simulation can guide decisions on how to balance resources for elective and non-elective surgical procedures

Kelt-4Ab: An inflated hot jupiter transiting the bright (V ∼ 10) component of a hierarchical triple

We report the discovery of KELT-4Ab, an inflated, transiting Hot Jupiter orbiting the brightest component of ahierarchical triple stellar system. The host star is an F star with Teff =6206 ± 75 K, log g =4.108 ± 0.014, [Fe/H]= -0.116+0.069+0.065, M∗ = 1.201-0.061+0.067 M⊙, and R∗ = 1.603-0.038+0.039 R⊙. The best-fit linear ephemeris is BJDTDB =2456193.29157±0.00021 + E(2.9895936±0.0000048). With a magnitude of V∼10, a planetary radius of 1.699-0.045+0.046 RJ, and a mass of 0.902-0.059+0.060 MJ, it is the brightest host among the population of inflated Hot Jupiters (RP \u3e 1.5RJ), making it a valuable discovery for probing the nature of inflated planets. In addition, its existence within a hierarchical triple and its proximity to Earth (210 pc) provide a unique opportunity for dynamical studies with continued monitoring with high resolution imaging and precision radial velocities. The projected separation between KELT-4A and KELT-4BC is 328±16 AU and the projected separation between KELT-4B and KELT-4C is 10.30±0.74 AU. Assuming face-on, circular orbits, their respective periods would be 3780±290 and 29.4±3.6 years and the astrometric motions relative to the epoch in this work of both the binary stars around each other and of the binary around the primary star would be detectable now and may provide meaningful constraints on the dynamics of the system

How many operating rooms are needed to manage non-elective surgical cases? A Monte Carlo simulation study.

BackgroundPatients often wait to have urgent or emergency surgery. The number of operating rooms (ORs) needed to minimize waiting time while optimizing resources can be determined using queuing theory and computer simulation. We developed a computer program using Monte Carlo simulation to determine the number of ORs needed to minimize patient wait times while optimizing resources.MethodsWe used patient arrival data and surgical procedure length from our institution, a tertiary-care academic medical center that serves a large diverse population. With ~4800 patients/year requiring non-elective surgery, and mean procedure length 185 min (median 150 min) we determined the number of ORs needed during the day and evening (0600-2200) and during the night (2200-0600) that resulted in acceptable wait times.ResultsSimulation of 4 ORs at day/evening and 3 ORs at night resulted in median wait time = 0 min (mean = 19 min) for emergency cases requiring surgery within 2 h, with wait time at the 95th percentile = 109 min. Median wait time for urgent cases needing surgery within 8-12 h was 34 min (mean = 136 min), with wait time at the 95th percentile = 474 min. The effect of changes in surgical length and volume on wait times was determined with sensitivity analysis.ConclusionsMonte Carlo simulation can guide decisions on how to balance resources for elective and non-elective surgical procedures

Modeling the effects of midazolam on cortical and thalamic neurons

Controversy exists regarding the site where anesthetics act in the brain to produce sedation and unconsciousness. Actions in the cerebral cortex and thalamus are likely, although the relative importance of each site is unclear. We used in computo modeling to investigate the sensitivity of cortical and thalamic neurons to midazolam (MDZ) at concentrations that produce unconsciousness. The GABA(A) receptor conductance of the model was manipulated to simulate the effects of MDZ at free-drug plasma concentrations ranging from 8 nM to 100 nM; sleepiness to complete unconsciousness occurs in humans in the 10-40 nM range. Prolongation of phasic inhibition was simulated by increasing the decay time constant and tonic inhibition was simulated by introducing a tonic current; the extent of phasic and tonic inhibition was appropriate for each simulated MDZ concentration. Phasic and tonic inhibition was simulated in cortex, and phasic inhibition was simulated in thalamus. Simulation of MDZ effect decreased cortical neuronal firing rate. For example, the mean cortical neuronal firing rate decreased by 15% (P<0.01) and 26% (P<0.01) at MDZ concentrations of 10 nM and 40 nM, respectively. However, thalamic firing rate did not change. In computo modeling of the thalamocortical system indicates that MDZ-induced GABAergic inhibition of cortical neurons plays a significant role in the transition from waking to unconsciousness. Although MDZ produces phasic inhibition in the thalamus, computer simulation suggests it is riot significant enough to decrease thalamic neuronal firing. Thus, based on in computo modeling, MDZ at sedative/hypnotic concentrations produces its effects by decreasing cortical neuronal firing. (C) 2009 Elsevier Ireland Ltd. All rights reserved