Application of Queuing Analytic Theory to Decrease Waiting Times in Emergency Department: Does it Make Sense?

Background: Patients who receive care in an emergency department (ED), are usually unattended while waiting in queues. Objectives: This study was done to determine, whether the application of queuing theory analysis might shorten the waiting times of patients admitted to emergency wards. Patients and Methods: This was an operational study to use queuing theory analysis in the ED. In the first phase, a field study was conducted to delineate the performance of the ED and enter the data obtained into simulator software. In the second phase, "ARENA" software was used for modeling, analysis, creating a simulation and improving the movement of patients in the ED. Validity of the model was confirmed through comparison of the results with the real data using the same instrument. The third phase of the study concerned modeling in order to assess the effect of various operational strategies, on the queue waiting time of patients who were receiving care in the ED. Results: In the first phase, it was shown that 47.7% of the 3000 patient records were cases referred for trauma treatment, and the remaining 52.3% were referred for non-trauma services. A total of 56% of the cases were male and 44% female. Maximum input was 4.5 patients per hour and the minimum input was 0.5 per hour. The average length of stay for patients in the trauma section was three hours, while for the non-trauma section it was four hours. In the second phase, modeling was tested with common scenarios. In the third phase, the scenario with the addition of one or more senior emergency resident(s) on each shift resulted in a decreased length of stay from 4 to 3.75 hours. Moreover, the addition of one bed to the Intensive Care Unit (ICU) and/or Critical Care Unit (CCU) in the study hospital, reduced the occupancy rate of the nursing service from 76% to 67%. By adding another clerk to take electrocardiograms (ECG) in the ED, the average time from a request to performing the procedure is reduced from 26 to 18 minutes. Furthermore, the addition of 50% more staff to the laboratory and specialist consultations led to a 90 minute reduction in the length of stay. It was also shown that earlier consultations had no effect on the length of stay. Conclusions: Application of queuing theory analysis can improve movement and reduce the waiting times of patients in bottlenecks within the ED throughput

Energy and economic analysis of evaporative vacuum easy desalination system with brine tank

Please read abstract in the article.http://link.springer.com/journal/109732020-11-02hj2020Mechanical and Aeronautical Engineerin

The Effect of Camellia Sinensis Ointment on Perineal Wound Healing in Primiparous Women

BACKGROUND AND OBJECTIVE: Delay in recovery of episiotomy can lead to infection and persistence of perineal pain. Perineal pain is a stressful problem for primiparous women and has a negative effect on their function.The present study was conducted to determine the effect of Green tea ointment on the healing process of episiotomy. METHODS: This three-blind clinical trial was conducted on 60 primiparous participated in this research, were divided in two groups: Green tea ointment and placebo ointment. According to the routine of the hospital, 500 mg capsule cephalexin was given to all mothers every six hours for seven days. Mothers used an ointments every 12 hours for a period of ten days in the area of sutures. Wound healing was measured on the fifth and tenth day after delivery using REEDA scale. FINDINGS: There was no significant difference in demographic features and obstetric variables (for example age and weight newborn). Before the intervention, two groups did not have a significant difference in score of the perineal evaluation scale (p=0.475). The average of this scale on the fifth day in the green tea group was (1.83±1.147) and in placebo group it was (3.33±1.155) on the 10th day, the average of the perineal evaluation scale was (1.2±0.805) for the green tea group and (2.63±1.066) for the placebo group. The average of REEDA scores on the 5th and 10th day after delivery was significantly different between the two groups(p<0.00001) CONCLUSION: Green tea can improve episiotomy wound healing, due to its healing propertie

Ecto- and arbuscular mycorrhizal symbiosis can induce tolerance to toxic pulses of phosphorus in jarrah (Eucalyptus marginata) seedlings

In common with many plants native to low P soils, jarrah (Eucalyptus marginata) develops toxicity symptoms upon exposure to elevated phosphorus (P). Jarrah plants can establish arbuscular mycorrhizal (AM) and ectomycorrhizal (ECM) associations, along with a non-colonizing symbiosis described recently. AM colonization is known to influence the pattern of expression of genes required for P uptake of host plants and our aim was to investigate this phenomenon in relation to P sensitivity. Therefore, we examined the effect on hosts of the presence of AM and ECM fungi in combination with toxic pulses of P and assessed possible correlations between the induced tolerance and the shoot P concentration. The P transport dynamics of AM (Rhizophagus irregularis and Scutellospora calospora), ECM (Scleroderma sp.), non-colonizing symbiosis (Austroboletus occidentalis), dual mycorrhizal (R. irregularis and Scleroderma sp.), and non-mycorrhizal (NM) seedlings were monitored following two pulses of P. The ECM and A. occidentalis associations significantly enhanced the shoot P content of jarrah plants growing under P-deficient conditions. In addition, S. calospora, A. occidentalis, and Scleroderma sp. all stimulated plant growth significantly. All inoculated plants had significantly lower phytotoxicity symptoms compared to NM controls 7 days after addition of an elevated P dose (30 mg P kg−1 soil). Following exposure to toxicity-inducing levels of P, the shoot P concentration was significantly lower in R. irregularis-inoculated and dually inoculated plants compared to NM controls. Although all inoculated plants had reduced toxicity symptoms and there was a positive linear relationship between rank and shoot P concentration, the protective effect was not necessarily explained by the type of fungal association or the extent of mycorrhizal colonization

Sensitivity of jarrah (Eucalyptus marginata) to phosphate, phosphite, and arsenate pulses as influenced by fungal symbiotic associations

Many plant species adapted to P-impoverished soils, including jarrah (Eucalyptus marginata), develop toxicity symptoms when exposed to high doses of phosphate (Pi) and its analogs such as phosphite (Phi) and arsenate (AsV). The present study was undertaken to investigate the effects of fungal symbionts Scutellospora calospora, Scleroderma sp., and Austroboletus occidentalis on the response of jarrah to highly toxic pulses (1.5 mmol kg−1 soil) of Pi, Phi, and AsV. S. calospora formed an arbuscular mycorrhizal (AM) symbiosis while both Scleroderma sp. and A. occidentalis established a non-colonizing symbiosis with jarrah plants. All these interactions significantly improved jarrah growth and Pi uptake under P-limiting conditions. The AM fungal colonization naturally declines in AM-eucalypt symbioses after 2–3 months; however, in the present study, the high Pi pulse inhibited the decline of AM fungal colonization in jarrah. Four weeks after exposure to the Pi pulse, plants inoculated with S. calospora had significantly lower toxicity symptoms compared to non-mycorrhizal (NM) plants, and all fungal treatments induced tolerance against Phi toxicity in jarrah. However, no tolerance was observed for AsV-treated plants even though all inoculated plants had significantly lower shoot As concentrations than the NM plants. The transcript profile of five jarrah high-affinity phosphate transporter (PHT1 family) genes in roots was not altered in response to any of the fungal species tested. Interestingly, plants exposed to high Pi supplies for 1 day did not have reduced transcript levels for any of the five PHT1 genes in roots, and transcript abundance of four PHT1 genes actually increased. It is therefore suggested that jarrah, and perhaps other P-sensitive perennial species, respond positively to Pi available in the soil solution through increasing rather than decreasing the expression of selected PHT1 genes. Furthermore, Scleroderma sp. can be considered as a fungus with dual functional capacity capable of forming both ectomycorrhizal and non-colonizing associations, where both pathways are always accompanied by evident growth and nutritional benefits

Microbial Functional Capacity Is Preserved Within Engineered Soil Formulations Used In Mine Site Restoration

Mining of mineral resources produces substantial volumes of crushed rock based wastes that are characterised by poor physical structure and hydrology, unstable geochemistry and potentially toxic chemical conditions. Recycling of these substrates is desirable and can be achieved by blending waste with native soil to form a 'novel substrate' which may be used in future landscape restoration. However, these post-mining substrate based 'soils' are likely to contain significant abiotic constraints for both plant and microbial growth. Effective use of these novel substrates for ecosystem restoration will depend on the efficacy of stored topsoil as a potential microbial inoculum as well as the subsequent generation of key microbial soil functions originally apparent in local pristine sites. Here, using both marker gene and shotgun metagenome sequencing, we show that topsoil storage and the blending of soil and waste substrates to form planting substrates gives rise to variable bacterial and archaeal phylogenetic composition but a high degree of metabolic conservation at the community metagenome level. Our data indicates that whilst low phylogenetic conservation is apparent across substrate blends we observe high functional redundancy in relation to key soil microbial pathways, allowing the potential for functional recovery of key belowground pathways under targeted management

The study of relationship between menorrhagia and gestational diabetes

Introduction: Gestational diabetes is defined as carbohydrate intolerance of variable severity withonset or recognition during pregnancy. Approximately, 4% of pregnancies are affected by diabetesmellitus, 90% of which represents gestational diabetes mellitus (GDM). Detection of risk factors ofGDM may reduce the risk of complications. One of the new risk factors is menorrhagia. This studywas conducted to identify the relation between menorrhagia and gestational diabetesMaterial and Method: This case-control study was performed on the pregnant women who werereferred to GDM and prenatal clinics in the endocrinology and metabolism centers of Shariati, andTaleghani hospitals as well as Iran endocrinology and metabolism institute of Tehran. In this study,data collection from the patients were carried out by interview method. Sampling was performed byconvenience method. Case group included 60 women with gestational diabetes and control groupincluded 60 women without gestational diabetes that they were selected at the same period of time.Demographic characteristics, history of menorrhagia and its etiology, were compared between twogroups. We excluded subject with history of fetal macrosomia (weight >4500g), pre-pregnancydiabetes, diabetes in previous pregnancy, neonatal morbidity and mortality, recurrent abortion,smoking before and during pregnancy and preterm delivery. The case and control subjects werematched based on their age, parity, pre-pregnancy body mass index, diabetes mellitus in first-degreerelative and the history of still-birth or malformed fetus or neonates.Results: Demographic characteristics and etiology of menorrhagia were similar between twogroups. Relative frequencies of menorrhagia were 41.7 % and 6% in the case and the control group,respectively (p<001 , Odds Ratio=6.43).Conclusion: A history of menorrhagia can be an independent predictor of gestational diabetesmellitus. If selective screening is implemented for gestational diabetes mellitus, such history should beconsidered in the decision of whom to test