Stress on the Ward – An Empirical Study of the Nonlinear Relationship between Organizational Workload and Service Quality

We discuss the impact of organizational workload on professional service outcomes, such as survival rates in hospitals. The prevailing view in the literature is that service quality deteriorates when organizational workload increases. In contrast, we argue that the relationship between workload and service outcomes is nonlinear and that there is a quality-optimal workload level. Whilst outcomes deteriorate with increasing workload when workload levels are already high, they will improve if workload increases from a low level. We reach this hypothesis by combining three perspectives: (i) the queuing theory perspective, with its focus on congestion, (ii) a discretionary choice perspective, with a focus on decisions made by professionals in response to changes in workload, and (iii) an endocrinological perspective, with a focus on the subconscious eff ects of workload on worker performance through the cognitive impact of stress hormones. Using a patient census of 1.4 million patients in 624 departments across 101 hospitals, we provide empirical support for the nonlinearity hypothesis in the context of hospital survival rates. We further discuss the implications for hospital capacity planning and the wider implications for service operations management.Service quality; service outcomes; organizational workload; hospital capacity planning; behavioral operations; stress

Distributed Markovian Bisimulation Reduction aimed at CSL Model Checking

The verification of quantitative aspects like performance and dependability by means of model checking has become an important and vivid area of research over the past decade.\ud \ud An important result of that research is the logic CSL (continuous stochastic logic) and its corresponding model checking algorithms. The evaluation of properties expressed in CSL makes it necessary to solve large systems of linear (differential) equations, usually by means of numerical analysis. Both the inherent time and space complexity of the numerical algorithms make it practically infeasible to model check systems with more than 100 million states, whereas realistic system models may have billions of states.\ud \ud To overcome this severe restriction, it is important to be able to replace the original state space with a probabilistically equivalent, but smaller one. The most prominent equivalence relation is bisimulation, for which also a stochastic variant exists (Markovian bisimulation). In many cases, this bisimulation allows for a substantial reduction of the state space size. But, these savings in space come at the cost of an increased time complexity. Therefore in this paper a new distributed signature-based algorithm for the computation of the bisimulation quotient of a given state space is introduced.\ud \ud To demonstrate the feasibility of our approach in both a sequential, and more important, in a distributed setting, we have performed a number of case studies

DISCOVERY OF X-RAY EMISSION FROM SUPERNOVA 1970G WITH CHANDRA: FILLING THE VOID BETWEEN SUPERNOVAE AND SUPERNOVA REMNANTS

We report the discovery of X-ray emission from SN 1970G in M101, 35 yr after its outburst, using deep X-ray imaging with the Chundra X-Ray Observatory. The Chandra ACIS spectrum shows that the emission is soft (52 keV) and characteristic of the reverse-shock region. The X-ray luminosity, Lo,,, = (1.1 3 0.2) x lo3# ergs s-1, is likely caused by the interaction of the supernova shock with dense circumstellar matter. If the material was deposited by the stellar wind from the progenitor, a mass-loss rate of M = (2.6 ? 0.4) x M, yr-I (v,/lO km s-I) is inferred. Utilizing the high-resolution Chandra ACIS data of SN 1970G and its environment, we reconstruct the X-ray lightcurve from previous ROSAT HRI, PSPC, and XMM-Newton EPIC observations, and find a best-fit linear rate of decline of L cc t-# with index s = 2.7 t 0.9 over a period of -20-35 yr after the outburst. As the oldest supernova detected in X-rays, SN 1970G allows, for the first time, direct observation of the transition from a supenova to its supernova remnant phase

Bodies and Glazes of Architectural Ceramics from the Ilkhanid Period at Takht-e Soleyman (North-Western Iran)

Bodies and glazes of tiles from the Ilkhanid period found at the UNESCO World Heritage site of Takht-e Soleyman were studied to identify materials and certain technical characteristics of the architectural ceramics as part of a larger project to establish different productions. In addition, ceramic vessels and technical ceramics excavated at the site were analysed for comparison. µXRF, SEM/EDX, and Raman spectroscopy were used for the material investigations. Qualitative non-invasive µXRF results allowed for categorisation of the glazes and ceramic bodies based on their overall composition. Quantitative analysis by SEM/EDX on a subset of the samples delivered detailed results on the bodies and glazes. Tiles, made from clay or stonepaste, were almost exclusively decorated with a mixed alkaline lead glaze. The PbO content of this type of glaze ranged from 8 wt% to 25 wt%. The clay bodies of some tiles corresponded to the material of the locally used kiln furniture. Moreover, glaze residues preserved on the kiln furniture proved to be from a mixed lead alkaline glaze with a PbO content of 15 wt% to 25 wt%, a composition that is comparable to the tiles’ glazes. For more insights into the local or regional production of the tiles, supplementary in-depth studies including petrographic analysis would be needed to confirm and further specify the results

Deterministic Execution Sequence in Component Based Multi-Contributor Powertrain Control Systems

International audienceModern complex control applications, e.g. engine management systems, typically are built using a component based architecture, enabling the reuse of components and allowing to manage the complexity of the application in terms of functional content, size and interfaces. This approach of independently developed components is supported by the concepts available in AUTOSAR and therefore can be expected to gain increasing importance. However, due to the nature of the task of control applications there still is a strong coupling between individual parts of the components resulting in signal chains and consequently in sequencing requirements. The challenge to get such execution sequences implemented correctly is increased, as often the components are delivered by different and external parties. Our approach extends the idea of functional partitioning of the application into the time domain by defining a system of phases with a fixed sequence and a defined content. This allows to design components right from the beginning into this sequencing frame like they are designed today into the component partitioning frame and to define a system sequencing across different suppliers

Creep–Fatigue Interaction of Inconel 718 Manufactured by Electron Beam Melting

Electron beam melting of Ni-base superalloy Inconel 718 allows producing a columnar-grained microstructure with a pronounced texture, which offers exceptional resistance against high-temperature loading with severe creep–fatigue interaction arising in components of aircraft jet engines. This study considers the deformation, damage, and lifetime behavior of electron-beammelted Inconel 718 under in-phase thermomechanical fatigue loading with varying amounts of creep–fatigue interaction. Strain-controlled thermomechanical fatigue tests with equal-ramp cycles, slow–fast cycles, and dwell time cycles are conducted in the temperature range from 300 to 650 °C. Results show that both dwell time and slow–fast cycles promote intergranular cracking, gradual tensile stress relaxation, as well as precipitate dissolution and coarsening giving rise to cyclic softening. The interplay of these mechanisms leads to increased lifetimes in both dwell time and slow–fast tests compared to equal ramp tests at higher strain amplitudes. Conversely, at lower mechanical strain amplitudes, the opposite is observed. A comparison with results of conventional Inconel 718 indicates that the electron-beam-melted material exhibits superior resistance against strain-controlled loading at elevated temperatures such as thermomechanical fatigue

Bacterial Species Associated with Highly Allergenic Plant Pollen Yield a High Level of Endotoxins and Induce Chemokine and Cytokine Release from Human A549 Cells

none10siSensitization to pollen allergens has been increasing in Europe every year. Most studies in this field are related to climate change, phenology, allergens associated with different pollens, and allergic disorders. As a plant microhabitat, pollen is colonized by diverse microorganisms, including endotoxin-producing bacteria which may contribute to pollen allergy (pollinosis). Therefore, bacteria isolated from high allergenic and low allergenic plant pollen, as well as the pollen itself with all microbial inhabitants, were used to assess the effect of the pollen by measuring the endotoxins lipopolysaccharides (LPS) and lipoteichoic acid (LTA) concentrations and their effect on chemokine and cytokine release from transwell cultured epithelial A549 cells as a model of epithelial lung barrier. High allergenic pollen showed a significantly higher level of bacterial endotoxins; interestingly, the endotoxin level found in the bacterial isolates from high allergenic pollen was significantly higher compared to that of bacteria from low allergenic pollen. Moreover, bacterial LPS concentrations across different pollen species positively correlated with the LPS concentration across their corresponding bacterial isolates. Selected bacterial isolates from hazel pollen (HA5, HA13, and HA7) co-cultured with A549 cells induced a potent concentration-dependent release of the chemokine interleukin-8 and monocyte chemotactic protein-1 as well as the cytokine TNF-alpha and interleukin-2 to both apical and basal compartments of the transwell model. This study clearly shows the role of bacteria and bacterial endotoxins in the pollen allergy as well as seasonal allergic rhinitis.Ambika Manirajan, Binoy; Hinrichs, Ann-Kathrin; Ratering, Stefan; Rusch, Volker; Schwiertz, Andreas; Geissler-Plaum, Rita; Eichner, Gerrit; Cardinale, Massimiliano; Kuntz, Sabine; Schnell, SylviaAmbika Manirajan, Binoy; Hinrichs, Ann-Kathrin; Ratering, Stefan; Rusch, Volker; Schwiertz, Andreas; Geissler-Plaum, Rita; Eichner, Gerrit; Cardinale, Massimiliano; Kuntz, Sabine; Schnell, Sylvi

Efficacy and Safety of Vamorolone in Duchenne Muscular Dystrophy: A 30-Month Nonrandomized Controlled Open-Label Extension Trial

Importance: Vamorolone is a synthetic steroidal drug with potent anti-inflammatory properties. Initial open-label, multiple ascending dose-finding studies of vamorolone among boys with Duchenne muscular dystrophy (DMD) found significant motor function improvement after 6 months treatment in higher-dose (ie, ≥2.0 mg/kg/d) groups. / Objective: To investigate outcomes after 30 months of open-label vamorolone treatment. / Design, Setting, and Participants: This nonrandomized controlled trial was conducted by the Cooperative International Neuromuscular Research Group at 11 US and non-US study sites. Participants were 46 boys ages 4.5 to 7.5 years with DMD who completed the 6-month dose-finding study. Data were analyzed from July 2020 through November 2021. / Interventions: Participants were enrolled in a 24-month, long-term extension (LTE) study with vamorolone dose escalated to 2.0 or 6.0 mg/kg/d. / Main Outcomes and Measures: Change in time-to-stand (TTSTAND) velocity from dose-finding baseline to end of LTE study was the primary outcome. Efficacy assessments included timed function tests, 6-minute walk test, and NorthStar Ambulatory Assessment (NSAA). Participants with DMD treated with glucocorticoids from the Duchenne Natural History Study (DNHS) and NorthStar United Kingdom (NSUK) Network were matched and compared with participants in the LTE study receiving higher doses of vamorolone. / Results: Among 46 boys with DMD who completed the dose-finding study, 41 boys (mean [SD] age, 5.33 [0.96] years) completed the LTE study. Among 21 participants treated with higher-dose (ie, ≥2.0 mg/kg/d) vamorolone consistently throughout the 6-month dose-finding and 24-month LTE studies with data available at 30 months, there was a decrease in mean (SD) TTSTAND velocity from baseline to 30 months (0.206 [0.070] rises/s vs 0.189 (0.124) rises/s), which was not a statistically significant change (-0.011 rises/s; CI, -0.068 to 0.046 rises/s). There were no statistically significant differences between participants receiving higher-dose vamorolone and matched participants in the historical control groups receiving glucocorticoid treatment (75 patients in DNHS and 110 patients in NSUK) over a 2-year period in NSAA total score change (0.22 units vs NSUK; 95% CI, -4.48 to 4.04]; P = .92), body mass index z score change (0.002 vs DNHS SD/mo; 95% CI, -0.006 to 0.010; P = .58), or timed function test change. Vamorolone at doses up to 6.0 mg/kg/d was well tolerated, with 5 of 46 participants discontinuing prematurely and for reasons not associated with study drug. Participants in the DNHS treated with glucocorticoids had significant growth delay in comparison with participants treated with vamorolone who had stable height percentiles (0.37 percentile/mo; 95% CI, 0.23 to 0.52 percentile/mo) over time. / Conclusions and Relevance: This study found that vamorolone treatment was not associated with a change in TTSTAND velocity from baseline to 30 months among boys with DMD aged 4 to 7 years at enrollment. Vamorolone was associated with maintenance of muscle strength and function up to 30 months, similar to standard of care glucocorticoid therapy, and improved height velocity compared with growth deceleration associated with glucocorticoid treatment, suggesting that vamorolone may be an attractive candidate for treatment of DMD. Trial Registration: ClinicalTrials.gov Identifier: NCT03038399

Towards an Intrinsic Doppler Correction for X-ray Spectroscopy of Stored Ions at CRYRING@ESR

We report on a new experimental approach for the Doppler correction of X-rays emitted by heavy ions, using novel metallic magnetic calorimeter detectors which uniquely combine a high spectral resolution with a broad bandwidth acceptance. The measurement was carried out at the electron cooler of CRYRING@ESR at GSI, Darmstadt, Germany. The X-ray emission associated with the radiative recombination of cooler electrons and stored hydrogen-like uranium ions was investigated using two novel microcalorimeter detectors positioned under 0∘ and 180∘ with respect to the ion beam axis. This new experimental setup allowed the investigation of the region of the N, M → L transitions in helium-like uranium with a spectral resolution unmatched by previous studies using conventional semiconductor X-ray detectors. When assuming that the rest-frame energy of at least a few of the recorded transitions is well-known from theory or experiments, a precise measurement of the Doppler shifted line positions in the laboratory system can be used to determine the ion beam velocity using only spectral information. The spectral resolution achievable with microcalorimeter detectors should, for the first time, allow intrinsic Doppler correction to be performed for the precision X-ray spectroscopy of stored heavy ions. A comparison with data from a previous experiment at the ESR electron cooler, as well as the conventional method of conducting Doppler correction using electron cooler parameters, will be discussed