Mitigating Emergency Department Crowding With Stochastic Population Models

Environments such as shopping malls, airports, or hospital emergency departments often experience crowding, with many people simultaneously requesting service. Crowding is highly noisy, with sudden overcrowding "spikes". Past research has either focused on average behavior or used context-specific non-generalizable models. Here we show that a stochastic population model, previously applied to a broad range of natural phenomena, can aptly describe hospital emergency-department crowding, using data from five-year minute-by-minute emergency-department records. The model provides reliable forecasting of the crowding distribution. Overcrowding is highly sensitive to the patient arrival-flux and length-of-stay: a 10% increase in arrivals triples the probability of overcrowding events. Expediting patient exit-rate to shorten the typical length-of-stay by just 20 minutes (8.5%) reduces severe overcrowding events by 50%. Such forecasting is crucial in prevention and mitigation of breakdown events. Our results demonstrate that despite its high volatility, crowding follows a dynamic behavior common to many natural systems.Comment: 21 pages, 6 figures + Supplementary informatio

The ‘Lost Caravan’ of Ma’den Ijafen revisited: Re-appraising its cargo of cowries, a medieval global commodity

The lost caravan of Ma’den Ijafen, Mauritania, with its cargo of cowries and brass, is widely discussed in African archaeology, providing significant insight into the nature of long-distance trade in the medieval period. While the brass bars recovered by Théodore Monod during his expedition to the site in 1962 have received considerable attention, the cowrie shells described in his comprehensive publication of the assemblage in 1969 have received much less coverage. This issue was addressed during a recent visit to the Institut Fondamental d’Afrique Noire (IFAN) in Dakar, Senegal in May 2017, when the authors re-examined the shells as part of a wider project which also involved archaeological and environmental surveys in the Maldives, the oft-assumed source of these shells. Examinations of natural history collections of cowries, ethnographic interviews in the Maldives, and environmental surveys in East Africa were also carried out. Drawing on insights from these surveys, we systematically compared the Ma’den Ijafen cowrie assemblage to three others from the Maldives, focussing on four criteria: species composition and diversity, shell size and evidence of modifications. This analysis enabled us to shed new light on the nature of the Ma’den Ijafen cowries and their wider significance to understanding the role of the shells in West African trade networks. La caravane perdue du Ma’den Ijafen, en Mauritanie, avec son chargement de cauris et de laiton, a fait l’objet de beaucoup de discussions en archéologie africaine, car elle offre des données importantes sur la nature du commerce médiéval à longue distance. Si les barres de laiton découvertes par Théodore Monod lors de son expédition sur le site en 1962 ont attiré beaucoup d’attention, les cauris, dont il offre une description dans sa publication de 1969, n’en ont presque pas reçu. Cette lacune a été comblée lors d’une visite en mai 2017 à l’Institut Fondamental d’Afrique Noire (IFAN) de Dakar. Lors de cette étude, les auteurs ont pu réexaminer, compter et décrire les cauris. Ceci a été fait dans le cadre d’un projet plus vaste qui a aussi permis des prospections environnementales et archéologiques aux Maldives, la source présumée de ces coquillages. L’étude de collections de cauris dans des musées d’histoire naturelle, des entretiens ethnographiques aux Maldives, et des prospections environnementales en Afrique de l’Est ont aussi été conduites. Ces éléments nous ont fourni un précieux éclairage lors de notre comparaison systématique des cauris du Ma’den Ijafen avec trois collections de cauris retrouvées aux Maldives. Nous avons pris en compte les espèces présentes et leur diversité, la taille des coquillages, et les indications de modifications. Cette analyse nous permet de jeter un nouveau regard sur la nature des cauris du Ma’den Ijafen et leur signification pour l’Afrique de l’Ouest.This article is in Englis

‘How, for God’s sake, can I be a good Muslim?' Gambian Youth in Search of a Moral Lifestyle

By analysing the case study of a young Muslim man's conversion within and between different expressions of Islam in the Gambia, this article challenges common understandings of conversion that see it as a transition from one form of religious belief or identity to another, as well as theories of Islam's place in Africa that distinguish between ‘local’ traditions and ‘world’ religions. The ethnographic case study illustrates that, for Gambian youth, conversion is not a unilinear path but entails the continuous making of moral negotiations and a preparedness to reflect on the ambiguity of selfhood – an inevitable result of the making of these negotiations

What Does It Mean to Be a College Student for Youth with Intellectual Disabilities? : A Survey on Department of Rehabilitation Independence of Korea Nazarene University

<strong>Background:</strong> Governments in several countries are facing problems concerning the accountability of regulators in health care. Questions have been raised about how patients’ complaints should be valued in the regulatory process. However, it is not known what patients who made complaints expect to achieve in the process of health-care quality regulation. <strong>Objective:</strong> To assess expectations and experiences of patients who complained to the regulator. Design Interviews were conducted with 11 people, and a questionnaire was submitted to 343 people who complained to the Dutch Health-care Inspectorate. The Inspectorate handled 92 of those complaints. This decision was based on the idea that the Inspectorate should only deal with complaints that relate to ‘structural and severe’ problems. <strong>Results:</strong> The response rate was 54%. Self-reported severity of physical injury of complaints that were not handled was significantly lower than of complaints that were. Most respondents felt that their complaint indicated a structural and severe problem that the Inspectorate should act upon. The desire for penalties or personal satisfaction played a lesser role. Only a minority felt that their complaint had led to improvements in health-care quality. <strong>Conclusions:</strong> Patients and the regulator share a common goal: improving health-care quality. However, patients’ perceptions of the complaints’ relevance differ from the regulator’s perceptions. Regulators should favour more responsive approaches, going beyond assessing against exclusively clinical standards to identify the range of social problems associated with complaints about health care. Long-term learning commitment through public participation mechanisms can enhance accountability and improve the detection of problems in health care. (aut. ref.

Cowries in the archaeology of West Africa: the present picture

Despite the perceived importance of cowrie shells as indicators of long-distance connections in the West African past, their distribution and consumption patterns in archaeological contexts remain surprisingly underexplored, a gap that is only partly explicable by the sparse distribution of archaeological sites within the sub-continent. General writings on the timeline of importation of cowries into West Africa often fail to take into account the latest archaeological evidence and rely instead on accounts drawn from historical or ethnographic documents. This paper is based on a first-hand assessment of over 4500 shells from 78 sites across West Africa, examining chronology, shell species and processes of modification to assess what distribution patterns can tell us about the history of importation and usage of cowries. These first-hand analyses are paralleled by a consideration of published materials. We re-examine the default assumption that two distinct routes of entry existed — one overland from North Africa before the fifteenth century, another coming into use from the time sea links were established with the East African coast and becoming predominant by the middle of the nineteenth century. We focus on the eastern part of West Africa, where the importance of imported cowries to local communities in relatively recent periods is well known and from where we have a good archaeological sample. The conclusion is that on suitably large assemblages shell size can be an indication of provenance and that, while the present archaeological picture seems largely to confirm historical sources, much of this may be due to the discrepancy in archaeological data available from the Sahara/Sahel zone compared to the more forested regions of the sub-continent. Future archaeological work will clarify this matter

The origins and development of Zuwīla, Libyan Sahara: an archaeological and historical overview of an ancient oasis town and caravan centre

Zuwīla in southwestern Libya (Fazzān) was one of the most important early Islamic centres in the Central Sahara, but the archaeological correlates of the written sources for it have been little explored. This paper brings together for the first time a detailed consideration of the relevant historical and archaeological data, together with new AMS radiocarbon dates from several key monuments. The origins of the settlement at Zuwīla were pre-Islamic, but the town gained greater prominence in the early centuries of Arab rule of the Maghrib, culminating with the establishment of an Ibāḍī state ruled by the dynasty of the Banū Khaṭṭāb, with Zuwīla its capital. The historical sources and the accounts of early European travellers are discussed and archaeological work at Zuwīla is described (including the new radiocarbon dates). A short gazetteer of archaeological monuments is provided as an appendix. Comparisons and contrasts are also drawn between Zuwīla and other oases of the ash-Sharqiyāt region of Fazzān. The final section of the paper presents a series of models based on the available evidence, tracing the evolution and decline of this remarkable site

Religious pluralism in the United States and Britain

This article provides a historically informed analysis of the contemporary incorporation of Islam and Muslims into an idea of common – national – membership in the United States and Britain. It shows that there is a current movement towards synthesis between religious and national identities by Muslims themselves, and explores the ways in which this synthesis is occurring within rich and dynamic public spheres in societies that have historically included and incorporated other religious groups. The authors argue that both countries are wrestling with the extent to which they accommodate Muslims in ways that allow them to reconcile their faith and citizenship commitments, and that the British ‘establishment’ is no less successful at achieving this than secular republicanism in the US

West Africa in the British Atlantic: trade, violence, and empire in the 1640s

The importance of Africa and African agency in the formation of the Atlantic world is now widely acknowledged by historians, but Africa has drawn less attention than other regions in analyses of the British Atlantic. Drawing upon the nascent methodology of global microhistory, this article contributes to a scholarly rebalancing by examining two maritime lawsuits from the 1640s concerning British voyages to Senegambia and Sierra Leone, both of which resulted in conflict between British seafarers and with their African trading partners. A close study of the documents surviving from these lawsuits provides an unusually detailed glimpse of these particular moments of contact and violence across cultures. More fundamentally, such an approach illuminates the ocean-spanning networks within which these ventures took place, and reveals the ways in which British traders and sailors perceived trade in Africa within their own legal frameworks. This article argues that by the middle of the seventeenth century, as merchants and politicians in Britain began to imagine an Atlantic empire, trade in West Africa was an important part of their vision of the Atlantic world