Exploring alternative routes to realising the benefits of simulation in healthcare

Discrete event simulation should offer numerous benefits in designing healthcare systems but the reality is often problematic. Healthcare modelling faces particular challenges: genuine, fundamental variations in practice and an opposition to any suggestion of standardisation from some professional groups. This paper compares the experiences of developing a new simulation in an Accident and Emergency (A&E) Department, a subsequent adaptation for modelling an outpatient clinic and applications of a generic A&E simulation. These studies provide examples of three distinct approaches to realising the potential benefits of simulation: the bespoke, the reuse and the generic route. Reuse has many advantages: it is relatively efficient in exploiting previous modelling experience, delivering timely results while providing scope for adaptations to local practice. Explicitly demonstrating this willingness to adapt to local conditions and engaging with stakeholders is particularly important in healthcare simulation

Success and Failure in the Simulation of an Accident and Emergency Department

Healthcare simulation has the potential to offer many benefits but the implementation is often problematic. This paper describes the development of a simulation of an Accident and Emergency Department in an NHS hospital. The early experience of the client provoked great enthusiasm but ultimately the simulation failed to meet all expectations. The simulation delivered a number of benefits, notably in terms of stimulating constructive debate and helping the stakeholders appreciate the complete Accident and Emergency system. The project produced a technically proficient tool that was delivered too late to have the desired impact. This mixed record of success appears typical of many simulations. Important lessons were learned, both technically and in the management of client expectations, which have contributed to subsequent successful implementation in other departments of the hospital. The experience suggests that both potential clients and analysts need to establish realistic expectations and appreciate the particular challenges of simulation in a healthcare environment

The impact of boron seed priming on seedling establishment, growth, and grain biofortification of mungbean (Vigna radiata L.) in yermosols

Boron-deficiency in Yermosols is among the major constraints to mungbean productivity and grain biofortification in Pakistan. However, agronomic strategies such as boron (B) seed priming have potential to improve mungbean yield and grain biofortification. Moreover, deficiency to toxicity range for B is very narrow; therefore, it is pre-requisite to optimize its dose before field evaluation. A wire house experiment was planned out to reconnoiter the impact of seed priming with B on growth and quality of two cultivars of mungbean, i.e., ‘NM-2011’ and ‘NM-2016’. Four different B levels were used as seed priming, i.e., 0.01%, 0.05%, 0.1% and 1.0% B, (borax Na2B4O7.10H2O, 11.5% B) were tested, whereas hydropriming was regarded as control. Seed priming with 0.01% B significantly (p≤0.05) lowered time taken to start germination and time to reach 50% emergence, whereas improved mean emergence time, emergence index, final emergence percentage, number of leaves, dry and fresh weight of root, shoot, and total weight, root length, plant height, chlorophyll contents, number of pods and 100-grain weight, seeds per plant, grain yield per plant, B concentrations in stem and grain, grain protein, carbohydrate and fiber in both cultivars. Boron seed priming proved beneficial under a specific range; however, deficiency (hydropriming) and excess (above 0.01% B) of B were detrimental for mungbean growth and productivity. The cultivar ‘NM-2016’ had significantly (p≤0.05) higher yield due to prominent increase in yield related traits with 0.01% B priming as compared to ‘NM-2011’. In conclusion, B seed priming (0.01% B) seemed a feasible choice for improving mungbean growth, yield related traits and grain-B concentration of mungbean on Yermosols

Development of ambient-cured geopolymer mortars with construction and demolition waste-based materials

YesDegrading infrastructure and applications of structural demolition create tremendous amounts of construction and demolition waste (CDW) all around the world. To address this issue in an effective way, recycling CDW in a most appropriate way has become a global concern in recent years. To this end, this study focused on the valorization of CDW-based materials such as tile, bricks, glass, and concrete in the development of geopolymer mortars. CDWs were first collected from demolition zone and then subjected to crushing-milling operations. To investigate the influence of slag (S) addition to the mixtures, 20% S substituted mixture designs were also made. Fine recycled concrete aggregates (FRCA) obtained from crushing and sieving of the waste concrete were used as the aggregate. A series of mixtures were designed using different proportions of three distinct alkali activators such as sodium hydroxide (NaOH), sodium silicate (Na2SiO3), and calcium hydroxide (CH; Ca(OH)2). To improve their applicability, the mixtures were left to cure at room temperature rather than the heat curing which is frequently applied in the literature. After 28 days ambient curing, the 100% CDW-based geopolymer mortar activated with three different activators reached a compressive strength of 31.6 MPa, whereas the 20% S substituted geopolymer mortar showed a 51.9 MPa compressive strength. While the geopolymer mortars activated with only NaOH exhibited poor performance, it was found that the use of Na2SiO3 and CH improved the mechanical performance. Main geopolymerization products were related to NASH (Sodium alumino-silicate hydrate), CASH (Calcium alumino-silicate hydrate), and C(N)ASH gel formations. Results demonstrated that mixed CDWs can be employed in the manufacturing geopolymers, making them potential alternatives to Portland cement (PC)-based systems by being eco-friendly, energy-efficient, and comparable in compressive strength.This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 894100

Integrating Lean Six Sigma and discrete-event simulation for shortening the appointment lead-time in gynecobstetrics departments: a case study

Long waiting time to appointment may be a worry for pregnant women, particularly those who need perinatology consultation since it could increase anxiety and, in a worst case scenario, lead to an increase in fetal, infant, and maternal mortality. Treatment costs may also increase since pregnant women with diverse pathologies can develop more severe complications. As a step towards improving this process, we propose a methodological approach to reduce the appointment lead-time in outpatient gynecobstetrics departments. This framework involves combining the Six Sigma method to identify defects in the appointment scheduling process with a discrete-event simulation (DES) to evaluate the potential success of removing such defects in simulation before we resort to changing the real-world healthcare system. To do these, we initially characterize the gynecobstetrics department using a SIPOC diagram. Then, six sigma performance metrics are calculated to evaluate how well the department meets the government target in relation to the appointment lead-time. Afterwards, a cause-and-effect analysis is undertaken to identify potential causes of appointment lead-time variation. These causes are later validated through ANOVA, regression analysis, and DES. Improvement scenarios are next designed and pretested through computer simulation models. Finally, control plans are deployed to maintain the results achieved through the implementation of the DES-Six sigma approach. The aforementioned framework was validated in a public gynecobstetrics outpatient department. The results revealed that mean waiting time decreased from 6.9 days to 4.1 days while variance passed from 2.46 days2 to 1.53 days2

Development of ambient-cured geopolymer mortars with construction and demolition waste-based materials

YesDegrading infrastructure and applications of structural demolition create tremendous amounts of construction and demolition waste (CDW) all around the world. To address this issue in an effective way, recycling CDW in a most appropriate way has become a global concern in recent years. To this end, this study focused on the utilization of CDW-based materials such as hollow brick (HB), red clay brick (RCB), roof tile (RT), glass (G) and concrete (C) in the production of geopolymer mortars. These materials were first collected from an urban transformation area and then subjected to an identical two-step crushing-milling procedure to provide sufficient fineness for geopolymerization. To investigate the influence of blast furnace slag (S) addition to the CDW-based mixtures, 20% S substituted mixture designs were also made. Fine recycled concrete aggregates (FRCA) obtained from crushing and sieving of the waste concrete were used as the aggregate. A series of mixtures were designed using different proportions of three distinct alkali activators such as sodium hydroxide (NaOH), sodium silicate (Na2SiO3) and calcium hydroxide (Ca[OH]2). To improve their applicability, the mixtures were left to cure at room temperature rather than the heat curing which is frequently applied in the literature. After 28 days of ambient curing, the 100% CDW-based geopolymer mortar activated with three different activators reached a compressive strength of 31.6 MPa, whereas the 20% S substituted geopolymer mortar achieved a compressive strength of 51.9 MPa. While the geopolymer mortars activated with only NaOH exhibited poor performance, it was found that the use of Na2SiO3 and Ca(OH)2 improved the compressive strength. Main geopolymerization products were related to NASH, CASH, and C(N)ASH gel formations. Our results demonstrated that mixed CDW-based materials can be employed in the manufacturing geopolymers, making them potential alternatives to Portland cement-based systems by being eco-friendly, energy-efficient, and comparable in compressive strength.This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 894100

Characterization and life cycle assessment of geopolymer mortars with masonry units and recycled concrete aggregates assorted from construction and demolition waste

YesDeveloping a fast, cost-effective, eco-friendly solution to recycle large amounts of construction and demolition waste (CDW) generated from construction industry-related activities and natural disasters is crucial. The present investigation aims to offer a solution for repurposing CDW into building materials suitable for accelerated construction and housing in developing countries and disaster-prone areas. Feasibility of recycled concrete aggregate (RCA) inclusion in geopolymer mortars constituted entirely from CDW (masonry elements) was investigated via an environmental impact-oriented approach by addressing the composition related key parameters. Mechanical performance was evaluated through compressive strength tests, and scanning electron microscope (SEM) imaging with line mapping analyses were carried out to monitor the interfacial transition zone (ITZ) properties. To investigate the environmental impacts of the geopolymer mortars and highlight the advantages over Portland cement-based mortars, a cradle-to-gate life cycle assessment (LCA) was performed. Findings revealed that roof tile (RT)-based geopolymer mortars mainly exhibited better strength performance due to their finer particle size. Mixtures activated with 15 M NaOH solution and cured at 105 °C achieved an average compressive strength above 55 MPa. RCA size was the most influential parameter on compressive strength, and a smaller maximum RCA size significantly increased the compressive strength. Microstructural analyses showed that the ITZ around smaller RCAs was relatively thinner, resulting in better compressive strength results. LCA proved that CDW-based geopolymer mortars provide the same compressive strength with around 60% less CO2 emissions and similar energy consumption compared to Portland cement-based mortars.This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 894100. The authors also wish to acknowledge the support of the Scientific and Technical Research Council of Turkey (TUBITAK) provided under project: 117M44

Roles of pathway-based models and their contribution to the redesign of health-care systems

Care pathways provide a practical analytical tool that encompasses both organizational efficiency and individual patients'care. In the UK, constructing the care pathway has been a recommended starting point for the re-design of health-caresystems. This paper examines the re-design cycle for health-care systems and looks at the role of pathway-basedmodels in the design and operation phases of the cycle. In addition, the models provide further benefits for communicatingrecommended practice and audit of care and outcomes. The models span the classic care pathway with extensions tosimulation modelling. An example of the use of care pathways in the re-design of an emergency department is used forillustration. This study shows the role of pathway models as: a tool for re-design, a catalyst for enhancing communicationand as a repository for audit information. The final role of a tool for modelling contingencies was not implemented. Fromthe example it can be concluded that sophisticated models can be useful, in some applications; however, the simplerapproaches may often be the best, offering rapid, transparent recommendations based on a multidisciplinary approach

Protective efficiacy of taurine against pulmonary edema progression: experimental study

Re-expansion pulmonary edema (RPE) is an acute, rare and potentially lethal complication [1,2]. Its beginning is sudden and dramatic. The mechanism is not yet fully understood [1]. Some authors suggest that it may occur after rapid re-inflation of a collapsed lung [1]. It was reported by other authors that it may relate to surfactant depletion or may result from hypoxic capillary damage, leading to increased capillary permeability [1,3]. In RPE, unilateral lung injury is initiated by cytotoxic oxygen metabolites and temporally associated with an influx of polymorphonuclear neutrophils [1]. These toxic oxygen products are the results of re-oxygenation of a collapsed lung. Treatment of re-expansion pulmonary edema is basically preventive [4]