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

Chain store taxation

This item was digitized by the Internet Archive

Relationship of the junior high school curriculum to the primary functions of the junior high school

This item was digitized by the Internet Archive. Thesis (Ed.M.)--Boston Universityhttps://archive.org/details/relationshipofju00obr

Preparing residents for family practice: role of an integrated “Triple C” curriculum

Background: There is limited understanding of the impact of Triple C competency-based curriculums on the preparation of residents for family practice. This paper describes a competency-based curriculum within an integrated longitudinal block design and presents preliminary evaluation data on the impact of this curriculum on preparedness for family practice. Methods: First and second year family medicine residents were surveyed as a component of a year-end program evaluation to assess the extent to which the residency program is preparing them to engage in a variety of practice domains, the likelihood that they would engage in these domains, and the extent to which this residency program is comprehensive, relevant to their development as a family physician, and promotes interprofessional practice. Results: Residents perceived themselves as prepared to engage in most practice areas and their intentions to engage in various practice domains were positively correlated to their ratings of preparedness. Ratings reflected that residents perceived this program as comprehensive and relevant to their development as a family physician and they perceived a high degree of encouragement for interprofessional practice. Conclusions: This study provides some preliminary evidence that an integrated competency-based curriculum, with an emphasis on interprofessional practice has the potential to effectively prepare residents for practice in family medicine.

Persistence of chimera states and the challenge for synchronization in real-world networks

The emergence of order in nature manifests in different phenomena, with synchronization being one of the most representative examples. Understanding the role played by the interactions between the constituting parts of a complex system in synchronization has become a pivotal research question bridging network science and dynamical systems. Particular attention has been paid to the emergence of chimera states, where subsets of synchronized oscillations coexist with asynchronous ones. Such coexistence of coherence and incoherence is a perfect example where order and disorder can persist in a long-lasting regime. Although considerable progress has been made in recent years to understand such coherent and (coexisting) incoherent states, how they manifest in real-world networks remains to be addressed. Based on a symmetry-breaking mechanism, in this paper, we shed light on the role that non-normality, a ubiquitous structural property of real networks, has in the emergence of several diverse dynamical phenomena, e.g., amplitude chimeras or oscillon patterns. Specifically, we demonstrate that the prevalence of source or leader nodes in networks leads to the manifestation of phase chimera states. Throughout the paper, we emphasize that non-normality poses ongoing challenges to global synchronization and is instrumental in the emergence of chimera states

NORMAN AND GRECIAN: A COMPARATIVE ARCHAEOLOGICAL SITE FORMATION ANALYSIS OF TWO STEEL-HULLED GREAT LAKES BULK CARRIERS IN LAKE HURON

Thunder Bay National Marine Sanctuary (TBNMS) in Alpena, Michigan contains the remains of approximately 200 shipwrecks. Located within the sanctuary are two vessels, Norman (1890-1895) and Grecian (1891-1906). Both built by Globe Iron Works in the early 1890s, they present an opportunity for a comparative archaeological site formation analysis study. Using historical and archaeological data from Norman and Grecian, several 3D models were created to showcase how they ships transformed as shipwreck sites. Model data is used to communicate the various environmental and anthropogenic factors that have altered these wrecks through time