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A Clustered Overflow Configuration of Inpatient Beds in Hospitals
Problem Definition: The shortage of inpatient beds is a major cause of delays and cancellations in many hospitals. It may also lead to patients being admitted to inappropriate wards, whereby resulting in a lower quality of care and a longer length of stay.
Academic/Practical Relevance: Investment in additional beds is not always feasible. Instead, new and creative solutions for a more efficient use of existing resources must be sought.
Methodology: We propose a new configuration of inpatient beds which we call the clustered overflow configuration. In this configuration, patients who are denied admission to their primary wards as a result of beds being fully occupied are admitted to overflow wards, with each designated to serve overflows from a certain subset of specialties and providing the same quality of care as in primary wards. We propose two different formulations for partitioning and bed allocation in the proposed configuration: one minimizing the sum of average daily costs of turning patients away and nursing teams, and another minimizing the numbers turned away subject to nursing cost falling below a given threshold. We heuristically solve instances from both formulations.
Results: Applying the models to real data shows that the configurations obtained from our models compare very well with the other configurations proposed in the literature, provided that
patients' willingness to wait is relatively short.
Managerial Implications: The proposed configuration provides the combined advantages of the dedicated configuration, wherein patients are only admitted to their primary wards, and the exible configuration, in which all specialties share a single ward. On the other hand, it restricts the adverse impacts of pooling and minimizes cross-training costs through appropriate partitioning and bed allocation. As such, it serves as a viable alternative to existing inpatient configurations
A Compromise between Neutrino Masses and Collider Signatures in the Type-II Seesaw Model
A natural extension of the standard gauge
model to accommodate massive neutrinos is to introduce one Higgs triplet and
three right-handed Majorana neutrinos, leading to a neutrino mass
matrix which contains three sub-matrices ,
and . We show that three light Majorana neutrinos (i.e., the mass
eigenstates of , and ) are exactly massless in this
model, if and only if
exactly holds. This no-go theorem implies that small but non-vanishing neutrino
masses may result from a significant but incomplete cancellation between
and terms in the Type-II
seesaw formula, provided three right-handed Majorana neutrinos are of TeV and experimentally detectable at the LHC. We propose three simple
Type-II seesaw scenarios with the flavor symmetry to
interpret the observed neutrino mass spectrum and neutrino mixing pattern. Such
a TeV-scale neutrino model can be tested in two complementary ways: (1)
searching for possible collider signatures of lepton number violation induced
by the right-handed Majorana neutrinos and doubly-charged Higgs particles; and
(2) searching for possible consequences of unitarity violation of the neutrino mixing matrix in the future long-baseline neutrino oscillation
experiments.Comment: RevTeX 19 pages, no figure
A review of the Cenozoic stratigraphy and glacial history of the Lambert Graben - Prydz Bay region, East Antarctica
The Cenozoic glacial history of East Antarctica is recorded in part by the stratigraphy of the Prydz Bay - Lambert Graben region. The glacigene strata and associated erosion surfaces record at least 10 intervals of glacial advance (with accompanying erosion and sediment compaction), and more than 17 intervals of glacial retreat (enabling open marine deposition in Prydz Bay and the Lambert Graben). The number of glacial advances and retreats is considerably less than would be expected from Milankovitch frequencies due to the incomplete stratigraphic record. Large advances of the Lambert Glacier caused progradation of the continental shelf edge. At times of extreme glacial retreat, marine conditions reached > 450 km inland from the modern ice shelf edge. This review presents a partial reconstruction of Cenozoic glacial extent within Prydz Bay and the Lambert Graben that can be compared to eustatic sea-level records from the southern Australian continental margin
Potential and current distribution in strongly anisotropic Bi(2)Sr(2) CaCu(2)O(8) single crystals at current breakdown
Experiments on potential differences in the low-temperature vortex solid
phase of monocrystalline platelets of superconducting Bi(2)Sr(2)CaCu(2)O(8)
(BSCCO) subjected to currents driven either through an "ab" surface or from one
such surface to another show evidence of a resistive/nonresistive front moving
progressively out from the current contacts as the current increases. The depth
of the resistive region has been measured by a novel in-depth voltage probe
contact. The position of the front associated with an injection point appears
to depend only on the current magnitude and not on its withdrawal point. It is
argued that enhanced nonresistive superconducting anisotropy limits current
penetration to less than the London length and results in a flat rectangular
resistive region with simultaneous "ab" and "c" current breakdown which moves
progressively out from the injection point with increasing current.
Measurements in "ab" or "c" configurations are seen to give the same
information, involving both ab-plane and c-axis conduction properties.Comment: 9 pages, 13 figures, typo error corrected, last section was refine
CantĂș syndrome with coexisting familial pituitary adenoma
Context: Pseudoacromegaly describes conditions with an acromegaly related physical appearance without abnormalities in the growth hormone (GH) axis. Acromegaloid facies, together with hypertrichosis, are typical manifestations of CantĂș syndrome. Case description: We present a three-generation family with 5 affected members, with marked acromegaloid facies and prominent hypertrichosis, due to a novel missense variant in the ABCC9 gene. The proband, a 2-year-old girl, was referred due to marked hypertrichosis, noticed soon after birth, associated with coarsening of her facial appearance. Her endocrine assessment, including of the GH axis, was normal. The proband's father, paternal aunt, and half-sibling were referred to the Endocrine department for exclusion of acromegaly. Although the GH axis was normal in all, two subjects had clinically non-functioning pituitary macroadenomas, a feature which has not previously been associated with CantĂș syndrome. Conclusions: Activating mutations in the ABCC9 and, less commonly, KCNJ8 genesârepresenting the two subunits of the ATP-sensitive potassium channelâhave been linked with CantĂș syndrome. Interestingly, minoxidil, a well-known ATP-sensitive potassium channel agonist, can cause a similar phenotype. There is no clear explanation why activating this channel would lead to acromegaloid features or hypertrichosis. This report raises awareness for this complex condition, especially for adult or pediatric endocrinologists who might see these patients referred for evaluation of acromegaloid features or hirsutism. The link between CantĂș syndrome and pituitary adenomas is currently unclear
In Vivo Measurement of Cerebral Mitochondrial Metabolism Using Broadband Near Infrared Spectroscopy Following Neonatal Stroke
Neonatal stroke presents with features of encephalopathy and can result in significant morbidity and mortality. We investigated the cerebral metabolic and haemodynamic changes following neonatal stroke in a term infant at 24 h of life. Changes in oxidation state of cytochrome-c-oxidase (oxCCO) concentration were monitored along with changes in oxy- and deoxy- haemoglobin using a new broadband near-infrared spectroscopy (NIRS) system. Repeated transient changes in cerebral haemodynamics and metabolism were noted over a 3-h study period with decrease in oxyhaemoglobin (HbO2), deoxy haemoglobin (HHb) and oxCCO in both cerebral hemispheres without significant changes in systemic observations. A clear asymmetry was noted in the degree of change between the two cerebral hemispheres. Changes in cerebral oxygenation (measured as HbDiff=HbO2-HHb) and cerebral metabolism (measured as oxCCO) were highly coupled on the injured side of the brain
The merger that led to the formation of the Milky Way's inner stellar halo and thick disk
The assembly process of our Galaxy can be retrieved using the motions and
chemistry of individual stars. Chemo-dynamical studies of the nearby halo have
long hinted at the presence of multiple components such as streams, clumps,
duality and correlations between the stars' chemical abundances and orbital
parameters. More recently, the analysis of two large stellar surveys have
revealed the presence of a well-populated chemical elemental abundance
sequence, of two distinct sequences in the colour-magnitude diagram, and of a
prominent slightly retrograde kinematic structure all in the nearby halo, which
may trace an important accretion event experienced by the Galaxy. Here report
an analysis of the kinematics, chemistry, age and spatial distribution of stars
in a relatively large volume around the Sun that are mainly linked to two major
Galactic components, the thick disk and the stellar halo. We demonstrate that
the inner halo is dominated by debris from an object which at infall was
slightly more massive than the Small Magellanic Cloud, and which we refer to as
Gaia-Enceladus. The stars originating in Gaia-Enceladus cover nearly the full
sky, their motions reveal the presence of streams and slightly retrograde and
elongated trajectories. Hundreds of RR Lyrae stars and thirteen globular
clusters following a consistent age-metallicity relation can be associated to
Gaia-Enceladus on the basis of their orbits. With an estimated 4:1 mass-ratio,
the merger with Gaia-Enceladus must have led to the dynamical heating of the
precursor of the Galactic thick disk and therefore contributed to the formation
of this component approximately 10 Gyr ago. These findings are in line with
simulations of galaxy formation, which predict that the inner stellar halo
should be dominated by debris from just a few massive progenitors.Comment: 19 pages, 8 figures. Published in Nature in the issue of Nov. 1st,
2018. This is the authors' version before final edit
Radiopaque drug-eluting embolisation beads as fiducial markers for stereotactic liver radiotherapy
OBJECTIVE: To determine the feasibility of using radiopaque (RO) beads as direct tumour surrogates for image-guided radiotherapy (IGRT) in patients with liver tumours after transarterial chemoembolisation (TACE). METHODS: A novel vandetanib-eluting RO bead was delivered via TACE as part of a first-in-human clinical trial in patients with either hepatocellular carcinoma or liver metastases from colorectal cancer. Following TACE, patients underwent simulated radiotherapy imaging with 4-dimensional computed tomography (4D-CT) and cone-beam CT (CBCT) imaging. RO beads were contoured using automated thresholding, and feasibility of matching between the simulated radiotherapy planning dataset (AVE-IP image from 4D data) and CBCT scans assessed. Additional kV, MV, helical CT and CBCT images of RO beads were obtained using an in-house phantom. Stability of RO bead position was assessed by comparing 4D-CT imaging to CT scans taken 6-20 days following TACE. RESULTS: Eight patients were treated and 4D-CT and CBCT images acquired. RO beads were visible on 4D-CT and CBCT images in all cases and matching successfully performed. Differences in centre of mass of RO beads between CBCT and simulated radiotherapy planning scans (AVE-IP dataset) were: 2.0âmm mediolaterally, 1.7âmm anteroposteriorally, 3.5âmm craniocaudally. RO beads in the phantom were visible on all imaging modalities assessed. RO bead position remained stable up to 29 days post-TACE. CONCLUSION: RO beads are visible on IGRT imaging modalities, showing minimal artefact. They can be used for on-set matching with CBCT and remain stable over time. ADVANCES IN KNOWLEDGE: The role of RO beads as fiducial markers for stereotactic liver radiotherapy is feasible and warrants further exploration as a combination therapy approach
Variations in Pastorsâ Perceptions of the Etiology of Depression By Race and Religious Affiliation
Depression is a major, preventable problem in the United States, yet relatively few individuals seek care in traditional mental health settings. Instead, many choose to confide in friends, family, or clergy. Thus, it is important to discover how clergy perceive the definition of and etiology of depression. The author conducted a survey with 204 Protestant pastors in California. Multinomial logistic regression revealed a statistically significant difference in how depression is perceived based on race. Caucasian American pastors more readily agreed with the statement that depression was a biological mood disorder, while African American pastors more readily agreed that depression was a moment of weakness when dealing with trials and tribulations. Also, mainline Protestants more frequently disagreed with statements about spiritual causes of depression than Pentecostals and non-denominational pastors. The findings suggest that racial and religious affiliational influences shape how pastors view, and ultimately intervene, in the area of depression
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