Improving Patient Flow Through Axiomatic Design of Hospital Emergency Departments

Organised by: Cranfield UniversityIn response to crowding in hospital emergency departments (ED), efforts have been made to increase patient flow through the Fast Track (FT). The use of FT, however, has not always been accompanied by an increase in the overall patient flow, sometimes leaving the FT underutilized. We find that this is mainly caused by the current practice of assigning patients to FT based only on the Emergency Severity Index. One index for two functional requirements results in a coupling between prioritizing of patients and encouraging the fast flow of them. By introducing a new index for patient flow, we could uncouple this design problem and significantly decrease the overall patient waiting time (~50%) compared to that of the existing use of FT.Mori Seiki – The Machine Tool Compan

Theological Education in Context: A Pilot Extension Program for the Seventh-day Adventist Church in Rwanda

Problem One of the most important concerns that presents itself to the Adventist Church in Rwanda is how to adequately cope with the rapid growth of new members. There are too few pastors equipped to care for the growing membership. It was the purpose of the present pilot project to design a strategy that would provide theological education and training for pastors currently employed and training for those mature church leaders who are motivated to improve their leadership abilities and skills. Method Theological Education by Extension (TEE) was the proposed solution to the problem. A two-tier approach was suggested. The first-tier certificate level would be viewed as professional upgrading/continuing education training. It would accommodate all those needing and desiring training but not aspiring to attain the two-year intermediate-level diploma. The second-tier diploma level would be directed specifically toward the attainment of a two-year intermediate-level diploma. This level would accommodate pastors lacking the ministerial diploma and those mature leaders who are the actual leaders of the rural churches, who need and desire theological training. Results Pastors and the newly trained lay leaders would be well equipped to care for their churches within the larger regional districts. As TEE graduates would function in their local churches, there would be a lessening of national church leadership deficiencies and a corresponding increase in competence. TEE graduates would be training the other members and imparting to them the knowledge they have gained. Both the TEE graduates and the members would be stimulated to higher learning levels. In addition, spiritual growth would be accelerated through increased participation of the newly trained members. Conclusions The TEE program would integrate national leaders into teaching and administrative positions from the outset of the project. Dependence upon expatriate staff would reduce with each B.A.-level graduating class from AUCA. Extension graduates would be evaluated against their residence counterparts in secondary school. Regular monitoring of the program would insure that the proper academic standards would be maintained. The proposed strategy would give an overall framework and direction for meeting the present and future educational needs of church leaders within the Rwanda Union Mission

Finite element modelling of blowouts in compressed air tunnels

This study develops criteria for predicting blowouts in compressed air tunnels through an integrated design approach using empirical laboratory test data in a finite element model. Compressed air tunnelling is first reviewed in the context of temporary works, and the relative merits of compressed air as a support system are compared with that of other methods commonly used. Design methods for estimating the stability of tunnel faces in general are discussed along with the particular problems of stability against a blowout. The various mechanical processes that contribute to the formation of blowouts are then discussed, including unsaturated shear strength, desaturation processes, and seepage forces. A plausible mechanism which can be used analytically in studying blowouts is presented, whereby the How of air desaturates the soil causing mechanical failure, which is the result of serious reductions in effective stress due to increased pore pressures and seepage forces. The failure self propagates with changes in the soil properties. The permeability of soils with respect to compressible fluids is a complex property not only dependent on the soil properties but on fluid properties and pressures as well. Permeability with respect to air is presented as an empirical power function of pressure. Laboratory methods of measuring permeability with respect to air is discussed along with a description of all relevant apparatus. A finite element package developed by NAg software was used as the basic model of potential flow. The model was adapted to account for the progressive desaturation of the soil and its influence on permeability. The model was also modified to account for compressible flow using the Rayleigh-Janzen method of linearizing the compressible potential equation. The model was run for subaqueous tunnels of various diameters in sands of different silt contents beneath rivers of various depth. The amount of excess air pressure was varied and provision was made for a forepoling hood on the shield. Results show compressible flow and incompressible flow are essentially the same except at the crown of the tunnel face. Blowouts demonstrate the unique feature of propagating from the surface down as well as from the tunnel up, a phenomenon which is attributed to high seepage forces and negligible total stresses at the ground surface. The overall factor of safety is most sensitive under shallow rivers, and critical tunnel depth is independent of river depth. The data satisfy a linear relationship between critical depth and tunnel diameter, with smaller diameter tunnels requiring more cover relative to tunnel diameter than large diameter tunnels. The effect of a hood is most significant at high air pressures and in clean sands. The critical tunnel depth is directly proportional to air pressure and is slightly more sensitive for small tunnels than for large tunnels. The critical depth generally is not influenced by silt content. A significant exception is a large drop in critical depth for silt contents between 5% and 10%.The results of the study were summed up in a set of nomographs to provide practical aid to the design of tunnels against blowouts. They can be used to estimate safe cover depths and operating pressures, or to estimate factors of safety for a given set of operating conditions

The COINS Sample - VLBA Identifications of Compact Symmetric Objects

We present results of multifrequency polarimetric VLBA observations of 34 compact radio sources. The observations are part of a large survey undertaken to identify CSOs Observed in the Northern Sky (COINS). Compact Symmetric Objects (CSOs) are of particular interest in the study of the physics and evolution of active galaxies. Based on VLBI continuum surveys of ~2000 compact radio sources, we have defined a sample of 52 CSOs and CSO candidates. In this paper, we identify 18 previously known CSOs, and introduce 33 new CSO candidates. We present continuum images at several frequencies and, where possible, images of the polarized flux density and spectral index distributions for the 33 new candidates and one previously known but unconfirmed source. We find evidence to support the inclusion of 10 of these condidates into the class of CSOs. Thirteen candidates, including the previously unconfirmed source, have been ruled out. Eleven sources require further investigation. The addition of the 10 new confirmed CSOs increases the size of this class of objects by 50%.Comment: 24 pages, incl 8 figures. Accepted for publication in ApJ. Figure quality degraded in the interests of space, full gzipped PS version also available at http://www.ee.nmt.edu/~apeck/papers

Monitoring the Bi-Directional Relativistic Jets of the Radio Galaxy 1946+708

We report on a multi-frequency, multi-epoch campaign of Very Long Baseline Interferometry observations of the radio galaxy 1946+708 using the VLBA and a Global VLBI array. From these high-resolution observations we deduce the kinematic age of the radio source to be $\sim$4000 years, comparable with the ages of other Compact Symmetric Objects (CSOs). Ejections of pairs of jet components appears to take place on time scales of 10 years and these components in the jet travel outward at intrinsic velocities between 0.6 and 0.9 c. From the constraint that jet components cannot have intrinsic velocities faster than light, we derive H_0 > 57 km s^-1 Mpc^-1 from the fastest pair of components launched from the core. We provide strong evidence for the ejection of a new pair of components in ~1997. From the trajectories of the jet components we deduce that the jet is most likely to be helically confined, rather than purely ballistic in nature.Comment: 20 pages, 8 figures, accepted to Ap