Creating short-term volume flexibility in healthcare capacity management

It is well-known that unpredictable variations in supply and demand capacity in healthcare systems create the need for flexibility. The main tools used to create short-term volume flexibility in the healthcare system include overtime, temporary staff from internal calling lists, moving staff across units, internal staffing pools, external staffing agencies, queuing patients, and purchasing care from external providers. We study the creation of short-term volume flexibility in healthcare systems to manage short-term capacity losses. A questionnaire was developed and distributed among department managers in the Region V\ue4stra G\uf6taland healthcare system. Respondents were asked to what extent they used each tool to create short-term flexibility in capacity. Data were analyzed using multiple regression analysis. Several significant tendencies were found, including that acute units use overtime and internal staffing pools to a larger extent, and patient queues and external providers to a smaller extent than planned units. The prerequisites and required managerial approaches used to manage aggregate capacity in the system efficiently differ substantially between different parts of the system. These differences must be addressed when, for example, capacity pools are considered. These results serve as a steppingstone towards a more thorough understanding of efficient capacity management in healthcare systems

Hospital Staffing during the COVID-19 Pandemic in Sweden

Staff management challenges in the healthcare system are inherently different during pandemic conditions than under normal circumstances. Surge capacity must be rapidly increased, particularly in the intensive care units (ICU), to handle the increased pressure, without depleting the rest of the system. In addition, sickness or fatigue among the staff can become a critical issue. This study explores the lessons learned by first- and second-line managers in Sweden with regard to staff management during the COVID-19 pandemic. A mixed-methods approach was used, with preliminary qualitative interview (n = 38) and principal quantitative questionnaire (n = 272) studies, based on principal component and multiple regression analyses. The results revealed that the pandemic created four types of challenges relating to staff management: staff movement within hospitals; addition of external staff; addition of hours for existing staff through overtime and new shift schedules; and avoidance of lost hours due to sickness or fatigue. Furthermore, the effects of these managerial challenges were different in the first wave than in later waves, and they significantly differed between the ICU and other units. Therefore, a greater proactive focus on staff management would be beneficial in future pandemic situations

The Limits of Individual Identification from Sample Allele Frequencies: Theory and Statistical Analysis

It was shown recently using experimental data that it is possible under certain conditions to determine whether a person with known genotypes at a number of markers was part of a sample from which only allele frequencies are known. Using population genetic and statistical theory, we show that the power of such identification is, approximately, proportional to the number of independent SNPs divided by the size of the sample from which the allele frequencies are available. We quantify the limits of identification and propose likelihood and regression analysis methods for the analysis of data. We show that these methods have similar statistical properties and have more desirable properties, in terms of type-I error rate and statistical power, than test statistics suggested in the literature

Constraining the effective action by a method of external sources

We propose a novel method of evaluating the effective action, wherein the physical one- and two-point functions are obtained in the limit of non-vanishing external sources. We illustrate the self-consistency of this method by recovering the usual 2PI effective action due to Cornwall, Jackiw and Tomboulis, differing only by the fact that the saddle-point evaluation of the path integral is performed along the extremal quantum, rather than classical, path. As such, this approach is of particular relevance to situations where the dominant quantum and classical paths are non-perturbatively far away from one-another. A pertinent example is the decay of false vacua in radiatively-generated potentials, as may occur for the electroweak vacuum of the Standard Model. In addition, we describe how the external sources may instead be chosen so as to yield the two-particle-point-irreducible (2PPI) effective action of Coppens and Verschelde. Finally, in the spirit of the symmetry-improved effective action of Pilaftsis and Teresi, we give an example of how the external sources can be used to preserve global symmetries in truncations of the 2PI effective action. Specifically, in the context of an O(2) model with spontaneous symmetry breaking, we show that this approach allows the Hartree–Fock approximation to be re-organized, such that the Goldstone boson remains massless algebraically in the symmetry-broken phase and we obtain the correct second-order thermal phase transition

Sarcoidosis of the hypothalamus and pituitary stalk

We report a rare case of sarcoidosis of the hypothalamic and suprasellar region, with clinical course and the magnetic resonance imaging follow-up

Quantum teleportation on a photonic chip

Quantum teleportation is a fundamental concept in quantum physics which now finds important applications at the heart of quantum technology including quantum relays, quantum repeaters and linear optics quantum computing (LOQC). Photonic implementations have largely focussed on achieving long distance teleportation due to its suitability for decoherence-free communication. Teleportation also plays a vital role in the scalability of photonic quantum computing, for which large linear optical networks will likely require an integrated architecture. Here we report the first demonstration of quantum teleportation in which all key parts - entanglement preparation, Bell-state analysis and quantum state tomography - are performed on a reconfigurable integrated photonic chip. We also show that a novel element-wise characterisation method is critical to mitigate component errors, a key technique which will become increasingly important as integrated circuits reach higher complexities necessary for quantum enhanced operation.Comment: Originally submitted version - refer to online journal for accepted manuscript; Nature Photonics (2014

Proteomic analysis of the cerebrospinal fluid of patients with Creutzfeldt-Jakob disease

So far, only the detection of 14-3-3 proteins in cerebrospinal fluid (CSF) has been accepted as diagnostic criterion for Creutzfeldt-Jakob disease (CJD). However, this assay cannot be used for screening because of the high rate of false-positive results, whereas patients with variant CJD are often negative for 14-3-3 proteins. The aim of this study was to compare the spot patterns of CSF by 2-dimensional polyacrylamide gel electrophoresis (2D-PAGE) to search for a CJD-specific spot pattern. We analyzed the CSF of 28 patients {[}11 CJD, 9 Alzheimer's disease ( AD), 8 nondemented controls (NDC)] employing 2D-PAGE which was optimized for minimal volumes of CSF (0.1 ml; 7-cm strips). All samples were run at least three times, gels were silver stained and analyzed by an analysis software and manually revised. We could consistently match 268 spots which were then compared between all groups. By the use of 5 spots, we were able to differentiate CJD from AD or NDC with a sensitivity of 100%. CJD could also be distinguished from both groups by using a heuristic clustering algorithm of 2 spots. We conclude that this proteomic approach can differentiate CJD from other diseases and may serve as a model for other neurodegenerative diseases. Copyright (C) 2007 S. Karger AG, Basel

Risk of latent tuberculosis infection in children living in households with tuberculosis patients: a cross sectional survey in remote northern Lao People's Democratic Republic

ABSTRACT: BACKGROUND: Tuberculosis is highly prevalent in Laos (289 per 100,000). We evaluated the risk of latent tuberculosis infection (LTBI) among children (0-15 years) living with tuberculosis patients in rural northern Laos. METHODS: In a cross sectional survey of 30 randomly selected villages, 72 tuberculosis patients were traced and their 317 contacts (148 were children) investigated using a questionnaire, a tuberculin skin tests (positive: <= 10mm), a 3-day sputum examination for acid-fast bacilli (AFB), and chest radiography. RESULTS: None of the 148 contact-children received prophylaxis, one had cervical tuberculosis; the risk for LTBI was 31.0%. Awareness of the infectiousness of tuberculosis was low among patients (31%) and their contacts (31%), and risky behavior was common. After multivariate logistic analysis, increased LTBI was found in children with contact with sputum positive adults (OR: 3.3, 95% CI: 1.4-7.7), patients highly positive sputum prior to treatment (AFB <2+; OR: 4.7, 95% CI: 1.7-12.3), and living in ethnic minorities (OR: 5.4, 95% CI: 2.2-13.6). CONCLUSION: The study supports the importance of contact tracing in remote settings with high TB prevalence. Suggestions to improve the children's detection rate, the use of existing guidelines, chemoprophylaxis of contact-children and the available interventions in Laos are discussed. Improving education and awareness of the infectiousness of TB in patients is urgently needed to reduce TB transmissio