Meeting the four-hour deadline in an A&E department

This is the print version of the Article. The official published version can be obtained from the link below - Copyright @ 2011 EmeraldPurpose – Accident and emergency (A&E) departments experience a secondary peak in patient length of stay (LoS) at around four hours, caused by the coping strategies used to meet the operational standards imposed by government. The aim of this paper is to build a discrete-event simulation model that captures the coping strategies and more accurately reflects the processes that occur within an A&E department. Design/methodology/approach – A discrete-event simulation (DES) model was used to capture the A&E process at a UK hospital and record the LoS for each patient. Input data on 4,150 arrivals over three one-week periods and staffing levels was obtained from hospital records, while output data were compared with the corresponding records. Expert opinion was used to generate the pathways and model the decision-making processes. Findings – The authors were able to replicate accurately the LoS distribution for the hospital. The model was then applied to a second configuration that had been trialled there; again, the results also reflected the experiences of the hospital. Practical implications – This demonstrates that the coping strategies, such as re-prioritising patients based on current length of time in the department, employed in A&E departments have an impact on LoS of patients and therefore need to be considered when building predictive models if confidence in the results is to be justified. Originality/value – As far as the authors are aware this is the first time that these coping strategies have been included within a simulation model, and therefore the first time that the peak around the four hours has been analysed so accurately using a model

Sub 1GHz M2M communications standardization: The advancement in white space utilization for enhancing the energy efficiency

Energy efficiency of machine to machine (M2M) communications terminals is one of the major design goals of M2M networks, resulting from anticipated over 50 billion M2M communications devices to be deployed into the networks by 2020 [1]. The stakeholders in the M2M communications have observed that it will be environmental and economic catastrophic to deploy M2M communications devices without solving the energy inefficiencies associated with wireless devices that are expected to be used for M2M communications. In view of the aforementioned energy challenge, sub 1GHz spectra have provided enormous opportunities that can be energy efficient, cost effective and coverage efficiency which can be utilized for M2M communications. This work will evaluate the energy efficiency benefits of optimized Sub 1GHz spectra for M2M communications

Penehcyclidine and awareness during anaesthesia: caution with zero numerators

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/96392/1/anae12114.pd

Lack of involvement of known DNA methyltransferases in familial hydatidiform mole implies the involvement of other factors in establishment of imprinting in the human female germline

BACKGROUND: Differential methylation of the two alleles is a hallmark of imprinted genes. Correspondingly, loss of DNA methyltransferase function results in aberrant imprinting and abnormal post-fertilization development. In the mouse, mutations of the oocyte-specific isoform of the DNA methyltransferase Dnmt1 (Dnmt1o) and of the methyltransferase-like Dnmt3L gene result in specific failures of imprint establishment or maintenance, at multiple loci. We have previously shown in humans that an analogous inherited failure to establish imprinting at multiple loci in the female germline underlies a rare phenotype of recurrent hydatidiform mole. RESULTS: We have identified a human homologue of the murine Dnmt1o and assessed its pattern of expression. Human DNMT1o mRNA is detectable in mature oocytes and early fertilized embryos but not in any somatic tissues analysed. The somatic isoform of DNMT1 mRNA, in contrast, is not detectable in human oocytes. In the previously-described family with multi-locus imprinting failure, mutation of DNMT1o and of the other known members of this gene family has been excluded. CONCLUSIONS: Mutation of the known DNMT genes does not underlie familial hydatidiform mole, at least in the family under study. This suggests that trans-acting factors other than the known methyltransferases are required for imprint establishment in humans, a concept that has indirect support from recent biochemical studies of DNMT3L

NICPRINT-50, Being some account of the history of the printing, packaging and newspaper industry of South Africa, and of the National Industrial Council for Printing, prepared to mark the Jubilee of the Council 1919-1969

The National Industrial Council of the Printing and Newspaper Industry of South Africa celebrates its Golden Jubilee in 1969 and this thesis was undertaken primarily to examine and record the Socio-economic effects of its work. To set the achievements of the Council in perspective it was proposed to preface the record with a brief sketch of the industry itself, but what was intended as an introduction has grown into a major part of the finished work which therefore contains more history and less economics than originally planned. It is hoped that the work will be no less acceptable for this change of emphasis

Modelling, simulation and experimental validation of nonlinear dynamic interactions in an aramid rope system

Vibration phenomena taking place in lifting and hoist installations may influence the dynamic performance of their components. For example, in an elevator system they may affect ride quality of a lift car. Lateral and longitudinal vibrations of suspension ropes and compensating cables may result in an adverse dynamic behaviour of the entire installation. Thus, there is a need to develop reliable mathematical and computer simulation models to predict the dynamic behaviour of suspension rope and compensating cable systems. The aim of this paper is to develop a model of an aramid suspension rope system in order to predict nonlinear modal interactions taking place in the installation. A laboratory model comprising an aramid suspension rope, a sheave/pulley assembly and a rigid suspended mass has been studied. Experimental tests have been conducted to identify modal nonlinear couplings in the system. The dynamic behaviour of the model has been described by a set of nonlinear partial differential equations. The equations have been solved numerically. The numerical results have been validated by experimental tests. It has been shown that the nonlinear couplings may lead to adverse modal interactions in the system

Phylogenetic relationships among NE Atlantic <i>Plocamionida</i> Topsent (1927) (Porifera, Poecilosclerida): under-estimated diversity in reef ecosystems

Background: Small and cryptic sponges associated with cold-water coral reefs are particularly numerous and challenging to identify, but their ecological and biochemical importance is likely to compete with megabenthic specimens.Methodology/Principal Findings: Here we use a combination of the standard M1M6 and I3M11 partitions of the COI fragment, partial rDNA 28S sequences and morphology to delineate small encrusting Plocamionida species. In total, 46 specimens were retrieved from seven shallow to deep-water coral locations, crossing 3,000 km along the European margins. Our work provides evidence that the Plocamionida ambigua f. tylotata and f. grandichelata can be considered valid species, whereas Plocamionida ambigua f. tornata corresponds to the species P. ambigua. Within the monophyletic group of Plocamionida, P. microcionides is shown as really divergent from the other taxa, and four putative new Plocamionida species are suggested.Conclusions/Significance: This study shows that the use of molecular and morphological information in an integrative approach is a powerful tool for the identification of sponge species, and suggests that an under-estimated biodiversity of sponges occurs in cold-water coral reefs

Convicts, Communication and Authority: Britain and New South Wales, 1810-1830

Knowledge of the convict period in New South Wales has been substantially expanded and enriched through a number of revisionist scholarly studies in the last quarter of the twentieth century. The cumulative result has been the establishment of a number of new orthodoxies. These studies have drawn on a number of analytic frameworks including feminism and cliometrics, successfully challenging the previous historiography. The rich archival sources in New South Wales have been utilised to reformulate the convict period by a number of scholars, demonstrating the complexity of life in the penal colony. Academic divisions between what are regarded as “Australian” history and “British” history have imposed their own agendas on writing about transportation. This study challenges this imposition through an examination of petitioners’ approaches to the home and colonial administrations. A lacuna in the scholarly studies has been a lack of attention to transportation’s consequences for married couples and their children. This study seeks to narrow that gap through these petitions. The findings of the study demonstrate the continuation of links between those who were transported and those who remained in Britain. It is argued that these findings have important implications for future research within Britain, and that what is disclosed by these petitions and the individuals who were involved in on-going communications cannot be restricted either to Australian or convict histories. Our knowledge of what transportation meant to individuals in the periphery as well as those in the metropole is diminished if the focus remains firmly on the settler community. Supplementary material from contemporary sources as well as the official records passing between the two administrations has been utilised and these supplementary sources suggest that there was a broad division between official publicly stated policy and practice in respect of transportees’ family circumstances. Chapter One establishes the architecture of the thesis and explains the methodology adopted. Chapter Two offers a reinterpretation of the colony’s formation in 1788 and inserts the “convict audience” of that day into the historiography . Chapter Three examines two petitioners writing from different gaols in Britain prior to their expected transportation. A resolution of the division between cliometrics and this more qualitative humanist approach is proposed. Chapter Four is a study of petitioners in Britain and a study of the process required for a reunion and reconstitution of family units in New South Wales. Chapter Five seeks to a resiting of male convicts as family members through an examination of a number of contemporary sources. Chapter Six examines the petitions raised by husbands and fathers for their wives and families to be given free passages to the colony. Chapter Seven provides case studies of three transportees and their experiences of the petitioning process. In Chapter Eight the focus broadens out from married men to examine and provide a revision of convicts’ correspondence with their relatives and friends in Britain. Such correspondence has previously provided the basis for nationalist interpretations; the revision here suggests that such interpretations are anachronistic. Chapter Nine is an extended metaphor drawing the material together to the conclusions of the study

Modelling of thermal behaviour of iron oxide layers on boiler tubes

Slender boiler tubes are subject to localised swelling when they are expose to excessive heat. The latter is due to the formation of an oxide layer, which acts as an insulation barrier. This excessive heat can lead to microstructural changes in the material that would reduce the mechanical strength and would eventually lead to critical and catastrophic failure. Detecting such creep damage remains a formidable challenge for boiler operators. It involves a costly process of shutting down the plant, performing electromagnetic and ultrasonic non-destructive inspection, repairing or replacing damaged tubes and finally restarting the plant to resume its service. This research explores through a model developed using a finite element computer simulation platform the thermal behaviour of slender tubes under constant temperature exceeding 723 \K. Our simulation results demonstrate that hematite layers up to 15 \μm thickness inside the tubes do not act as insulation. They clearly show the process of long term overheating on the outside of boiler tubes which in turn leads to initiation of flaws

Isolation and expression of the human gametocyte-specific factor 1 gene (GTSF1) in fetal ovary, oocytes, and preimplantation embryos

Purpose: Gametocyte-specific factor 1 has been shown in other species to be required for the silencing of retrotransposons via the Piwi-interacting RNA (piRNA) pathway. In this study, we aimed to isolate and assess expression of transcripts of the gametocyte-specific factor 1 (GTSF1) gene in the human female germline and in preimplantation embryos. Methods: Complementary DNA (cDNA) libraries from human fetal ovaries and testes, human oocytes and preimplantation embryos and ovarian follicles isolated from an adult ovarian cortex biopsy were used to as templates for PCR, cloning and sequencing, and real time PCR experiments of GTSF1 expression. Results: GTSF1 cDNA clones that covered the entire coding region were isolated from human oocytes and preimplantation embryos. GTSF1 mRNA expression was detected in archived cDNAs from staged human ovarian follicles, germinal vesicle (GV) stage oocytes, metaphase II oocytes, and morula and blastocyst stage preimplantation embryos. Within the adult female germline, expression was highest in GV oocytes. GTSF1 mRNA expression was also assessed in human fetal ovary and was observed to increase during gestation, from 8 to 21 weeks, during which time oogonia enter meiosis and primordial follicle formation first occurs. In human fetal testis, GTSF1 expression also increased from 8 to 19 weeks. Conclusions: To our knowledge, this report is the first to describe the expression of the human GTSF1 gene in human gametes and preimplantation embryos