Methodologies for determining staffing needs in healthcare: systematic literature review

The determination of staffing needs in healthcare is not just calculating the optimal number of professionals but is defining how the professional contingent accompanies the development of the healthcare organisation and of the population’s care needs. This research investigates the existence of a gold standard for determining health personnel requirements. We perform a systematic literature review to explore several approaches worldwide, examining a wide range of contextual variables, useful for the definition of an omni-comprehensive approach. A total of 557 articles was initially detected, then reduced to 57 after excluding everything not related to healthcare context and staff planning models. Results do not reveal a recognized standard for determining staffing needs. Approaches to the definition of staffing standards are mainly ex-ante (31%), based on the characteristics of specific models and organisational needs, or ex-post (62%), based on production analysis and historical trends. Most of these refer to the medical and nursing category (68.4%), while the minority proposes a multi-professional approach (17.5%). This review highlights innovative approaches based on algorithms which, starting from historical data, are adjusted by moderating key variables such as contextual factors, healthcare organisation models and professional attributes. The review suggests: 1. Develop and share a unique tool for defining standards based on several variables that identify the characteristics of the context 2. Use up-to-date information flows and quality data 3. Consider a multi-professional approach 4. Adopt a long-term vision and continuous dialogue with the training process It is clear the need to develop a tool for the definition of personnel requirements in line with internal and external changes in the health system. Therefore, such models need to account for an adequate number of variables, useful to identify the characteristics of the overall context. Key messages: The development of staffing needs estimates must necessarily rely on a certain level of standardisation, but at the same time must take into account the variability characterising different contexts. In order to respond to recent demographic and epidemiological trends, it is crucial to include in the model skill mix and task shifting strategies involving health professionals as a whole

Epidemiology of patients presenting to a pediatric emergency department in Karachi, Pakistan

Background: There is little data describing pediatric emergencies in resource-poor countries, such as Pakistan. We studied the demographics, management, and outcomes of patients presenting to the highest-volume, public, pediatric emergency department (ED) in Karachi, Pakistan.Methods: In this prospective, observational study, we approached all patients presenting to the 50-bed ED during 28 12-h study periods over four consecutive weeks (July 2013). Participants’ chief complaints and medical care were documented. Patients were followed-up at 48-h and 14-days via telephone. Results: Of 3115 participants, 1846 were triaged to the outpatient department and 1269 to the ED. Patients triaged to the ED had a median age of 2.0 years (IQR 0.5–4.0); 30% were neonates (\u3c 28 days). Top chief complaints were fever (45.5%), diarrhea/vomiting (32.3%), respiratory (23.1%), abdominal (7.5%), and otolaryngological problems (5.8%). Temperature, pulse and respiratory rate, and blood glucose were documented for 66, 42, and 1.5% of patients, respectively. Interventions included medications (92%), IV fluids (83%), oxygen (35%), and advanced airway management (5%). Forty-five percent of patients were admitted; 11 % left against medical advice. Outcome data was available at time of ED disposition, 48-h, and 14 days for 83, 62, and 54% of patients, respectively. Of participants followed-up, 4.3% died in the ED, 11.5% within 48 h, and 19.6% within 14 days.Conclusions: This first epidemiological study at Pakistan’s largest pediatric ED reveals dramatically high mortality, particularly among neonates. Future research in developing countries should focus on characterizing reasons for high mortality through pre-ED arrival tracking, ED care quality assessment, and post-ED follow-up

Correction to: Epidemiology of patients presenting to a pediatric emergency department in Karachi, Pakistan

An amendment to this paper has been published and can be accessed via the original article

Response determination of linear dynamical systems with singular matrices: A polynomial matrix theory approach

An approach is developed based on polynomial matrix theory for formulating the equations of motion and for determining the response of multi-degree-of-freedom (MDOF) linear dynamical systems with singular matrices and subject to linear constraints. This system modeling may appear for reasons such as utilizing redundant DOFs, and can be advantageous from a computational cost perspective, especially for complex (multi-body) systems. The herein developed approach can be construed as an alternative to the recently proposed methodology by Udwadia and coworkers, and has the significant advantage that it circumvents the use of pseudoinverses in determining the system response. In fact, based on the theoretical machinery of polynomial matrices, a closed form analytical solution is derived for the system response that involves non-singular matrices and relies on the use of a basis of the null space of the constraints matrix. Several structural/mechanical systems with singular matrices are included as examples for demonstrating the validity of the developed framework and for elucidating certain numerical aspects

An Integrated Approach for Structural Health Monitoring and Damage Detection of Bridges: An Experimental Assessment

The issue of monitoring the structural condition of bridges is becoming a top priority worldwide. As is well known, any infrastructure undergoes a progressive deterioration of its structural conditions due to aging by normal service loads and environmental conditions. At the same time, it may suffer serious damages or collapse due to natural phenomena such as earthquakes or strong winds. For this reason, it is essential to rely on efficient and widespread monitoring techniques applied throughout the entire road network. This paper aims to introduce an integrated procedure for structural and material monitoring. With regard to structural monitoring, an innovative approach for monitoring based on Vehicle by Bridge Interaction (VBI) will be proposed. Furthermore, with regard to material monitoring, to evaluate concrete degradation, a non-invasive method based on the continuous monitoring of the pH, as well as chloride and sulfate ions concentration in the concrete, is presented

LICIACube Mission: The Fastest Fly-By Ever Done by a CubeSat

As SmallSats are gathering an ever-increasing importance for all types of space missions, they are asked more often to operate in harshest environments and to complete the most complex tasks. One of these demanding technical challenges arises in the frame of the planetary defense. Space missions towards asteroids have garnered the due attention in recent years and, in this regard, NASA has developed the Double Asteroid Redirection Test (DART) mission, in which the Italy will lend its contribution. While DART acts as a kinetic impactor deflecting the orbit of the asteroid Dimorphos, the moon of the targeted binary system Didymos, the Light Italian CubeSat for Imaging of Asteroid (LICIACube) collects and gathers valuable images of the effect of the DART impact on the rocky body. LICIACube will allow to study the structure and evolution of the ejecta plume resulting from the impact, and to model both impacted and non-impacted sides of Dimorphos. LICIACube is an Italian Space Agency (ASI) project, whose design, integration and testing have been assigned to the aerospace company Argotec. The scientific team is enriched by University of Bologna team, supporting the orbit determination and the satellite navigation, Polytechnic of Milan, for mission analysis support and optimization and INAF (National Institute of Astrophysics), which provides support in the scientific operations of the satellite, instrument calibrations and data exploitation. This work focuses on the fly-by of LICIACube which will be accomplished using the imaging capabilities provided by theArgotecHAWK-6 platform and by the autonomous navigation system. In order to acquire high-resolution images, LICIACube approaches Dimorphos at a relative distance of 55km. The very close fly-by, the high relative velocity of ∼7 km/s with respect to the asteroid and the need to keep LICIACube camera pointed at Dimorphos make the mission very challenging. In addition, since the binary asteroid system is ∼10 million kilometers away from Earth, the fly-by has to be performed with no real time commanding. As a result, LICIACube shall be able to autonomously analyze all information from its sensors to track the asteroid. The evaluation and subsequent solutions to this problem are presented in this paper, as well as a unit-level description of the parts included in the autonomous navigation system. Finally, an overview of the verification of both unit-level and system-level strategies is outlined

Characterization and Testing of the Passive Magnetic Attitude Control System for the 3U AstroBio CubeSat

AstroBio CubeSat is a mission funded by the Italian Space Agency aimed at validating novel lab-on-chip technology, that would enable the use of micro- and nanosatellites as autonomous orbiting laboratories for research in astrobiology. This 3U CubeSat is equipped with a passive magnetic attitude control system (PMACS), including permanent magnets and hysteresis strips, which allows for stabilizing the spacecraft with the longitudinal axis in the direction of the geomagnetic field vector. This work presents the process followed for the experimental characterization of the system, performed on the engineering unit of the satellite by using a Helmholtz cage facility and a spherical air-bearing to recreate environmental conditions similar to the ones experienced during the orbital motion. The hysteresis strips are characterized starting from the determination of the hysteresis loop, from which the energy dissipation per cycle and the apparent magnetic permeability are extracted. Tests performed by using the Helmholtz cage and the air-bearing facility allows for further investigating the damping torque produced by the PMACS and validating the abovementioned parameters. Numerical analysis is then used to select the number of permanent magnets which allows for achieving a pointing accuracy within an error of 10° within 24 h from the deployment. The analysis of the flight data supports the results obtained from the experimental test campaigns, confirming the effectiveness of the proposed methods and of the PMACS design

Usage of Light Emitting Diodes (LEDs) for improved satellite tracking

With the increasing number of satellite launches, especially in Low Earth Orbit (LEO), optical tracking can offer a convenient enhancement of tracking precision and availability. Spaceborne active illumination devices, such as LED payloads, can offer a significant improvement to optical observations, extending the observability interval to the whole eclipse time and performing optimized flash sequences for identification, orbit determination, attitude reconstruction or low data rate communication. The main features of LED panels for optical tracking mounted on small satellites platforms (and with particular regards to nano-satellite platforms) are outlined in this paper, along with the description of the design drivers. The analysis of the performance is referred to Sun-Synchronous (at 700 km of altitude) and International Space Station (400 km) orbits, while the ground segment and the optical link budget reference design relies on a standard university space debris observation station architecture. The paper also outlines the advantages of using different observation techniques and the variety of flashing patterns. The LEDSAT 1U CubeSat, aiming at demonstrating the effectiveness of an LED-based payload for observation and tracking, is used as a study case for examples of the LED payloads and related operations that are reported and described in this paper

Evolution of a Novel Appendage Ground Plan in Water Striders Is Driven by Changes in the Hox Gene Ultrabithorax

Water striders, a group of semi-aquatic bugs adapted to life on the water surface, have evolved mid-legs (L2) that are long relative to their hind-legs (L3). This novel appendage ground plan is a derived feature among insects, where L2 function as oars and L3 as rudders. The Hox gene Ultrabithorax (Ubx) is known to increase appendage size in a variety of insects. Using gene expression and RNAi analysis, we discovered that Ubx is expressed in both L2 and L3, but Ubx functions to elongate L2 and to shorten L3 in the water strider Gerris buenoi. Therefore, within hemimetabolous insects, Ubx has evolved a new expression domain but maintained its ancestral elongating function in L2, whereas Ubx has maintained its ancestral expression domain but evolved a new shortening function in L3. These changes in Ubx expression and function may have been a key event in the evolution of the distinct appendage ground plan in water striders