Measuring access: how accurate are patient-reported waiting times?

Introduction: A national audit of waiting times in England’s genitourinary medicine clinics measures patient access. Data are collected by patient questionnaires, which rely upon patients’ recollection of first contact with health services, often several days previously. The aim of this study was to assess the accuracy of patient-reported waiting times. Methods: Data on true waiting times were collected at the time of patient booking over a three-week period and compared with patient-reported data collected upon clinic attendance. Factors contributing to patient inaccuracy were explored. Results: Of 341 patients providing initial data, 255 attended; 207 as appointments and 48 ‘walk-in’. The accuracy of patient-reported waiting times overall was 52% (133/255). 85% of patients (216/255) correctly identified themselves as seen within or outside of 48 hours. 17% of patients (17/103) seen within 48 hours reported a longer waiting period, whereas 20% of patients (22/108) reporting waits under 48 hours were seen outside that period. Men were more likely to overestimate their waiting time (10.4% versus 3.1% p<0.02). The sensitivity of patient-completed questionnaires as a tool for assessing waiting times of less than 48 hours was 83.5%. The specificity and positive predictive value were 85.5% and 79.6%, respectively. Conclusion: The overall accuracy of patient reported waiting times was poor. Although nearly one in six patients misclassified themselves as being seen within or outside of 48 hours, given the under and overreporting rates observed, the overall impact on Health Protection Agency waiting time data is likely to be limited

Premixed turbulent flame calculation

The importance of turbulent premixed flames in a variety of applications has led to a substantial amount of effort towards improving the understanding of these flames. Although these efforts have increased the understanding, many questions still remain. The use of direct numerical simulation (DNS) in solving these questions is examined

Three-dimensional modeling of diesel engine intake flow, combustion and emissions-2

A three-dimensional computer code, KIVA, is being modified to include state-of-the-art submodels for diesel engine flow and combustion. Improved and/or new submodels which have already been implemented and previously reported are: wall heat transfer with unsteadiness and compressibility, laminar-turbulent characteristic time combustion with unburned HC and Zeldo'vich NO(x), and spray/wall impingement with rebounding and sliding drops. Progress on the implementation of improved spray drop drag and drop breakup models, the formulation and testing of a multistep kinetics ignition model, and preliminary soot modeling results are described. In addition, the use of a block structured version of KIVA to model the intake flow process is described. A grid generation scheme was developed for modeling realistic (complex) engine geometries, and computations were made of intake flow in the ports and combustion chamber of a two-intake-value engine. The research also involves the use of the code to assess the effects of subprocesses on diesel engine performance. The accuracy of the predictions is being tested by comparisons with engine experiments. To date, comparisons were made with measured engine cylinder pressure, temperature and heat flux data, and the model results are in good agreement with the experiments. Work is in progress that will allow validation of in-cylinder flow and soot formation predictions. An engine test facility is described that is being used to provide the needed validation data. Test results were obtained showing the effect of injection rate and split injections on engine performance and emissions

Large-Eddy simulation analysis of spark configuration effect on cycle-to-cycle variability of combustion and knock

Cycle-to-cycle variability is numerically simulated for high-speed, full-load operation of a turbocharged gasoline direct injection engine. Large-Eddy simulation is adopted to replicate the fluctuations of the flow field affecting the turbulent combustion. Experimental data were provided at knock onset, and large-Eddy simulation was validated for the same condition. In the original engine configuration, the spark plug is displaced toward the exhaust side, while the electrodes orientation is arbitrary. A 90 rotation is imposed to evaluate the effects of the aerodynamic obstruction caused by the electrode with respect to the flow field and the flame kernel growth. A second speculative analysis is performed modifying the position of the spark plug. The electrodes are shifted 2mm toward the intake side since this variation is compatible with the cylinder head layout. For both variations in orientation and position, the effects on the flow field around the spark plug are investigated. Statistical analysis is carried out on early flame kernel formation and knock tendency. The results highlight that the orientation of the electrodes affects the flow field for each cycle but plays a negligible role on the statistical cyclic variability, indirectly justifying the lack of an imposed orientation. As for the spark plug position, the numerical analysis indicate that the shifting of the electrodes toward the intake side slightly improves the knock limit mainly because of a reduction in in-cylinder peak pressure. In general, it is inferred that improvements may be achieved only through a simultaneous modification of the fuel jet orientation and phasing

Terascale High-Fidelity Simulations of Turbulent Combustion with Detailed Chemistry: Spray Simulations

The Terascale High-Fidelity Simulations of Turbulent Combustion (TSTC) project is a multi-university collaborative effort to develop a high-fidelity turbulent reacting flow simulation capability utilizing terascale, massively parallel computer technology. The main paradigm of the approach is direct numerical simulation (DNS) featuring the highest temporal and spatial accuracy, allowing quantitative observations of the fine-scale physics found in turbulent reacting flows as well as providing a useful tool for development of sub-models needed in device-level simulations. Under this component of the TSTC program the simulation code named S3D, developed and shared with coworkers at Sandia National Laboratories, has been enhanced with new numerical algorithms and physical models to provide predictive capabilities for turbulent liquid fuel spray dynamics. Major accomplishments include improved fundamental understanding of mixing and auto-ignition in multi-phase turbulent reactant mixtures and turbulent fuel injection spray jets

The importance of anatomy

Anatomy is the knowledge about the structure of the bodies of animals and people. This includes information about blood vessels, organs, the skeleton, and nerves. But have you ever wondered where the anatomical information in science books and websites comes from? When did our fascination with the body begin and why do people still study it now? Who teaches doctors, nurses, veterinary surgeons, and other health professionals about the body? How has anatomy inspired art, and vice versa? This paper looks at the amazing world of anatomy: what anatomy is; why it is needed; why it is important; who studies, teaches, and researches anatomy; and what the future holds for this fascinating science

Knock Tendency Prediction in a High Performance Engine Using LES and Tabulated Chemistry

The paper reports the application of a look-up table approach within a LES combustion modelling framework for the prediction of knock limit in a highly downsized turbocharged DISI engine. During experimental investigations at the engine test bed, high cycle-to-cycle variability was detected even for relatively stable peak power / full load operations of the engine, where knock onset severely limited the overall engine performance. In order to overcome the excessive computational cost of a direct chemical solution within a LES framework, the use of look-up tables for auto-ignition modelling perfectly fits with the strict mesh requirements of a LES simulation, with an acceptable approximation of the actual chemical kinetics. The model here presented is a totally stand-alone tool for autoignition analysis integrated with look-up table reading from detailed chemical kinetic schemes for gasoline. The look-up table access is provided by a multi-linear interpolating routine internally developed at the \u201cGruppo Motori (GruMo)\u201d of the University of Modena and Reggio Emilia. As the experimental tests were conducted operating the engine at knock-limited spark advance, the tool is at first validated for three different LES cycles in terms of knock tolerance, i.e. the safety margin to knock occurrence. As a second stage, the validation of the methodology is performed for discrete spark advance increases in order to assess the sensitivity of the modelling strategy to variations in engine operations. A detailed analysis of the unburnt gas physical state is performed which confirms the knock-limited condition suggested by the experimental tests

Optimizing Low Temperature Diesel Combustion (LTC-D) "FreedomCAR and Vehicle Technologies Program Solicitation for University Research and Graduate Automotice Technology Education (GATE) Centers of Excellence"

The engine industry is currently facing severe emissions mandates. Pollutant emissions from mobile sources are a major source of concern. For example, US EPA mandates require emissions of particulate and nitrogen oxides (NOx) from heavy-duty diesel engine exhaust to drop at least 90 percent between 1998 and 2010. Effective analysis of the combustion process is required to guide the selection of technologies for future development since exhaust after-treatment solutions are not currently available that can meet the required emission reduction goals. The goal of this project is to develop methods to optimize and control Low Temperature Combustion Diesel technologies (LTC-D) that offers the potential of nearly eliminating engine NOx and particulate emissions at reduced cost over traditional methods by controlling pollutant emissions in-cylinder. The work was divided into 5 Tasks, featuring experimental and modeling components: 1.) Fundamental understanding of LTC-D and advanced model development, 2.) Experimental investigation of LTC-D combustion control concepts, 3.) Application of detailed models for optimization of LTC-D combustion and emissions, 4.) Impact of heat transfer and spray impingement on LTC-D combustion, and 5.) Transient engine control with mixed-mode combustion. As described in the final report (December 2008), outcomes from the research included providing guidelines to the engine and energy industries for achieving optimal low temperature combustion operation through using advanced fuel injection strategies, and the potential to extend low temperature operation through manipulation of fuel characteristics. In addition, recommendations were made for improved combustion chamber geometries that are matched to injection sprays and that minimize wall fuel films. The role of fuel-air mixing, fuel characteristics, fuel spray/wall impingement and heat transfer on LTC-D engine control were revealed. Methods were proposed for transient engine operation during load and speed changes to extend LTC-D engine operating limits, power density and fuel economy. Low emissions engine design concepts were proposed and evaluated

Final report: Prototyping a combustion corridor

The Combustion Corridor is a concept in which researchers in combustion and thermal sciences have unimpeded access to large volumes of remote computational results. This will enable remote, collaborative analysis and visualization of state-of-the-art combustion science results. The Engine Research Center (ERC) at the University of Wisconsin - Madison partnered with Lawrence Berkeley National Laboratory, Argonne National Laboratory, Sandia National Laboratory, and several other universities to build and test the first stages of a combustion corridor. The ERC served two important functions in this partnership. First, we work extensively with combustion simulations so we were able to provide real world research data sets for testing the Corridor concepts. Second, the ERC was part of an extension of the high bandwidth based DOE National Laboratory connections to universities