Application of Queuing Analytic Theory to Decrease Waiting Times in Emergency Department: Does it Make Sense?

Background: Patients who receive care in an emergency department (ED), are usually unattended while waiting in queues. Objectives: This study was done to determine, whether the application of queuing theory analysis might shorten the waiting times of patients admitted to emergency wards. Patients and Methods: This was an operational study to use queuing theory analysis in the ED. In the first phase, a field study was conducted to delineate the performance of the ED and enter the data obtained into simulator software. In the second phase, "ARENA" software was used for modeling, analysis, creating a simulation and improving the movement of patients in the ED. Validity of the model was confirmed through comparison of the results with the real data using the same instrument. The third phase of the study concerned modeling in order to assess the effect of various operational strategies, on the queue waiting time of patients who were receiving care in the ED. Results: In the first phase, it was shown that 47.7% of the 3000 patient records were cases referred for trauma treatment, and the remaining 52.3% were referred for non-trauma services. A total of 56% of the cases were male and 44% female. Maximum input was 4.5 patients per hour and the minimum input was 0.5 per hour. The average length of stay for patients in the trauma section was three hours, while for the non-trauma section it was four hours. In the second phase, modeling was tested with common scenarios. In the third phase, the scenario with the addition of one or more senior emergency resident(s) on each shift resulted in a decreased length of stay from 4 to 3.75 hours. Moreover, the addition of one bed to the Intensive Care Unit (ICU) and/or Critical Care Unit (CCU) in the study hospital, reduced the occupancy rate of the nursing service from 76% to 67%. By adding another clerk to take electrocardiograms (ECG) in the ED, the average time from a request to performing the procedure is reduced from 26 to 18 minutes. Furthermore, the addition of 50% more staff to the laboratory and specialist consultations led to a 90 minute reduction in the length of stay. It was also shown that earlier consultations had no effect on the length of stay. Conclusions: Application of queuing theory analysis can improve movement and reduce the waiting times of patients in bottlenecks within the ED throughput

Intrauterine device is embraced by the placenta

The intrauterine device (IUD) is a contraceptive method which are tiny, T-shaped plastic, that is placed within the uterus and left there, is used all throughout the world with more than 99% effectiveness rate. Pregnancy with a levonorgestrel-releasing intrauterine system (LNG-IUS) in situ is very rare. Intracavitary pregnancy with an IUD can lead to a higher risk of infection and preterm birth. We described a case of a live birth with an IUD inserted into the placenta. A 27-year-old Syrian woman in G4P3 with a history of healthy vaginal deliveries arrived in our delivery room at 39+3 weeks gestation complaining of labor pain A vaginal examination revealed bulging membranes and a fully dilated cervix. She delivered a live baby boy, weighing 3100 g and being sent to the nursery with an APGAR score of 9 to 10. When the placenta was examined, a white foreign object that was embedded there was discovered to be an intrauterine device. Although intrauterine pregnancy is a potential problem that must be taken into account, ectopic pregnancy is a reasonably common complication of intrauterine contraceptive devices. Although several studies have shown that term pregnancies with excellent prognoses can occur after the removal of intrauterine devices, close monitoring is necessary to detect misplaced copper-T and prevent undesired births

Microlenses fabricated by two-photon laser polymerization for cell imaging with non-linear excitation microscopy

Non-linear excitation microscopy offers several advantages for in-vivo imaging compared to conventional confocal techniques. However, tissue penetration can still be an issue due to scattering and spherical aberrations induced on focused beams by the tissue. The use of low numerical aperture objectives to pass through the outer layers of the skin, together with high dioptric power microlenses implanted in-vivo close to the observation volume, can be beneficial to the reduction of optical aberrations. Here, Fibroblast cell culture plano-convex microlenses to be used for non-linear imaging of biological tissue are developed and tested. The microlenses can be used as single lenses or multiplexed in an array. A thorough test of the lenses wavefront is reported together with the modulation transfer function and wavefront profile. Magnified fluorescence images can be retrieved through the microlenses coupled to commercial confocal and two-photon excitation scanning microscopes. The signal-to-noise ratio of the images is not substantially affected by the use of the microlenses and the magnification can be adjusted by changing the relative position of the microlens array to the microscope objective and the immersion medium. These results are opening the way to the application of implanted micro-optics for optical in-vivo inspection of biological processes

Sensitivity of jarrah (Eucalyptus marginata) to phosphate, phosphite, and arsenate pulses as influenced by fungal symbiotic associations

Many plant species adapted to P-impoverished soils, including jarrah (Eucalyptus marginata), develop toxicity symptoms when exposed to high doses of phosphate (Pi) and its analogs such as phosphite (Phi) and arsenate (AsV). The present study was undertaken to investigate the effects of fungal symbionts Scutellospora calospora, Scleroderma sp., and Austroboletus occidentalis on the response of jarrah to highly toxic pulses (1.5 mmol kg−1 soil) of Pi, Phi, and AsV. S. calospora formed an arbuscular mycorrhizal (AM) symbiosis while both Scleroderma sp. and A. occidentalis established a non-colonizing symbiosis with jarrah plants. All these interactions significantly improved jarrah growth and Pi uptake under P-limiting conditions. The AM fungal colonization naturally declines in AM-eucalypt symbioses after 2–3 months; however, in the present study, the high Pi pulse inhibited the decline of AM fungal colonization in jarrah. Four weeks after exposure to the Pi pulse, plants inoculated with S. calospora had significantly lower toxicity symptoms compared to non-mycorrhizal (NM) plants, and all fungal treatments induced tolerance against Phi toxicity in jarrah. However, no tolerance was observed for AsV-treated plants even though all inoculated plants had significantly lower shoot As concentrations than the NM plants. The transcript profile of five jarrah high-affinity phosphate transporter (PHT1 family) genes in roots was not altered in response to any of the fungal species tested. Interestingly, plants exposed to high Pi supplies for 1 day did not have reduced transcript levels for any of the five PHT1 genes in roots, and transcript abundance of four PHT1 genes actually increased. It is therefore suggested that jarrah, and perhaps other P-sensitive perennial species, respond positively to Pi available in the soil solution through increasing rather than decreasing the expression of selected PHT1 genes. Furthermore, Scleroderma sp. can be considered as a fungus with dual functional capacity capable of forming both ectomycorrhizal and non-colonizing associations, where both pathways are always accompanied by evident growth and nutritional benefits

Therapeutic lung lavages in children and adults

BACKGROUND: Pulmonary alveolar proteinosis (PAP) is a rare disease, characterized by excessive intra-alveolar accumulation of surfactant lipids and proteins. Therapeutic whole lung lavages are currently the principle therapeutic option in adults. Not much is known on the kinetics of the wash out process, especially in children. METHODS: In 4 pediatric and 6 adult PAP patients 45 therapeutic half lung lavages were investigated retrospectively. Total protein, protein concentration and, in one child with a surfactant protein C mutation, aberrant pro-SP-C protein, were determined during wash out. RESULTS: The removal of protein from the lungs followed an exponential decline and averaged for adult patients 2 – 20 g and <0.5 to 6 g for pediatric patients. The average protein concentration of consecutive portions was the same in all patient groups, however was elevated in pediatric patients when expressed per body weight. The amount of an aberrant pro-SP-C protein, which was present in one patient with a SP-C mutation, constantly decreased with ongoing lavage. Measuring the optical density of the lavage fluid obtained allowed to monitor the wash out process during the lavages at the bedside and to determine the termination of the lavage procedure at normal protein concentration. CONCLUSION: Following therapeutic half lung lavages by biochemical variables may help to estimate the degree of alveolar filling with proteinaceous material and to improve the efficiency of the wash out, especially in children

Accuracy of emergency severity index of triage in Imam Hossein hospital - Tehran, Iran (2011)

Background and Objective: Triage is the most important and the first stage of patient’s management at the time of arrival to hospital emergency department. Emergency severity index (ESI) is a common triage system worldwide. This study was aimed to evaluate the accuracy of ESI in emergency department of Imam Hossein hospital in Tehran, Iran. Materials and Methods: In this descriptive study the result of patients’ triage based on ESI were gathered for all patients referred to emergency department of Imam Hossein Hospital from January to April 2011. A questioner was filled for each patient by the nurse and a emergency specialist independently. The l for the degree of agreement of triage between nurse and clinician was 81% (95% CI: 0.79-0.83). The sensivity of triage for step I, II, III, IV and V were 100%, 53.2%, 90.7%, 67.1% and 98% respectively. The specificity of triage for step I, II, III, IV and V were 99.8%, 97.5%, 93.7%, 98.3% and 94% respectively. There was a significant overlapping between the triage step and the patient clinical outcome. Conclusion: This study showed that five steps triage contain a high accuracy and estimation of patient outcomes