OR Practice—Efficient Short-Term Allocation and Reallocation of Patients to Floors of a Hospital During Demand Surges

Many hospitals face the problem of insufficient capacity to meet demand for inpatient beds, especially during demand surges. This results in quality degradation of patient care due to large delays from admission time to the hospital until arrival at a floor. In addition, there is loss of revenue because of the inability to provide service to potential patients. A solution to the problem is to proactively transfer patients between floors in anticipation of a demand surge. Optimal reallocation poses an extraordinarily complex problem that can be modeled as a finite-horizon Markov decision process. Based on the optimization model, a decision-support system has been developed and implemented at Windham Hospital in Willimantic, Connecticut. Projections from an initial trial period indicate very significant financial gains of about 1% of their total revenue, with no negative impact on any standard quality of care or staffing effectiveness indicators. In addition, the hospital showed a marked improvement in quality of care because of a resulting decrease of almost 50% in the average time that an admitted patient has to wait from admission until being transferred to a floor

Characterization of Electronic Transport through Amorphous TiO_2 Produced by Atomic-Layer Deposition

Electrical transport in amorphous titanium dioxide (a-TiO_2) thin films, deposited by atomic layer deposition (ALD), and across heterojunctions of p+-Si|a-TiO_2|metal substrates that had various top metal contacts has been characterized by ac conductivity, temperature-dependent dc conductivity, space-charge-limited current spectroscopy, electron paramagnetic resonance (EPR) spectroscopy, X-ray photoelectron spectroscopy, and current density versus voltage (J–V) characteristics. Amorphous TiO_2 films were fabricated using either tetrakis(dimethylamido)-titanium with a substrate temperature of 150 °C or TiCl_4 with a substrate temperature of 50, 100, or 150 °C. EPR spectroscopy of the films showed that the Ti^(3+) concentration varied with the deposition conditions and increases in the concentration of Ti^(3+) in the films correlated with increases in film conductivity. Valence band spectra for the a-TiO_2 films exhibited a defect-state peak below the conduction band minimum (CBM) and increases in the intensity of this peak correlated with increases in the Ti^(3+) concentration measured by EPR as well as with increases in film conductivity. The temperature-dependent conduction data showed Arrhenius behavior at room temperature with an activation energy that decreased with decreasing temperature, suggesting that conduction did not occur primarily through either the valence or conduction bands. The data from all of the measurements are consistent with a Ti^(3+) defect-mediated transport mode involving a hopping mechanism with a defect density of 10^(19) cm^(–3), a 0.83 wide defect band centered 1.47 eV below the CBM, and a free-electron concentration of 10^(16) cm^(–3). The data are consistent with substantial room-temperature anodic conductivity resulting from the introduction of defect states during the ALD fabrication process as opposed to charge transport intrinsically associated with the conduction band of TiO_2

Coordinated nasal mucosa-mediated immunity accelerates recovery from COVID-19

Introduction Understanding the interplay of immune mediators in relation to clinical outcomes during acute infection has the potential to highlight immune networks critical to symptom recovery. The objective of the present study was to elucidate the immune networks critical to early symptom resolution following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods In a community-based randomised clinical trial comparing inhaled budesonide against usual care in 139 participants with early onset SARS-CoV-2 (the STOIC study; clinicaltrials.gov identifier NCT04416399), significant clinical deterioration (reported need for urgent care, emergency department visit, hospitalisation: the primary outcome), self-reported symptom severity (Influenza Patient-Reported Outcome questionnaire) and immune mediator networks were assessed. Immune mediator networks were determined using pre-defined mathematical modelling of immune mediators, determined by the Meso Scale Discovery U-Plex platform, within the first 7 days of SARS-CoV-2 infection compared to 22 healthy controls. Results Interferon-and chemokine-dominant networks were associated with high viral burden. Elevated levels of the mucosal network (chemokine (C-C motif) ligand (CCL)13, CCL17, interleukin (IL)-33, IL-5, IL-4, CCL26, IL-2, IL-12 and granulocyte–macrophage colony-stimulating factor) was associated with a mean 3.7-day quicker recovery time, with no primary outcome events, irrespective of treatment arm. This mucosal network was associated with initial nasal and throat symptoms at day 0. Conclusion A nasal immune network is critical to accelerated recovery and improved patient outcomes in community-acquired viral infections. Overall, early prognostication and treatments aimed at inducing epithelial responses may prove clinically beneficial in enhancing early host response to virus

The risk of unintended deforestation from scaling sustainable livestock production systems

Silvopastoral systems (SPS)-production systems integrating trees, forages, and livestock within the same land area-are recognized as critical for reducing tropical deforestation and improving livelihoods, ecosystem services, and carbon sinks. Yet, research on how scaling SPS influences forest cover changes at large geographical scales is scant. Our study delves deeper into the interlinkages between scaling SPS and deforestation. In two surveys conducted among 144 Colombian Amazon livestock producers with traditional or SPS farms, we assessed changes in herd composition between 2016 and 2020. Results showed a change in herd composition, with fewer males and more cows/heifers, suggesting a shift toward specializing in milk production, which, with the appropriate environmental incentives and safeguards, would unlikely broaden deforestation. However, interlinkages between the dairy and beef value chains suggest that extra male cattle from SPS intensification would be moved for fattening as a source of beef to new pastures at the forest border. If SPS scaling interventions in the Colombian Amazon are to be truly deforestation-free, they need to be designed based on a clear understanding of the interlinkages between food and land systems. Therefore, policies advancing the livestock and land-use agenda must create mechanisms that support deforestation-free livestock intensification, based on biophysical and socioeconomic evaluations

Transforming Growth Factor-β1 Decreases β2-Agonist–induced Relaxation in Human Airway Smooth Muscle

Helper T effector cytokines implicated in asthma modulate the contractility of human airway smooth muscle (HASM) cells. We have reported recently that a profibrotic cytokine, transforming growth factor (TGF)-β1, induces HASM cell shortening and airway hyperresponsiveness. Here, we assessed whether TGF-β1 affects the ability of HASM cells to relax in response to β2-agonists, a mainstay treatment for airway hyperresponsiveness in asthma. Overnight TGF-β1 treatment significantly impaired isoproterenol (ISO)-induced relaxation of carbachol-stimulated, isolated HASM cells. This single-cell mechanical hyporesponsiveness to ISO was corroborated by sustained increases in myosin light chain phosphorylation. In TGF-β1–treated HASM cells, ISO evoked markedly lower levels of intracellular cAMP. These attenuated cAMP levels were, in turn, restored with pharmacological and siRNA inhibition of phosphodiesterase 4 and Smad3, respectively. Most strikingly, TGF-β1 selectively induced phosphodiesterase 4D gene expression in HASM cells in a Smad2/3-dependent manner. Together, these data suggest that TGF-β1 decreases HASM cell β2-agonist relaxation responses by modulating intracellular cAMP levels via a Smad2/3-dependent mechanism. Our findings further define the mechanisms underlying β2-agonist hyporesponsiveness in asthma, and suggest TGF-β1 as a potential therapeutic target to decrease asthma exacerbations in severe and treatment-resistant asthma

Anticipating and Adapting to the Future Impacts of Climate Change on the Health, Security and Welfare of Low Elevation Coastal Zone (LECZ) Communities in Southeastern USA

Low elevation coastal zones (LECZ) are extensive throughout the southeastern United States. LECZ communities are threatened by inundation from sea level rise, storm surge, wetland degradation, land subsidence, and hydrological flooding. Communication among scientists, stakeholders, policy makers and minority and poor residents must improve. We must predict processes spanning the ecological, physical, social, and health sciences. Communities need to address linkages of (1) human and socioeconomic vulnerabilities; (2) public health and safety; (3) economic concerns; (4) land loss; (5) wetland threats; and (6) coastal inundation. Essential capabilities must include a network to assemble and distribute data and model code to assess risk and its causes, support adaptive management, and improve the resiliency of communities. Better communication of information and understanding among residents and officials is essential. Here we review recent background literature on these matters and offer recommendations for integrating natural and social sciences. We advocate for a cyber-network of scientists, modelers, engineers, educators, and stakeholders from academia, federal state and local agencies, non-governmental organizations, residents, and the private sector. Our vision is to enhance future resilience of LECZ communities by offering approaches to mitigate hazards to human health, safety and welfare and reduce impacts to coastal residents and industries

Performance of the MALTA Telescope

MALTA is part of the Depleted Monolithic Active Pixel sensors designed in Tower 180nm CMOS imaging technology. A custom telescope with six MALTA planes has been developed for test beam campaigns at SPS, CERN, with the ability to host several devices under test. The telescope system has a dedicated custom readout, online monitoring integrated into DAQ with realtime hit map, time distribution and event hit multiplicity. It hosts a dedicated fully configurable trigger system enabling to trigger on coincidence between telescope planes and timing reference from a scintillator. The excellent time resolution performance allows for fast track reconstruction, due to the possibility to retain a low hit multiplicity per event which reduces the combinatorics. This paper reviews the architecture of the system and its performance during the 2021 and 2022 test beam campaign at the SPS North Area