Longitudinal Study of the Variation in Patient Turnover and Patient-to-Nurse Ratio: Descriptive Analysis of a Swiss University Hospital

Variations in patient demand increase the challenge of balancing high-quality nursing skill mixes against budgetary constraints. Developing staffing guidelines that allow high-quality care at minimal cost requires first exploring the dynamic changes in nursing workload over the course of a day.; Accordingly, this longitudinal study analyzed nursing care supply and demand in 30-minute increments over a period of 3 years. We assessed 5 care factors: patient count (care demand), nurse count (care supply), the patient-to-nurse ratio for each nurse group, extreme supply-demand mismatches, and patient turnover (ie, number of admissions, discharges, and transfers).; Our retrospective analysis of data from the Inselspital University Hospital Bern, Switzerland included all inpatients and nurses working in their units from January 1, 2015 to December 31, 2017. Two data sources were used. The nurse staffing system (tacs) provided information about nurses and all the care they provided to patients, their working time, and admission, discharge, and transfer dates and times. The medical discharge data included patient demographics, further admission and discharge details, and diagnoses. Based on several identifiers, these two data sources were linked.; Our final dataset included more than 58 million data points for 128,484 patients and 4633 nurses across 70 units. Compared with patient turnover, fluctuations in the number of nurses were less pronounced. The differences mainly coincided with shifts (night, morning, evening). While the percentage of shifts with extreme staffing fluctuations ranged from fewer than 3% (mornings) to 30% (evenings and nights), the percentage within "normal" ranges ranged from fewer than 50% to more than 80%. Patient turnover occurred throughout the measurement period but was lowest at night.; Based on measurements of patient-to-nurse ratio and patient turnover at 30-minute intervals, our findings indicate that the patient count, which varies considerably throughout the day, is the key driver of changes in the patient-to-nurse ratio. This demand-side variability challenges the supply-side mandate to provide safe and reliable care. Detecting and describing patterns in variability such as these are key to appropriate staffing planning. This descriptive analysis was a first step towards identifying time-related variables to be considered for a predictive nurse staffing model

The Fermi accelerator in atom optics

We study the classical and quantum dynamics of a Fermi accelerator realized by an atom bouncing off a modulated atomic mirror. We find that in a window of the modulation amplitude dynamical localization occurs in both position and momentum. A recent experiment [A. Steane, P. Szriftgiser, P. Desbiolles, and J. Dalibard, Phys. Rev. Lett. {\bf 74}, 4972 (1995)] shows that this system can be implemented experimentally.Comment: 5 pages, 5 figure

An optically driven quantum dot quantum computer

We propose a quantum computer structure based on coupled asymmetric single-electron quantum dots. Adjacent dots are strongly coupled by means of electric dipole-dipole interactions enabling rapid computation rates. Further, the asymmetric structures can be tailored for a long coherence time. The result maximizes the number of computation cycles prior to loss of coherence.Comment: 4 figure

Quantum phase retrieval of a Rydberg wave packet using a half-cycle pulse

A terahertz half-cycle pulse was used to retrieve information stored as quantum phase in an $N$-state Rydberg atom data register. The register was prepared as a wave packet with one state phase-reversed from the others (the "marked bit"). A half-cycle pulse then drove a significant portion of the electron probability into the flipped state via multimode interference.Comment: accepted by PR

Quantum Revivals in Periodically Driven Systems close to nonlinear resonance

We calculate the quantum revival time for a wave-packet initially well localized in a one-dimensional potential in the presence of an external periodic modulating field. The dependence of the revival time on various parameters of the driven system is shown analytically. As an example of application of our approach, we compare the analytically obtained values of the revival time for various modulation strengths with the numerically computed ones in the case of a driven gravitational cavity. We show that they are in very good agreement.Comment: 14 pages, 1 figur

Innate Signaling in Otitis Media: Pathogenesis and Recovery

Otitis media (OM) is the most prevalent childhood disease in developed countries. Involvement of innate immunity mediated by Toll-like receptors (TLRs) in OM has been implicated primarily in cell lines and by association studies of innate immune gene polymorphisms with OM prevalence. However, the precise role of innate immunity in OM is incompletely understood. We review recent research that has advanced our understanding of how innate immunity in the middle ear is mediated by the interaction of pathogen molecules with receptors such as the TLRs, leading to the activation of adaptor molecules and production of proinflammatory cytokines. TLR genes and signaling molecules are upregulated in OM in a murine model. Deletion of several key innate immune genes results in persistent OM in mice, coupled with an inability to clear bacterial infection from the middle ear. It is concluded that an intact innate immune signaling system is critical to recovery from bacterial OM