A patient flow simulator for healthcare management education

Simulation and analysis of patient flow can contribute to the safe and efficient functioning of a healthcare system, yet it is rarely incorporated into routine healthcare management, partially due to the technical training required. This paper introduces a free and open source patient flow simulation software tool that enables training and experimentation with healthcare management decisions and their impact on patient flow. Users manage their simulated hospital with a simple web-based graphical interface. The model is a stochastic discrete event simulation in which patients are transferred between wards of a hospital according to their treatment needs. Entry to each ward is managed by queues, with different policies for queue management and patient prioritisation per ward. Users can manage a simulated hospital, distribute resources between wards and decide how those resources should be prioritised. Simulation results are immediately available for analysis in-browser, including performance against targets, patient flow networks and ward occupancy. The patient flow simulator, freely available at https://khp-informatics.github.io/patient-flow-simulator, is an interactive educational tool that allows healthcare students and professionals to learn important concepts of patient flow and healthcare management

Aussie women game developers

Women are underrepresented in the digital games industry all over the world. In Australia, womens level of contribution to game development is much lower than the USA, Canada, and UK. Reviewing literature from the areas of computer science, information technology, and digital games, this study focuses on the impact of social, structural and cultural aspects, and how these factors might influence women choosing a career in the Australian digital games industry. Using a mixed-method, Grounded Theory approach, a large-scale census of Australian digital game studios was conducted, and followed up by semi-structured interviews of a small group of women game developers. Findings reveal that the number of women game developers in Australia has recently increased, and although work culture stereotypes and poor workplace conditions persist overseas, Australian women are not experiencing these issues. However, getting interested in digital game development is still a major obstacle in convincing young women to enroll in game development degrees at university. Once enrolled though, attrition is a problem that has been attributed to teaching styles, lack of confidence and how male peers treat female students in their first year. Those women, who eventually graduate and pursue a career in digital games, more often share the influence of strong parents, male siblings, and enjoyed playing games from a young age

Changes in the severity and subtype of Guillain-Barré syndrome admitted to a specialist Neuromedical ICU over a 25 year period

We report a retrospective review of 110 patients with acute Guillain-Barré syndrome (GBS) admitted to a specialised intensive care unit (ICU) in a tertiary referral centre over a 25 year period, the start of which coincided with the widespread introduction of plasma exchange (PE) and intravenous immunoglobulin (IVIG). The results were analysed by comparing 52 patients admitted in the first decade (1991-2000; Group 1) with 58 patients admitted between 2001-2014 (Group 2). Patients in both groups were comparable with respect to age and sex, and had a similar incidence and range of ICU complications. They received a comparable range of immunomodulatory treatments including IVIG and PE. However, the delay from presentation to referral to the tertiary ICU was longer in patients in Group 2. They also required mechanical ventilation for a longer duration, and had longer ICU and hospital stays. In Group 2, there was a higher incidence of axonal neuropathy (51%, compared to 24% in Group 1). Despite the longer delay to referral, the prevalence of axonal neuropathy and the duration of ventilation, overall mortality showed a downward trend (Group 1: 13.5%; Group 2: 5.2%). There was no late mortality in either group after step-down to neuro-rehabilitation or following discharge home or to the referring hospital. The rehabilitation outcomes were similar. This data show a shift in the pattern of referral to a tertiary referral ICU between the first and second decades following the wider availability of IVIG and PE for the treatment of GBS. The possible causes and implications of these findings are discussed

May I have your consent? Informed consent in clinical trials- feasibility in emergency situations

Clinical researchers in acute emergency settings are commonly faced with the difficulty of satisfying the conventional ethical requirement of obtaining informed consent, whilst ensuring a representative group of patients is recruited into studies. We discuss our own experience in addressing institutional ethical requirements to obtain informed consent in a multi-centre trial, recruiting highly agitated patients in the emergency setting in Melbourne, Australia. We suggest that, through the application of existing ethical and legal frameworks and pre-emptive communication with the key stakeholders in ethics committees, hospital insurers and legal representatives, a balance can be struck between ethical and legal requirements on the one hand, and the integrity of the research question, on the other.published_or_final_versio

Shear design of HSC beams with combination of links and horizontal web steel

The existing recommendations in Eurocode 2 and the British Code of Practice for the shear design of beams are derived from research conducted essentially on normal-strength concrete (NSC) with cube strengths up to 50 MPa, and it was found that the shear strengths of high-strength concrete (HSC) members made with limestone aggregate are below the characteristic resistances of identical NSC members. Previous experimental tests have also shown that significant differences exist in the angle of crack of shear failure of NSC and HSC. This paper presents data from five beam tests, which demonstrate that HSC with limestone aggregate has a reduced shear strength compared with NSC made with gravel and thus shows a gap in knowledge in the design approach to shear resistance of HSC beams. Previous investigations have suggested that horizontal web steels can contribute to the overall shear resistance of a reinforced concrete member in conjunction with the other constituents, concrete, tension and shear steel. The paper also presents data from tests on 11 beam tests and shows that the shear resistance of HSC beams is highly dependent on dowel action resulting from horizontal web bars positioned at the centre of the depth of the beam. Past attempts to quantify this dowel action are investigated and an improved design rule is proposed

Family memories in the home: contrasting physical and digital mementos

We carried out fieldwork to characterise and compare physical and digital mementos in the home. Physical mementos are highly valued, heterogeneous and support different types of recollection. Contrary to expectations, we found physical mementos are not purely representational, and can involve appropriating common objects and more idiosyncratic forms. In contrast, digital mementos were initially perceived as less valuable, although participants later reconsidered this. Digital mementos were somewhat limited in function and expression, largely involving representational photos and videos, and infrequently accessed. We explain these digital limitations and conclude with design guidelines for digital mementos, including better techniques for accessing and integrating these into everyday life, allowing them to acquire the symbolic associations and lasting value that characterise their physical counterparts

Outbreak of West Nile virus causing severe neurological involvement in children, Nuba Mountains, Sudan, 2002.

An atypical outbreak of West Nile virus (WNV) occurred in Ngorban County, South Kordophan, Sudan, from May to August 2002. We investigated the epidemic and conducted a case-control study in the village of Limon. Blood samples were obtained for cases and controls. Patients with obvious sequelae underwent cerebrospinal fluid (CSF) sampling as well. We used enzyme-linked immunosorbent assay (ELISA) and neutralization tests for laboratory diagnosis and identified 31 cases with encephalitis, four of whom died. Median age was 36 months. Bivariate analysis did not reveal any significant association with the risk factors investigated. Laboratory analysis confirmed presence of IgM antibodies caused by WNV in eight of 13 cases, indicative of recent viral infection. The unique aspects of the WNW outbreak in Sudan, i.e. disease occurrence solely among children and the clinical domination of encephalitis, involving severe neurological sequelae, demonstrate the continuing evolution of WNV virulence. The spread of such a virus to other countries or continents cannot be excluded

Skin-derived dendritic cells acquire and degrade the scrapie agent following in vitro exposure

The accumulation of the scrapie agent in lymphoid tissues following inoculation via the skin is critical for efficient neuroinvasion, but how the agent is initially transported from the skin to the draining lymph node is not known. Langerhans cells (LCs) are specialized antigen-presenting cells that continually sample their microenvironment within the epidermis and transport captured antigens to draining lymph nodes. We considered LCs probable candidates to acquire and transport the scrapie agent after inoculation via the skin. XS106 cells are dendritic cells (DCs) isolated from mouse epidermis with characteristics of mature LC cells. To investigate the potential interaction of LCs with the scrapie agent XS106 cells were exposed to the scrapie agent in vitro. We show that XS106 cells rapidly acquire the scrapie agent following in vitro exposure. In addition, XS106 cells partially degrade the scrapie agent following extended cultivation. These data suggest that LCs might acquire and degrade the scrapie agent after inoculation via the skin, but data from additional experiments demonstrate that this ability could be lost in the presence of lipopolysaccharide or other immunostimulatory molecules. Our studies also imply that LCs would not undergo maturation following uptake of the scrapie agent in the skin, as the expression of surface antigens associated with LC maturation were unaltered following exposure. In conclusion, although LCs or DCs have the potential to acquire the scrapie agent within the epidermis our data suggest it is unlikely that they become activated and stimulated to transport the agent to the draining lymph node

Mitochondrial DNA mutations in individuals occupationally exposed to ionizing radiation

Mutations in a 443-bp amplicon of the hypervariable region HVR1 of the D-loop of mitochondrial DNA (mtDNA) were quantified in DNA extracted from peripheral blood samples of 10 retired radiation workers who had accumulated external radiation doses of .0.9 Sv over the course of their working life and were compared to the levels of mutations in 10 control individuals matched for age and smoking status. The mutation rate in the 10 exposed individuals was 9.92 3 1025 mutations/ nucleotide, and for the controls it was 8.65 3 1025 mutations/ nucleotide, with a procedural error rate of 2.65 3 1025 mutations/ nucleotide. No increase in mtDNA mutations due to radiation exposure was detectable (P 5 0.640). In contrast, chromosomal translocation frequencies, a validated radiobiological technique for retrospective dosimetric purposes, were significantly elevated in the exposed individuals. This suggests that mutations identified through sequencing of mtDNA in peripheral blood lymphocytes do not represent a promising genetic marker of DNA damage after low-dose or low-doserate exposures to ionizing radiation. There was an increase in singleton mutations above that attributable to procedural error in both exposed and control groups that is likely to reflect age-related somatic mutation

Ecological succession of a Jurassic shallow-water ichthyosaur fall.

After the discovery of whale fall communities in modern oceans, it has been hypothesized that during the Mesozoic the carcasses of marine reptiles created similar habitats supporting long-lived and specialized animal communities. Here, we report a fully documented ichthyosaur fall community, from a Late Jurassic shelf setting, and reconstruct the ecological succession of its micro- and macrofauna. The early 'mobile-scavenger' and 'enrichment-opportunist' stages were not succeeded by a 'sulphophilic stage' characterized by chemosynthetic molluscs, but instead the bones were colonized by microbial mats that attracted echinoids and other mat-grazing invertebrates. Abundant cemented suspension feeders indicate a well-developed 'reef stage' with prolonged exposure and colonization of the bones prior to final burial, unlike in modern whale falls where organisms such as the ubiquitous bone-eating worm Osedax rapidly destroy the skeleton. Shallow-water ichthyosaur falls thus fulfilled similar ecological roles to shallow whale falls, and did not support specialized chemosynthetic communities