A Clustered Overflow Configuration of Inpatient Beds in Hospitals

Problem Definition: The shortage of inpatient beds is a major cause of delays and cancellations in many hospitals. It may also lead to patients being admitted to inappropriate wards, whereby resulting in a lower quality of care and a longer length of stay. Academic/Practical Relevance: Investment in additional beds is not always feasible. Instead, new and creative solutions for a more efficient use of existing resources must be sought. Methodology: We propose a new configuration of inpatient beds which we call the clustered overflow configuration. In this configuration, patients who are denied admission to their primary wards as a result of beds being fully occupied are admitted to overflow wards, with each designated to serve overflows from a certain subset of specialties and providing the same quality of care as in primary wards. We propose two different formulations for partitioning and bed allocation in the proposed configuration: one minimizing the sum of average daily costs of turning patients away and nursing teams, and another minimizing the numbers turned away subject to nursing cost falling below a given threshold. We heuristically solve instances from both formulations. Results: Applying the models to real data shows that the configurations obtained from our models compare very well with the other configurations proposed in the literature, provided that patients' willingness to wait is relatively short. Managerial Implications: The proposed configuration provides the combined advantages of the dedicated configuration, wherein patients are only admitted to their primary wards, and the exible configuration, in which all specialties share a single ward. On the other hand, it restricts the adverse impacts of pooling and minimizes cross-training costs through appropriate partitioning and bed allocation. As such, it serves as a viable alternative to existing inpatient configurations

Prevalence of psychosis in black ethnic minorities in Britain: analysis based on three national surveys

Purpose A considerable excess of psychosis in black ethnic minorities is apparent from clinical studies, in Britain, as in other developed economies with white majority populations. This excess is not so marked in population surveys. Equitable health service provision should be informed by the best estimates of the excess. We used national survey data to establish the difference in the prevalence of psychosis between black ethnic groups and the white majority in the British general population. Methods Analysis of the combined datasets (N = 26,091) from the British national mental health surveys of 1993, 2000 and 2007. Cases of psychosis were determined either by the use of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), or from a combination of screening items. We controlled for sex, age, social class, unemployment, design features and other putative confounders, using a Disease Risk Score. Results People from black ethnic minorities had an excess prevalence rate of psychosis compared with the white majority population. The OR, weighted for study design and response rate, was 2.72 (95 % CI 1.3–5.6, p = 0.002). This was marginally increased after controlling for potential confounders (OR = 2.90, 95 % CI 1.4–6.2, p = 0.006). Conclusions The excess of psychosis in black ethnic minority groups was similar to that in two previous British community surveys, and less than that based on clinical studies. Even so it confirms a considerable need for increased mental health service resources in areas with high proportions of black ethnic minority inhabitants

Satellite observations are needed to understand ocean acidification and multi-stressor impacts on fish stocks in a changing Arctic Ocean

This is the final version. Available from Frontiers Media via the DOI in this record. It is widely projected that under future climate scenarios the economic importance of Arctic Ocean fish stocks will increase. The Arctic Ocean is especially vulnerable to ocean acidification and already experiences low pH levels not projected to occur on a global scale until 2100. This paper outlines how ocean acidification must be considered with other potential stressors to accurately predict movement of fish stocks toward, and within, the Arctic and to inform future fish stock management strategies. First, we review the literature on ocean acidification impacts on fish, next we identify the main obstacles that currently preclude ocean acidification from Arctic fish stock projections. Finally, we provide a roadmap to describe how satellite observations can be used to address these gaps: improve knowledge, inform experimental studies, provide regional assessments of vulnerabilities, and implement appropriate management strategies. This roadmap sets out three inter-linked research priorities: (1) Establish organisms and ecosystem physiochemical baselines by increasing the coverage of Arctic physicochemical observations in both space and time; (2) Understand the variability of all stressors in space and time; (3) Map life histories and fish stocks against satellite-derived observations of stressors.European Space AgencyAXA XL Ocean Risk Scholarshi

Decision for reconstructive interventions of the upper limb in individuals with tetraplegia: the effect of treatment characteristics

Objective: To determine the effect of treatment characteristics on the\ud decision for reconstructive interventions for the upper extremities (UE) in\ud subjects with tetraplegia. - \ud Setting: Seven specialized spinal cord injury centres in the Netherlands. - \ud Method: Treatment characteristics for UE reconstructive interventions were\ud determined. Conjoint analysis (CA) was used to determine the contribution\ud and the relative importance of the treatment characteristics on the decision\ud for therapy. Therefore, a number of different treatment scenarios using these\ud characteristics were established. Different pairs of scenarios were presented\ud to subjects who were asked to choose the preferred scenario of each set. - \ud Results: forty nine subjects with tetraplegia with a stable C5, C6 or C7\ud lesion were selected. All treatment characteristics significantly influenced\ud the choice for treatment. Relative importance of treatment characteristics\ud were: intervention type (surgery or surgery with FES implant) 13%, number\ud of operations 15%, in patient rehabilitation period 22%, ambulant\ud rehabilitation period 9%, complication rate 15%, improvement of elbow\ud function 10%, improvement of hand function 15%. In deciding for therapy\ud 40% of the subjects focused on one characteristic. - \ud Conclusion: CA is applicable in Spinal Cord Injury medicine to study the\ud effect of health outcomes and non-health outcomes on the decision for\ud treatment. Non-health outcomes which relate to the intensity of treatment\ud are equally important or even more important than functional outcome in the\ud decision for reconstructive UE surgery in subjects with tetraplegia

Observing temporally varying synoptic‐scale total alkalinity and dissolved inorganic carbon in the Arctic Ocean

This is the final version. Available from Wiley via the DOI in this record. Data Availability Statement: The matchup database “OceanSODA-MDB” which was used in the algorithm evaluation is available at https:// data-cersat.ifremer.fr/data/ocean-carbonate/oceansoda-mmdb/ (Land et al., 2023; Land & Piollé, 2022). The python code used to run the analysis can be found at https://doi.org/10.5281/zenodo.10067204 (Green et al., 2023) and was adapted from DOI: https://doi.org/10.5281/zenodo.10069611 (Sims et al., 2022).The long-term absorption by the oceans of atmospheric carbon dioxide is leading to the slow decline of ocean pH, a process termed ocean acidification (OA). The Arctic is a challenging region to gather enough data to examine the changes in carbonate chemistry over sufficient scales. However, algorithms that calculate carbonate chemistry parameters from more frequently measured parameters, such as temperature and salinity, can be used to fill in data gaps. Here, these published algorithms were evaluated against in situ measurements using different data input types (data from satellites or in situ re-analysis climatologies) across the Arctic Ocean. With the lowest uncertainties in the Atlantic influenced Seas (AiS), where re-analysis inputs achieved total alkalinity estimates with Root Mean Squared Deviation (RMSD) of 21 μmol kg−1 and a bias of 2 μmol kg−1 (n = 162) and dissolved inorganic carbon RMSD of 24 μmol kg−1 and bias of −14 μmol kg−1 (n = 262). AiS results using satellite observation inputs show similar bias but larger RMSD, although due to the shorter time span of available satellite observations, more contemporary in situ data would provide further assessment and improvement. Synoptic-scale observations of surface water carbonate conditions in the Arctic are now possible to monitor OA, but targeted in situ data collection is needed to enable the full exploitation of satellite observation-based approaches.European Space AgencyAXA XLJoint Transnational Call on Next Generation Climate Science in Europe for the Ocea

The role of mentorship in protege performance

The role of mentorship on protege performance is a matter of importance to academic, business, and governmental organizations. While the benefits of mentorship for proteges, mentors and their organizations are apparent, the extent to which proteges mimic their mentors' career choices and acquire their mentorship skills is unclear. Here, we investigate one aspect of mentor emulation by studying mentorship fecundity---the number of proteges a mentor trains---with data from the Mathematics Genealogy Project, which tracks the mentorship record of thousands of mathematicians over several centuries. We demonstrate that fecundity among academic mathematicians is correlated with other measures of academic success. We also find that the average fecundity of mentors remains stable over 60 years of recorded mentorship. We further uncover three significant correlations in mentorship fecundity. First, mentors with small mentorship fecundity train proteges that go on to have a 37% larger than expected mentorship fecundity. Second, in the first third of their career, mentors with large fecundity train proteges that go on to have a 29% larger than expected fecundity. Finally, in the last third of their career, mentors with large fecundity train proteges that go on to have a 31% smaller than expected fecundity.Comment: 23 pages double-spaced, 4 figure

OceanSODA-UNEXE: a multi-year gridded Amazon and Congo River outflow surface ocean carbonate system dataset

Large rivers play an important role in transferring water and all of its constituents, including carbon in its various forms, from the land to the ocean, but the seasonal and inter-annual variations in these riverine flows remain unclear. Satellite Earth observation datasets and reanalysis products can now be used to observe synoptic-scale spatial and temporal variations in the carbonate system within large river outflows. Here, we present the University of Exeter (UNEXE) Satellite Oceanographic Datasets for Acidification (OceanSODA) dataset (OceanSODA-UNEXE) time series, a dataset of the full carbonate system in the surface water outflows of the Amazon (2010–2020) and Congo (2002–2016) rivers. Optimal empirical approaches were used to generate gridded total alkalinity (TA) and dissolved inorganic carbon (DIC) fields in the outflow regions. These combinations were determined by equitably evaluating all combinations of algorithms and inputs against a reference matchup database of in situ observations. Gridded TA and DIC along with gridded temperature and salinity data enable the calculation of the full carbonate system in the surface ocean (which includes pH and the partial pressure of carbon dioxide, pCO2). The algorithm evaluation constitutes a Type-A uncertainty evaluation for TA and DIC, in which model, input and sampling uncertainties are considered. Total combined uncertainties for TA and DIC were propagated through the carbonate system calculation, allowing all variables to be provided with an associated uncertainty estimate. In the Amazon outflow, the total combined uncertainty for TA was 36 µmol kg−1 (weighted root-mean-squared difference, RMSD, of 35 µmol kg−1 and weighted bias of 8 µmol kg−1 for n = 82), whereas it was 44 µmol kg−1 for DIC (weighted RMSD of 44 µmol kg−1 and weighted bias of −6 µmol kg−1 for n = 70). The spatially averaged propagated combined uncertainties for the pCO2 and pH were 85 µatm and 0.08, respectively, where the pH uncertainty was relative to an average pH of 8.19. In the Congo outflow, the combined uncertainty for TA was identified as 29 µmol kg−1 (weighted RMSD of 28 µmol kg−1 and weighted bias of 6 µmol kg−1 for n = 102), whereas it was 40 µmol kg−1 for DIC (weighted RMSD of 37 µmol kg−1 and weighted bias of −16 µmol kg−1 for n = 77). The spatially averaged propagated combined uncertainties for pCO2 and pH were 74 µatm and 0.08, respectively, where the pH uncertainty was relative to an average pH of 8.21. The combined uncertainties in TA and DIC in the Amazon and Congo outflows are lower than the natural variability within their respective regions, allowing the time-varying regional variability to be evaluated. Potential uses of these data would be the assessment of the spatial and temporal flow of carbon from the Amazon and Congo rivers into the Atlantic and the assessment of the riverine-driven carbonate system variations experienced by tropical reefs within the outflow regions. The data presented in this work are available at https://doi.org/10.1594/PANGAEA.946888 (Sims et al., 2023)

Sebomic identification of sex- and ethnicity-specific variations in residual skin surface components (RSSC) for bio-monitoring or forensic applications

Background: “Residual skin surface components” (RSSC) is the collective term used for the superficial layer of sebum, residue of sweat, small quantities of intercellular lipids and components of natural moisturising factor present on the skin surface. Potential applications of RSSC include use as a sampling matrix for identifying biomarkers of disease, environmental exposure monitoring, and forensics (retrospective identification of exposure to toxic chemicals). However, it is essential to first define the composition of “normal” RSSC. Therefore, the aim of the current study was to characterise RSSC to determine commonalities and differences in RSSC composition in relation to sex and ethnicity. Methods: Samples of RSSC were acquired from volunteers using a previously validated method and analysed by high-pressure liquid chromatography–atmospheric pressure chemical ionisation–mass spectrometry (HPLC-APCI-MS). The resulting data underwent sebomic analysis. Results: The composition and abundance of RSSC components varied according to sex and ethnicity. The normalised abundance of free fatty acids, wax esters, diglycerides and triglycerides was significantly higher in males than females. Ethnicity-specific differences were observed in free fatty acids and a diglyceride. Conclusions: The HPLC-APCI-MS method developed in this study was successfully used to analyse the normal composition of RSSC. Compositional differences in the RSSC can be attributed to sex and ethnicity and may reflect underlying factors such as diet, hormonal levels and enzyme expression.Peer reviewedFinal Published versio

A composite light-harvesting layer from photoactive polymer and halide perovskite for planar heterojunction solar cells

A new route for fabrication of photoactive materials in organic-inorganic hybrid solar cells is presented in this report. Photoactive materials by blending a semiconductive conjugated polymer with an organolead halide perovskite were fabricated for the first time. The composite active layer was then used to make planar heterojunction solar cells with the PCBM film as the electron-acceptor. Photovoltaic performance of solar cells was investigated by J-V curves and external quantum efficiency spectra. We demonstrated that the incorporation of the conjugated photoactive polymer into organolead halide perovskites did not only contribute to the generation of charges, but also enhance stability of solar cells by providing a barrier protection to halide perovskites. It is expected that versatile of conjugated semi-conductive polymers and halide perovskites in photoactive properties enables to create various combinations, forming composites with advantages offered by both types of photoactive materials

Forced migrants involved in setting the agenda and designing research to reduce impacts of complex emergencies: combining Swarm with patient and public involvement

Background: Many events with wide-ranging negative health impacts are notable for complexity: lack of predictability, non-linear feedback mechanisms and unexpected consequences. A multi-disciplinary research team was tasked with reducing the public health impacts from complex events, but without a pre-specified topic area or research design. This report describes using patient and public involvement within an adaptable but structured development process to set research objectives and aspects of implementation. Methods: An agile adaptive development approach, sometimes described as swarm, was used to identify possible research areas. Swarm is meant to quickly identify strengths and weaknesses of any candidate project, to accelerate early failure before resources are invested. When aspects of the European migration crisis were identified as a potential priority topic area, two representatives of forced migrant communities were recruited to explore possible research ideas. These representatives helped set the specific research objectives and advised on aspects of implementation, still within the swarm framework for project development. Results: Over ten months, many research ideas were considered by the collaborative working group in a series of six group meetings, supplemented by email contact in between. Up to four possible research ideas were scrutinised at any one meeting, with a focus on identifying practical or desirable aspects of each proposed project. Interest settled on a study to solicit original data about successful strategies that forced migrants use to adapt to life in the UK, with an emphasis on successfully promoting resilience and minimizing emotional distress. “Success in resettlement” was identified to be a more novel theme than “barriers to adaption” research. A success approach encourages participation when individuals may find discussion of mental illness stigmatising. The patient representatives helped with design of patient-facing and interview training materials, interviewer training (mock interviews), and aspects of the recruitment. Conclusion: Using patient and public involvement (PPI) within an early failure development approach that itself arises from theory on complex adaptive systems, we successfully implemented a dynamic development process to determine research topic and study design. The PPI representatives were closely involved in setting research objectives and aspects of implementation