Stress on the ward: evidence of safety tipping points in hospitals

Do hospitals experience safety tipping points as utilization increases, and if so, what are the implications for hospital operations management? We argue that safety tipping points occur when managerial escalation policies are exhausted and workload variability buffers are depleted. Front-line clinical staff is forced to ration resources and, at the same time, becomes more error prone as a result of elevated stress hormone levels. We confirm the existence of safety tipping points for in-hospital mortality using the discharge records of 82,280 patients across six high-mortality-risk conditions from 256 clinical departments of 83 German hospitals. Focusing on survival during the first seven days following admission, we estimate a mortality tipping point at an occupancy level of 92.5%. Among the 17% of patients in our sample who experienced occupancy above the tipping point during the first seven days of their hospital stay, high occupancy accounted for one in seven deaths. The existence of a safety tipping point has important implications for hospital management. First, flexible capacity expansion is more cost-effective for safety improvement than rigid capacity, because it will only be used when occupancy reaches the tipping point. In the context of our sample, flexible staffing saves more than 40% of the cost of a fully staffed capacity expansion, while achieving the same reduction in mortality. Second, reducing the variability of demand by pooling capacity in hospital clusters can greatly increase safety in a hospital system, because it reduces the likelihood that a patient will experience occupancy levels beyond the tipping point. Pooling the capacity of nearby hospitals in our sample reduces the number of deaths due to high occupancy by 34%.

Fast Hands-free Writing by Gaze Direction

We describe a method for text entry based on inverse arithmetic coding that relies on gaze direction and which is faster and more accurate than using an on-screen keyboard. These benefits are derived from two innovations: the writing task is matched to the capabilities of the eye, and a language model is used to make predictable words and phrases easier to write.

Directly-modulated DS-DBR tunable laser for uncooled C-band WDM system

A tunable DS-DBR laser is demonstrated for uncooled WDM C-band channel generation with tight spacing (SOGHz) and low thermal drift (±2.5GHz) up to 70°C. 2.5Gb/s direct modulation with transmission over a 75km link is achieved. © 2000 Optical Society of America.

INFLUENCE OF MICROSTRUCTURE ON THE TOUGHNESS OF CARBON FIBRE/PLASTIC COMPOSITES.

A preliminary study is presented of the relationship between the microstructural aspects of failure and the fracture energy G//1//C for cracking parallel to the fibres in long-fibre/thermoplastic matrix composites. Fracture energies are measured by a new technique, and fracture surfaces generated by the test are examined by scanning electron microscopy.

INFLUENCE OF MICROSTRUCTURE ON THE TOUGHNESS OF CARBON FIBRE/PLASTIC COMPOSITES.

A preliminary study is presented of the relationship between the microstructural aspects of failure and the fracture energy G//l//C for cracking parallel to the fibres in long-fibre/thermoplastic matrix composites. Fracture energies are measured by a new technique, and fracture surfaces generated by the test are examined by scanning electron microscopy.

Dasher - A data entry interface using continuous gestures and language models

Existing devices for communicating information to computers are bulky, slow to use, or unreliable. Dasher is a new interface incorporating language modelling and driven by continuous two-dimensional gestures, e.g. a mouse, touchscreen, or eye-tracker. Tests have shown that this device can be used to enter text at a rate of up to 34 words per minute, compared with typical ten-finger keyboard typing of 40-60 words per minute. Although the interface is slower than a conventional keyboard, it is small and simple, and could be used on personal data assistants and by motion-impaired computer users.

UK guidance on the initial evaluation of an infant or an adolescent with a suspected disorder of sex development

It is paramount that any child or adolescent with a suspected disorder of sex development (DSD) is assessed by an experienced clinician with adequate knowledge about the range of conditions associated with DSD. If there is any doubt, the case should be discussed with the regional team. In most cases, particularly in the case of the newborn, the paediatric endocrinologist within the regional DSD team acts as the first point of contact. The underlying pathophysiology of DSD and the strengths and weaknesses of the tests that can be performed should be discussed with the parents and affected young person and tests undertaken in a timely fashion. This clinician should be part of a multidisciplinary team experienced in management of DSD and should ensure that the affected person and parents are as fully informed as possible and have access to specialist psychological support. Finally, in the field of rare conditions, it is imperative that the clinician shares the experience with others through national and international clinical and research collaboration. © 2011 Blackwell Publishing Ltd.