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%.

The night purging of a two-storey atrium building

We examine the fluid mechanics of night purging in a two-storey naturally ventilated atrium building. We develop a mathematical model of a simplified atrium building and focus on the rate at which warm air purges from each storey and the atrium by displacement ventilation into a still cool night environment of a constant temperature. To develop a first insight into how the geometry of the building influences the rate at which warm air purges from each storey via the atrium we neglect heat exchange with the fabric (so there is no thermal buffering) and furthermore assume that the warm air layers in each storey and the atrium are of uniform temperature. The plumes of warm air that rise from the storeys into the atrium, causing the atrium to fill with warm air, have a very strong influence on the night purge. Modelling these as axisymmetric turbulent plumes, we identify three forms of purging behaviour. Each purge is characterised by five key times identified in the progression of the night purge and physical rationale for these differing behaviours is given. An interface velocity deficit and volumetric purge deficit are introduced as measures of the efficiency of a night purge. © 2010 Elsevier Ltd.

Dead-time minimisation using active voltage control gate drive for high-power IGBT converters

High-power converters usually need longer dead-times than their lower-power counterparts and a lower switching frequency. Also due to the complicated assembly layout and severe variations in parasitics, in practice the conventional dead-time specific adjustment or compensation for high-power converters is less effective, and usually this process is time-consuming and bespoke. For general applications, minimising or eliminating dead-time in the gate drive technology is a desirable solution. With the growing acceptance of power electronics building blocks (PEBB) and intelligent power modules (IPM), gate drives with intelligent functions are in demand. Smart functions including dead time elimination/minimisation can improve modularity, flexibility and reliability. In this paper, a dead-time minimisation using Active Voltage Control (AVC) gate drive is presented. © 2012 IEEE.

Tomorrow's cities - a framework for building resilience

Urbanisation is the great driving force of the twenty-first century. Cities are associated with both productivity and creativity, and the benefits offered by closely connected and high density living and working contribute to sustainability. At the same time, cities need extensive infrastructure – like water, power, sanitation and transportation systems – to operate effectively. Cities therefore comprise multiple components, forming both static and dynamic systems that are interconnected directly and indirectly on a number of levels, all forming the backdrop for the interaction of people and processes. Bringing together large numbers of people and complex products in rich interactions can lead to vulnerability from hazards, threats and even trends, whether natural hazards, epidemics, political upheaval, demographic changes, economic instability and/or mechanical failures; The key to countering vulnerability is the identification of critical systems and clear understanding of their interactions and dependencies. Critical systems can be assessed methodically to determine the implications of their failure and their interconnectivities with other systems to identify options. The overriding need is to support resilience – defined here as the degree to which a system or systems can continue to function effectively in a changing environment. Cities need to recognise the significance of devising adaptation strategies and processes to address a multitude of uncertainties relating to climate, economy, growth and demography. In this paper we put forward a framework to support cities in understanding the hazards, threats and trends that can make them vulnerable to unexpected changes and unpredictable shocks. The framework draws on an asset model of the city, in which components that contribute to resilience include social capital, economic assets, manufactured assets, and governance. The paper reviews the field, and draws together an overarching framework intended to help cities plan a robust trajectory towards increased resilience through flexibility, resourcefulness and responsiveness. It presents some brief case studies demonstrating the applicability of the proposed framework to a wide variety of circumstances.

Turbine blade tip heat transfer in low speed and high speed flows

In this paper, high and low speed tip flows are investigated for a high-pressure turbine blade. Previous experimental data are used to validate a CFD code, which is then used to study the tip heat transfer in high and low speed cascades. The results show that at engine representative Mach numbers the tip flow is predominantly transonic. Thus, compared to the low speed tip flow, the heat transfer is affected by reductions in both the heat transfer coefficient and the recovery temperature. The high Mach numbers in the tip region (M>1.5) lead to large local variations in recovery temperature. Significant changes in the heat transfer coefficient are also observed. These are due to changes in the structure of the tip flow at high speed. At high speeds, the pressure side corner separation bubble reattachment occurs through supersonic acceleration which halves the length of the bubble when the tip gap exit Mach number is increased from 0.1 to 1.0. In addition, shock/boundary-layer interactions within the tip gap lead to large changes in the tip boundary-layer thickness. These effects give rise to significant differences in the heat-transfer coefficient within the tip region compared to the low-speed tip flow. Compared to the low speed tip flow, the high speed tip flow is much less dominated by turbulent dissipation and is thus less sensitive to the choice of turbulence model. These results clearly demonstrate that blade tip heat transfer is a strong function of Mach number, an important implication when considering the use of low speed experimental testing and associated CFD validation in engine blade tip design. Copyright © 2009 by ASME.

The high strain rate response of Ultra High Molecular-weight Polyethylene: From fibre to laminate

The effect of strain rate upon the uniaxial response of Ultra High Molecular-weight Polyethylene (UHMWPE) fibres, yarns and laminates of lay-up [0/90]48 has been measured in both the 0/90 and ±45 configurations. The tensile strength of the matrix-dominated ±45 laminate is two orders of magnitude less than that of the fibre-dominated 0/90 laminate, and is more sensitive to strain rate. A piezoelectric force sensor device was developed to obtain the high strain rate data, and this achieved a rise time of less than 1 μs. It is found that the failure strength (and failure strain) of the yarn is almost insensitive to strain rate within the range (10 -1-103 s-1). At low strain rates (below 10 -1 s-1), creep of the yarn dominates and the failure strain increases with diminishing strain rate. The tensile strength of the dry yarn exceeds that of the laminate by about 20%. Tests on single fibres exceed the strength of the yarn by 20%. © 2013 Elsevier Ltd. All rights reserved.

High resolution direct measurement of temperature distribution in silicon nanophotonics devices.

Following the miniaturization of photonic devices and the increase in data rates, the issues of self heating and heat removal in active nanophotonic devices should be considered and studied in more details. In this paper we use the approach of Scanning Thermal Microscopy (SThM) to obtain an image of the temperature field of a silicon micro ring resonator with sub-micron spatial resolution. The temperature rise in the device is a result of self heating which is caused by free carrier absorption in the doped silicon. The temperature is measured locally and directly using a temperature sensitive AFM probe. We show that this local temperature measurement is feasible in the photonic device despite the perturbation that is introduced by the probe. Using the above method we observed a significant self heating of about 10 degrees within the device.

A bottom-up energy analysis across a diverse urban building portfolio: Retrofits for the buildings at the Royal Botanic Gardens, Kew, UK

A methodology for the analysis of building energy retrofits has been developed for a diverse set of buildings at the Royal Botanic Gardens (RBG), Kew in southwest London, UK. The methodology requires selection of appropriate building simulation tools dependent on the nature of the principal energy demand. This has involved the development of a stand-alone model to simulate the heat flow in botanical glasshouses, as well as stochastic simulation of electricity demand for buildings with high equipment density and occupancy-led operation. Application of the methodology to the buildings at RBG Kew illustrates the potential reduction in energy consumption at the building scale achievable from the application of retrofit measures deemed appropriate for heritage buildings and the potential benefit to be gained from onsite generation and supply of energy. © 2014 Elsevier Ltd.

Dopant compensation in HfO2 and other high K oxides

The theory of doping limits in semiconductors and insulators is applied to the case of wide gap oxides, crystalline, or amorphous, and used to explain that impurities do not in general give rise to gap states or a doping response. Instead, the system tends to form defect complexes or undergo symmetry-lowering reconstructions to expel gap states out of the band gap. The model is applied to impurities, such as trivalent metals, carbon, N, P, and B, in HfO2, the main gate dielectric used in field effect transistors. © 2014 AIP Publishing LLC.