29 resultados para hospital discharge


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Hydrogenated amorphous silicon (a-Si:H) thin films have been deposited from silane using a novel photo-enhanced decomposition technique. The system comprises a hydrogen discharge lamp contained within the reaction vessel; this unified approach allows high energy photon excitation of the silane molecules without absorption by window materials or the need for mercury sensitisation. The film growth rates (exceeding 4 Angstrom/s) and material properties obtained are comparable to those of films produced by plasma-enhanced CVD techniques. The reduction of energetic charged particles in the film growth region should enable the fabrication of cleaner semiconductor/insulator interfaces in thin-film transistors.

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Desired performance of unpressurized integral collector storage systems hinges on the appropriate selection of storage volume and the immersed heat exchanger. This paper presents analytical results expressing the relation between storage volume, number of heat exchanger transfer units and temperature limited performance. For a system composed of a single storage element, the limiting behavior of a perfectly stratified storage element is shown to be superior to a fully-mixed storage element, consistent with more general analysis of thermal storage. Since, however, only the fully-mixed limit is readily obtainable in a physical system, the present paper also examines a division of the storage volume into separate compartments. This multi-element storage system shows significantly improved discharge characteristics as a result of improved elemental area utilization and temperature variation between elements, comparable in many cases to a single perfectly-stratified storage element. In addition, the multi-element system shows increased robustness with respect to variations in heat exchanger effectiveness and initial storage temperature.

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Hospitals are facing a triple challenge - meeting mandatory climate change targets and refurbishing aging infrastructure while simultaneously providing quality of care. With the potential of more frequent disruptive weather events, a UK government-funded project was launched in 2009 to investigate practical strategies for the National Health Service to increase its resilience to climate change. This paper presents the process of defining resilience by using the Delphi method and demonstrates its applicability within healthcare design. A Delphi survey is nearing completion which has determined the significant resilience issues and temperature ranges for ideal and critical conditions. Our preliminary findings identified six priorities that lead towards increasing resilience. Using the Delphi method can be a useful tool in clarifying the focus for healthcare design considerations. Copyright © 2002-2012 The Design Society. All rights reserved.

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The shallow water equations are widely used in modelling environmental flows. Being a hyperbolic system of differential equations, they admit shocks that represent hydraulic jumps and bores. Although the water surface can be solved satisfactorily with the modern shock-capturing schemes, the predicted flow rate often suffers from imbalances where shocks occur, eg the mass conservation is violated by failing to maintain a constant discharge rate at every cross-section in a steady open channel flow. A total-variation-diminishing Lax-Wendroff scheme is developed, and used to demonstrate how to achieve an exact flux balance. The performance of the proposed methods is inspected through some test cases, which include 1- and 2-dimensional, flat and irregular bed scenarios. The proposed methods are shown to preserve the mass exactly, and can be easily extended to other shock-capturing models.

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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%.

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Non-conventional methods of machining are used for many engineering applications where the traditional processes fail to be cost-effective. Such processes include Ion Beam Machining (IBM), focused ion beam (FIB) machining and plasma discharge machining. The mechanisms of material removal and associated hardware and software developed for industrial applications of these fascinating electro-physical and chemical machining processes are reviewed together with the latest research findings. © 2009 CIRP.