Emergency department crowding: prioritising quantified crowding measures using a Delphi study.

AimsEmergency department (ED) crowding has been associated with a number of negative health outcomes, including unnecessary deaths, increased waiting times and a decrease in care quality. Despite the seriousness of this issue, there is little agreement on appropriate crowding measures to assess crowding effects on ED operations. The objective of this study was to prioritise a list of quantified crowding measures that would assess the current state of a department.MethodsA three round Delphi study was conducted via email and an Internet based survey tool. The panel consisted of 40 professionals who had exposure to and expertise in crowding. Participants submitted quantified crowding measures which, through three rounds, were evaluated and ranked to assess participant agreement for inclusion.ResultsThe panel identified 27 measures of which eight (29.6%) reached consensus at the end of the study. These measures comprised: (1) ability of ambulances to offload; (2) patients who leave without being seen or treated; (3) time until triage; (4) ED occupancy rate; (5) patients' total length of stay in the ED; (6) time to see a physician; (7) ED boarding time; and (8) number of patients boarding in the ED.ConclusionsThis study resulted in the identification of eight quantified crowding measures, which present a comprehensive view of how crowding is affecting ED operations, and highlighted areas of concern. These quantified measures have the potential to make a considerable contribution to decision making by ED management and to provide a basis for learning across different departments.

Copula-based Kernel Dependency Measures

The paper presents a new copula based method for measuring dependence between random variables. Our approach extends the Maximum Mean Discrepancy to the copula of the joint distribution. We prove that this approach has several advantageous properties. Similarly to Shannon mutual information, the proposed dependence measure is invariant to any strictly increasing transformation of the marginal variables. This is important in many applications, for example in feature selection. The estimator is consistent, robust to outliers, and uses rank statistics only. We derive upper bounds on the convergence rate and propose independence tests too. We illustrate the theoretical contributions through a series of experiments in feature selection and low-dimensional embedding of distributions.

Use of wavefront encoding in optical interconnects and fiber switches for cross talk mitigation

A technique of cross talk mitigation developed for liquid crystal on silicon spatial light modulator based optical interconnects and fiber switches is demonstrated. By purposefully introducing an appropriate aberration into the system, it is possible to reduce the worst-case cross talk by over 10 dB compared to conventional Fourier-transform-based designs. Tests at a wavelength of 674nm validate this approach, and show that there is no noticeable reduction in diffraction efficiency. A 27% spot increase in beam diameter is observed, which is predicted to reduce at longer datacom and telecom wavelengths. © 2012 Optical Society of America.

Closing the Energy Efficiency Gap: A study linking demographics with barriers to adopting energy efficiency measures in the home

This paper presents a study which linked demographic variables with barriers affecting the adoption of domestic energy efficiency measures in large UK cities. The aim was to better understand the 'Energy Efficiency Gap' and improve the effectiveness of future energy efficiency initiatives. The data for this study was collected from 198 general population interviews (1.5-10 min) carried out across multiple locations in Manchester and Cardiff. The demographic variables were statistically linked to the identified barriers using a modified chi-square test of association (first order Rao-Scott corrected to compensate for multiple response data), and the effect size was estimated with an odds-ratio test. The results revealed that strong associations exist between demographics and barriers, specifically for the following variables: sex; marital status; education level; type of dwelling; number of occupants in household; residence (rent/own); and location (Manchester/Cardiff). The results and recommendations were aimed at city policy makers, local councils, and members of the construction/retrofit industry who are all working to improve the energy efficiency of the domestic built environment. © 2012 Elsevier Ltd.

Ventilation effectiveness measures based on heat removal: Part 2. Application to natural ventilation flows

The three effectiveness measures based on the ability of a flow to flush buoyancy from a ventilated space proposed by Coffey and Hunt [Ventilation effectiveness measures based on heat removal-part 1. Definitions. Building and Environment, in press, doi:10.1016/j.buildenv.2006.03.016.] are applied to assess and compare two fundamental natural ventilation flows. We focus on the limiting cases of passive displacement and passive mixing ventilation flows during transient conditions. These transient flows occur when, for example, heat is purged from a building at night. Whilst it is widely recognised that mixing flows are less efficient at purging heat than displacement flows, our results indicate that, when a particular zone of a room is considered, displacement ventilation can result in lower effectiveness than mixing ventilation. When a room is considered as a whole, displacement ventilation yields higher effectiveness than mixing ventilation and we quantify these differences in terms of the geometry of the space and opening area. The proposed theoretical predictions are compared with effectiveness deduced from measurements made during laboratory experiments and show good agreement. © 2006 Elsevier Ltd. All rights reserved.

Ventilation effectiveness measures based on heat removal: Part 1. Definitions

The effectiveness of ventilation flows is considered from the perspective of buoyancy (or heat) removal from a space. This perspective is distinct from the standard in which the effectiveness is based on the concentrations of a neutrally buoyant contaminant/passive tracer. Three new measures of effectiveness are proposed based on the ability of a flow to flush buoyancy from a ventilated space. These measures provide estimates of instantaneous and time-averaged effectiveness for the entire space, and local effectiveness at any height of interest. From a generalisation of the latter, a vertical profile of effectiveness is defined. These measures enable quantitative comparisons to be made between different flows and they are applicable when there is a difference in density (as is typical due to temperature differences) between the interior environment and the replacement air. Applications, therefore, include natural ventilation, hybrid ventilation and a range of forced ventilation flows. Finally, we demonstrate how the ventilation effectiveness of a room may be assessed from simple traces of temperature versus time. © 2006 Elsevier Ltd. All rights reserved.

New ventilation efficiency measures based on buoyancy removal

New measures for estimating the efficiency of transient ventilation flows are proposed. These measures are developed by considering how effectively a ventilation system removes buoyancy from a space. This approach is distinct from standard efficiency measures which are, in general, based on the removal of a neutrally-buoyant passive tracer. Our new measures, based on (active) buoyancy removal, allow both the instantaneous and time-averaged efficiency of the entire space, or of any region within it, to be determined. In addition, expressions for determining vertical profiles of efficiency are proposed. These new measures enable the effectiveness of different flows to be compared directly and are applicable providing density (temperature) differences exist between the interior environment and the replacement air. Thus, they may be used to contrast the effectiveness of a broad range of building ventilation flows including natural, hybrid and forced ventilation.

Climate resilience of schools: a case study

Social and political concerns are frequently reflected in the design of school buildings, often in turn leading to the development of technical innovations. One example is a recurrent concern about the physical health of the nation, which has at several points over the last century prompted new design approaches to natural light and ventilation. The most critical concern of the current era is the global, rather than the indoor, environment. The resultant political focus on mitigating climate change has resulted in new regulations, and in turn considerable technical changes in building design and construction. The vanguard of this movement has again been in school buildings, set the highest targets for reducing operational carbon by the previous Government. The current austerity measures have moved the focus to the refurbishment and retrofit of existing buildings, in order to bring them up to the exacting new standards. Meanwhile there is little doubt that climate change is happening already, and that the impacts will be considerable. Climate scientists have increasing confidence in their predictions for the future; if today’s buildings are to be resilient to these changes, building designers will need to understand and design for the predicted climates in order to continue to provide comfortable and healthy spaces through the lifetimes of the buildings. This paper describes the decision processes, and the planned design measures, for adapting an existing school for future climates. The project is at St Faith’s School in Cambridge, and focuses on three separate buildings: a large Victorian block built as a substantial domestic dwelling in 1885, a smaller single storey 1970s block with a new extension, and an as-yet unbuilt single storey block designed to passivhaus principles and using environmentally friendly materials. The implications of climate change have been considered for the three particular issues of comfort, construction, and water, as set out in the report on Design for Future Climate: opportunities for adaptation in the built environment (Gething, 2010). The adaptation designs aim to ensure each of the three very different buildings remains fit for purpose throughout the 21st century, continuing to provide a healthy environment for the children. A forth issue, the reduction of carbon and the mitigation of other negative environmental impacts of the construction work, is also a fundamental aim for the school and the project team. Detailed modelling of both the operational and embodied energy and carbon of the design options is therefore being carried out, in order that the whole life carbon costs of the adaptation design options may be minimised. The project has been funded by the Technology Strategy Board as part of the Design for Future Climates programme; the interdisciplinary team includes the designers working on the current school building projects and the school bursar, supported by researchers from the University of Cambridge Centre for Sustainable Development. It is hoped that lessons from the design process, as well as the solutions themselves, will be transferable to other buildings in similar climatic regions.

Atmospheric turbulence mitigation using complex wavelet-based fusion

Restoring a scene distorted by atmospheric turbulence is a challenging problem in video surveillance. The effect, caused by random, spatially varying, perturbations, makes a model-based solution difficult and in most cases, impractical. In this paper, we propose a novel method for mitigating the effects of atmospheric distortion on observed images, particularly airborne turbulence which can severely degrade a region of interest (ROI). In order to extract accurate detail about objects behind the distorting layer, a simple and efficient frame selection method is proposed to select informative ROIs only from good-quality frames. The ROIs in each frame are then registered to further reduce offsets and distortions. We solve the space-varying distortion problem using region-level fusion based on the dual tree complex wavelet transform. Finally, contrast enhancement is applied. We further propose a learning-based metric specifically for image quality assessment in the presence of atmospheric distortion. This is capable of estimating quality in both full-and no-reference scenarios. The proposed method is shown to significantly outperform existing methods, providing enhanced situational awareness in a range of surveillance scenarios. © 1992-2012 IEEE.

N-gram posterior probability confidence measures for statistical machine translation: An empirical study

We report an empirical study of n-gram posterior probability confidence measures for statistical machine translation (SMT). We first describe an efficient and practical algorithm for rapidly computing n-gram posterior probabilities from large translation word lattices. These probabilities are shown to be a good predictor of whether or not the n-gram is found in human reference translations, motivating their use as a confidence measure for SMT. Comprehensive n-gram precision and word coverage measurements are presented for a variety of different language pairs, domains and conditions. We analyze the effect on reference precision of using single or multiple references, and compare the precision of posteriors computed from k-best lists to those computed over the full evidence space of the lattice. We also demonstrate improved confidence by combining multiple lattices in a multi-source translation framework. © 2012 The Author(s).