Physicians in leadership: the association between medical director involvement and staff-to-patient ratios

In a hospital environment that demands a careful balance between commercial and clinical interests, the extent to which physicians are involved in hospital leadership varies greatly. This paper assesses the influence of the extent of this involvement on staff-to-patient ratios. Using data gathered from 604 hospitals across Germany, this study evidences the positive relationship between a full-time medical director (MD) or heavily involved part-time MD and a higher staff-to-patient ratio. The data allows us to control for a range of confounding variables, such as size, rural/urban location, ownership structure, and case-mix. The results contribute to the sparse body of empirical research on the effect of clinical leadership on organizational outcomes.

A theoretical approach to the passive control of spiral vortex breakdown

Previous numerical simulations have shown that vortex breakdown starts with the formation of a steady axisymmetric bubble and that an unsteady spiralling mode then develops on top of this.We study how this spiral mode of vortex breakdown might be suppressed or promoted. We use a Lagrangian approach to identify regions of the flow which are sensitive to small open-loop steady and unsteady (harmonic) forces. We find these regions to be upstream of the vortex breakdown bubble. We investigate passive control using a small axisymmetric control ring. In this case, the steady and unsteady control forces are caused by the drag force on the control ring. We find a narrow region upstream of the bubble where the control ring will stabilise the flow and we verify this using numerical simulations. © 2012 IEEE.

Hybrid passive/active inertial actuators to attenuate the structural response of a submerged hull

This paper theoretically investigates the application of tuned vibration absorbers and hybrid passive/active inertial actuators to reduce the vibrational responses of plates and shells. The passive/active actuators are initially applied to a simple plate. A model of a submerged hull consisting of a ring stiffened finite cylinder with bulkheads and external fluid loading is then considered. The fluctuating forces from the propeller result in excitation of the low frequency global hull modes. Inertial actuators and tuned vibration absorbers are located at each end of the hull and in circumferential arrays to reduce the hull structural response at its axial resonances. The control performance of the hybrid passive/active inertial actuator, where the passive component is tuned to a structural resonance, is compared to the attenuation achieved by a fully passive tuned vibration absorber. This work shows the potential of using hybrid passive/active inertial actuators to attenuate the global structural responses of a submerged vessel.

Wide Area Passive UHF RFID System using Antenna Diversity Combined with Phase and Frequency Hopping

This paper presents a long range and effectively error-free ultra high frequency (UHF) radio frequency identification (RFID) interrogation system. The system is based on a novel technique whereby two or more spatially separated transmit and receive antennas are used to enable greatly enhanced tag detection performance over longer distances using antenna diversity combined with frequency and phase hopping. The novel technique is first theoretically modelled using a Rician fading channel. It is shown that conventional RFID systems suffer from multi-path fading resulting in nulls in radio environments. We, for the first time, demonstrate that the nulls can be moved around by varying the phase and frequency of the interrogation signals in a multi-antenna system. As a result, much enhanced coverage can be achieved. A proof of principle prototype RFID system is built based on an Impinj R2000 transceiver. The demonstrator system shows that the new approach improves the tag detection accuracy from <50% to 100% and the tag backscatter signal strength by 10dB over a 20 m x 9 m area, compared with a conventional switched multi-antenna RFID system.

An Error Free Passive UHF RFID System using a New Form of Wireless Signal Distribution

A wide area and error free ultra high frequency (UHF) radio frequency identification (RFID) interrogation system based on the use of multiple antennas used in cooperation to provide high quality ubiquitous coverage, is presented. The system uses an intelligent distributed antenna system (DAS) whereby two or more spatially separated transmit and receive antenna pairs are used to allow greatly improved multiple tag identification performance over wide areas. The system is shown to increase the read accuracy of 115 passive UHF RFID tags to 100% from <60% over a 10m x 8m open plan office area. The returned signal strength of the tag backscatter signals is also increased by an average of 10dB and 17dB over an area of 10m x 8m and 10m x 4m respectively. Furthermore, it is shown that the DAS RFID system has improved immunity to tag orientation. Finally, the new system is also shown to increase the tag read speed/rate of a population of tags compared with a conventional RFID system.

Demonstration of Improved Passive UHF RFID Coverage using Optically-Fed Distributed Multi-Antenna System

Optically-fed distributed antenna system (DAS) technology is combined with passive ultra high frequency (UHF) radio frequency identification (RFID). It is shown that RFID signals can be carried on directly modulated radio over fiber links without impacting their performance. It is also shown that a multi-antenna DAS can greatly reduce the number of nulls experienced by RFID in a complex radio environment, increasing the likelihood of successful tag detection. Consequently, optimization of the DAS reduces nulls further. We demonstrate RFID tag reading using a three antenna DAS system over a 20mx6m area, limited by building constraints, where 100% of the test points can be successfully read. The detected signal strength from the tag is also observed to increase by an average of approximately 10dB compared with a conventional switched multi-antenna RFID system. This improvement is achieved at +31dBm equivalent isotropically radiated power (EIRP) from all three antenna units (AUs).

A Novel Passive UHF RFID Real Time Location Sensing System

Ubiquitous in-building Real Time Location Systems (RTLS) today are limited by costly active radio frequency identification (RFID) tags and short range portal readers of low cost passive RFID tags. We, however, present a novel technology locates RFID tags using a new approach based on (a) minimising RFID fading using antenna diversity, frequency dithering, phase dithering and narrow beam-width antennas, (b) measuring a combination of RSSI and phase shift in the coherent received tag backscatter signals and (c) being selective of use of information from the system by, applying weighting techniques to minimise error. These techniques make it possible to locate tags to an accuracy of less than one metre. This breakthrough will enable, for the first time, the low-cost tagging of items and the possibility of locating them at relatively high precision.

Graduate education for leadership and organisational change in sustainable development

This paper reflects on the motivation, method and effectiveness of teaching leadership and organisational change to graduate engineers. Delivering progress towards sustainable development requires engineers who are aware of pressing global issues (such as resource depletion, climate change, social inequity and an interdependent economy) since it is they who deliver the goods and services that underpin society within these constraints. They also must understand how to implement change in the organisations within which they will work. In recognition of this fact the Cambridge University MPhil in Engineering for Sustainable Development has focussed on educating engineers to become effective change agents in their professional field with the confidence to challenge orthodoxy in adopting traditional engineering solutions. This paper reflects on ten years of delivering a special module to review how teaching change management and leadership aspects of the programme have evolved and progressed over that time. As the students who embark on this professional practice have often extensive experience as practising engineers and scientists, many have already learned the limitations of their technical background when solving complex problems. Students often join the course recognising their need to broaden their knowledge of relevant cross-disciplinary skills. The programme offers an opportunity for these early to mid-career engineers to explore an ethical and value-based approach to bringing about effective change in their particular sectors and organisations. This is achieved through action learning assignments in combination with reflections on the theory of change to enable students to equip themselves with tools that help them to be effective in making their professional and personal life choices. This paper draws on feedback gathered from students during their participation on the programme and augments this with alumni reflections gathered some years after their graduation. These professionals are able to look back on their experience of the taught components and reflect on how they have been able to apply this key learning in their subsequent careers. Copyright © 2012 September.

Passive UHF RFID Interrogation System Using Wireless RFID Repeater Nodes

This paper presents a new wireless radio frequency identification (RFID) repeater system, facilitating remote interrogation without the need for arrays of wired antennas, despite using entirely passive, low-cost ultra high frequency (UHF) RFID tags. The proposed system comprises a master RFID reader with both transmit and receive functions, and multiple RFID repeaters to receive, amplify and retransmit tag-to-reader and reader-to-tag communications. This expands the area over which the master RFID reader may provide coverage for a given maximum transmit power at each antenna. We first demonstrate a single hop wireless repeater system to allow similar read performance to a standard commercial passive UHF RFID reader. Finally, a proof of principle system demonstrates that a single wireless repeater node can allow an extension in range.

Neural activity associated with the passive prediction of ambiguity and risk for aversive events.

In economic decision making, outcomes are described in terms of risk (uncertain outcomes with certain probabilities) and ambiguity (uncertain outcomes with uncertain probabilities). Humans are more averse to ambiguity than to risk, with a distinct neural system suggested as mediating this effect. However, there has been no clear disambiguation of activity related to decisions themselves from perceptual processing of ambiguity. In a functional magnetic resonance imaging (fMRI) experiment, we contrasted ambiguity, defined as a lack of information about outcome probabilities, to risk, where outcome probabilities are known, or ignorance, where outcomes are completely unknown and unknowable. We modified previously learned pavlovian CS+ stimuli such that they became an ambiguous cue and contrasted evoked brain activity both with an unmodified predictive CS+ (risky cue), and a cue that conveyed no information about outcome probabilities (ignorance cue). Compared with risk, ambiguous cues elicited activity in posterior inferior frontal gyrus and posterior parietal cortex during outcome anticipation. Furthermore, a similar set of regions was activated when ambiguous cues were compared with ignorance cues. Thus, regions previously shown to be engaged by decisions about ambiguous rewarding outcomes are also engaged by ambiguous outcome prediction in the context of aversive outcomes. Moreover, activation in these regions was seen even when no actual decision is made. Our findings suggest that these regions subserve a general function of contextual analysis when search for hidden information during outcome anticipation is both necessary and meaningful.

Leadership of healthcare commissioning networks in England: a mixed-methods study on clinical commissioning groups.

To explore the relational challenges for general practitioner (GP) leaders setting up new network-centric commissioning organisations in the recent health policy reform in England, we use innovation network theory to identify key network leadership practices that facilitate healthcare innovation.

Investigating the link between well-being and energy use; an explorative case study between passive and active domestic energy management systems

The aim of this study was to explore how the remote control of appliances/lights (active energy management system) affected household well-being, compared to in-home displays (passive energy management system). A six-week exploratory study was conducted with 14 participants divided into the following three groups: active; passive; and no equipment. The effect on well-being was measured through thematic analysis of two semi-structured interviews for each participant, administered at the start and end of the study. The well-being themes were based on existing measures of Satisfaction and Affect. The energy demand for each participant was also measured for two weeks without intervention, and then compared after four weeks with either the passive or active energy management systems. These measurements were used to complement the well-being analysis. Overall, the measure of Affect increased in the passive group but Satisfaction decreased; however, all three measures on average decreased in the active group. The measured energy demand also highlighted a disconnect between well-being and domestic energy consumption. The results point to a need for further investigation in this field; otherwise, there is a risk that nationally implemented energy management solutions may negatively affect our happiness and well-being. © 2013 Elsevier Ltd.