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%.

Capacity approaching codes for non-coherent orthogonal modulation

This paper describes a curve-fitting approach for the design of capacity approaching coded modulation for orthogonal signal sets with non-coherent detection. In particular, bit-interleaved coded modulation with iterative decoding is considered. Decoder metrics are developed that do not require knowledge of the signal-to-noise ratio, yet still offer very good performance. © 2007 IEEE.

The plastic collapse and energy absorption capacity of egg-box panels

The plastic collapse response of aluminium egg-box panels subjected to out-of-plane compression has been measured and modelled. It is observed that the collapse strength and energy absorption are sensitive to the level of in-plane constraint, with collapse dictated either by plastic buckling or by a travelling plastic knuckle mechanism. Drop weight tests have been performed at speeds of up to 6 m s-1, and an elevation in strength with impact velocity is noted. A 3D finite element shell model is needed in order to reproduce the observed behaviours. Additional calculations using an axisymmetric finite element model give the correct collapse modes but are less accurate than the more sophisticated 3D model. The finite element simulations suggest that the observed velocity dependence of strength is primarily due to strain-rate sensitivity of the aluminium sheet, with material inertia playing a negligible role. Finally, it is shown that the energy absorption capacity of the egg-box material is comparable to that of metallic foams. © 2003 Elsevier Ltd. All rights reserved.

Field of view expansion for 3-D holographic display using a single spatial light modulator with scanning reconstruction light

Increasing the field of view of a holographic display while maintaining adequate image size is a difficult task. To address this problem, we designed a system that tessellates several sub-holograms into one large hologram at the output. The sub-holograms we generate is similar to a kinoform but without the paraxial approximation during computation. The sub-holograms are loaded onto a single spatial light modulator consecutively and relayed to the appropriate position at the output through a combination of optics and scanning reconstruction light. We will review the method of computer generated hologram and describe the working principles of our system. Results from our proof-of-concept system are shown to have an improved field of view and reconstructed image size. ©2009 IEEE.

An experimental study on the load carrying capacity of cold-formed steel studs and panels

A full-scale experimental study on the structural performance of load-bearing wall panels made of cold-formed steel frames and boards is presented. Six different types of C-channel stud, a total of 20 panels with one middle stud and 10 panels with two middle studs were tested under vertical compression until failure. For panels, the main variables considered are screw spacing (300 mm, 400 mm, or 600 mm) in the middle stud, board type (oriented strand board - OSB, cement particle board - CPB, or calcium silicate board - CSB), board number (no sheathing, one-side sheathing, or two-side sheathing), and loading type (1, 3, or 4-point loading). The measured load capacity of studs and panels agrees well with analytical prediction. Due to the restraint by rivet connections between stud and track, the effective length factor for the middle stud and the side stud in a frame (unsheathed panel) is reduced to 0.90 and 0.84, respectively. The load carrying capacity of a stud increases significantly whenever one- or two-side sheathing is used, although the latter is significantly more effective. It is also dependent upon the type of board used. Whereas panels with either OSB or CPB boards have nearly identical load carrying capacity, panels with CSB boards are considerably weaker. Screw spacing affects the load carrying capacity of a stud. When the screw spacing on the middle stud in panels with one-side sheathing is reduced from 600 mm to 300 mm, its load carrying capacity increases by 14.5 %, 20.6% and 94.2% for OSB, CPB and CSB, respectively.