Modelling of long-term ground response to tunnelling under St James's Park, London

Following a tunnel excavation in low-permeability soil, it is commonly observed that the ground surface continues to settle and ground loading on the tunnel lining changes, as the pore pressures in the ground approach a new equilibrium condition. The monitored ground response following the tunnelling under St James's Park, London, shows that the mechanism of subsurface deformation is composed of three different zones: swelling, consolidation and rigid body movement. The swelling took place in a confined zone above the tunnel crown, extending vertically to approximately 5 m above it. On the sides of the tunnel, the consolidation of the soil occurred in the zone primarily within the tunnel horizon, from the shoulder to just beneath the invert, and extending laterally to a large offset from the tunnel centreline. Above these swelling and consolidation zones the soil moved downward as a rigid body. In this study, soil-fluid coupled three-dimensional finite element analyses were performed to simulate the mechanism of long-term ground response monitored at St James's Park. An advanced critical state soil model, which can simulate the behaviour of London Clay in both drained and undrained conditions, was adopted for the analyses. The analysis results are discussed and compared with the field monitoring data. It is found that the observed mechanism of long-term subsurface ground and tunnel lining response at St James's Park can be simulated accurately only when stiffness anisotropy, the variation of permeability between different units within the London Clay and non-uniform drainage conditions for the tunnel lining are considered. This has important implications for future prediction of the long-term behaviour of tunnels in clays.

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%.

Numerical simulation of long-term twin-tunnel behaviour at St James's park

The twin-tunnel construction of the Jubilee Line Extension tunnels beneath St James's Park was simulated using coupled-consolidation finite-element analyses. The effect of defining different permeabilities for the final consolidation stage was investigated, and the performance of a fissure softening model was also evaluated. The analyses suggested an unexpectedly high permeability anisotropy for soil around the tunnel crown, possibly due to stress-induced permeability changes, or low-permeability laminations. Also, the permeability profile and lining conductivity were found to differ between the tunnels. Inclusion of the fissure model gave a narrower settlement trough, more alike that in the field, by preferentially softening simple shear behaviour. Long-term settlements at the site continue to increase at an unexpectedly high rate, suggesting the possibility of creep or unexpected soil softening during excavation. © 2012 Taylor & Francis Group.