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.

The effect of work processes on the casing heat transfer of a transonic turbine

This paper considers the effect of the rotor tip on the casing heat load of a transonic axial flow turbine. The aim of the research is to understand the dominant causes of casing heat-transfer. Experimental measurements were conducted at engine-representative Mach number, Reynolds number and stage inlet to casing wall temperature ratio. Time-resolved heat-transfer coefficient and gas recovery temperature on the casing were measured using an array of heat-transfer gauges. Time-resolved static pressure on the casing wall was measured using Kulite pressure transducers. Time-resolved numerical simulations were undertaken to aid understanding of the mechanism responsible for casing heat load. The results show that between 35% and 60% axial chord the rotor tip-leakage flow is responsible for more than 50% of casing heat transfer. The effects of both gas recovery temperature and heat transfer coefficient were investigated separately and it is shown that an increased stagnation temperature in the rotor tip gap dominates casing heat-transfer. In the tip gap the stagnation temperature is shown to rise above that found at stage inlet (combustor exit) by as much as 35% of stage total temperature drop. The rise in stagnation temperature is caused by an isentropic work input to the tip-leakage fluid by the rotor. The size of this mechanism is investigated by computationally tracking fluid path-lines through the rotor tip gap to understand the unsteady work processes that occur. Copyright © 2005 by ASME.

Contact and channel modelling using part and function libraries in a function-based design approach

To support the development and analysis of engineering designs at the embodiment stage, designers work iteratively with representations of those designs as they consider the function and form of their constituent parts. Detailed descriptions of "what a machine does" usually include flows of forces and active principles within the technical system, and their localization within parts and across the interfaces between them. This means that a representation should assist a designer in considering form and function at the same time and at different levels of abstraction. This paper describes a design modelling approach that enables designers to break down a system architecture into its subsystems and parts, while assigning functions and flows to parts and the interfaces between them. In turn, this may reveal further requirements to fulfil functions in order to complete the design. The approach is implemented in a software tool which provides a uniform, computable language allowing the user to describe functions and flows as they are iteratively discovered, created and embodied. A database of parts allows the user to search for existing design solutions. The approach is illustrated through an example: modelling the complex mechanisms within a humanoid robot. Copyright © 2010 by ASME.

Ageing, Adaption and Accessibility: Time for the Inclusive Revolution!

Information and Communication Technology (ICT) is becoming increasingly central to many people’s lives, making it possible to be connected in any place at any time, be unceasingly and instantly informed, and benefit from greater economic and educational opportunities. With all the benefits afforded by these new-found capabilities, however, come potential drawbacks. A plethora of new PCs, laptops, tablets, smartphones, Bluetooth, the internet, Wi-Fi (the list goes on) expect us to know or be able to guess, what, where and when to connect, click, double-click, tap, flick, scroll, in order to realise these benefits, and to have the physical and cognitive capability to do all these things. One of the groups most affected by this increase in high-demand technology is older people. They do not understand and use technology in the same way that younger generations do, because they grew up in the simpler electro-mechanical era and embedded that particular model of the world in their minds. Any consequential difficulty in familiarising themselves with modern ICT and effectively applying it to their needs can also be exacerbated by age-related changes in vision, motor control and cognitive functioning. Such challenges lead to digital exclusion. Much has been written about this topic over the years, usually by academics from the area of inclusive product design. The issue is complex and it is fair to say that no one researcher has the whole picture. It is difficult to understand and adequately address the issue of digital exclusion among the older generation without looking across disciplines and at industry’s and government’s understanding, motivation and efforts toward resolving this important problem. To do otherwise is to risk misunderstanding the true impact that ICT has and could have on people’s lives across all generations. In this European year of Active Ageing and Solidarity between Generations and as the British government is moving forward with its Digital by Default initiative as part of a wider objective to make ICT accessible to as many people as possible by 2015, the Engineering Design Centre (EDC) at the University of Cambridge collaborated with BT to produce a book of thought pieces to address, and where appropriate redress, these important and long-standing issues. “Ageing, Adaption and Accessibility: Time for the Inclusive Revolution!” brings together opinions and insights from twenty one prominent thought leaders from government, industry and academia regarding the problems, opportunities and strategies for combating digital exclusion among senior citizens. The contributing experts were selected as individuals, rather than representatives of organisations, to provide the broadest possible range of perspectives. They are renowned in their respective fields and their opinions are formed not only from their own work, but also from the contributions of others in their area. Their views were elicited through conversations conducted by the editors of this book who then drafted the thought pieces to be edited and approved by the experts. We hope that this unique collection of thought pieces will give you a broader perspective on ageing, people’s adaption to the ever changing world of technology and insights into better ways of designing digital devices and services for the older population.