Unity in diversity: electronic patient record use in multidisciplinary practice

In this paper we examine the use of electronic patient records (EPR) by clinical specialists in their development of multidisciplinary care for diagnosis and treatment of breast cancer. We develop a practice theory lens to investigate EPR use across multidisciplinary team practice. Our findings suggest that there are oppositional tendencies towards diversity in EPR use and unity which emerges across multidisciplinary work, and this influences the outcomes of EPR use. The value of this perspective is illustrated through the analysis of a year-long, longitudinal case study of a multidisciplinary team of surgeons, oncologists, pathologists, radiologists, and nurse specialists adopting a new EPR. Each group adapted their use of the EPR to their diverse specialist practices, but they nonetheless orientated their use of the EPR to each others' practices sufficiently to support unity in multidisciplinary teamwork. Multidisciplinary practice elements were also reconfigured in an episode of explicit negotiations, resulting in significant changes in EPR use within team meetings. Our study contributes to the growing literature that questions the feasibility and necessity of achieving high levels of standardized, uniform health information technology use in healthcare.

The effects of non-unity lewis numbers on turbulent premixed flame interactions in a twin V-flame configuration

The influence of Lewis number on turbulent premixed flame interactions is investigated using automatic feature extraction (AFE) applied to high-resolution flame simulation data. Premixed turbulent twin V-flames under identical turbulence conditions are simulated at global Lewis numbers of 0.4, 0.8, 1.0, and 1.2. Information on the position, frequency, and magnitude of the interactions is compared, and the sensitivity of the results to sample interval is discussed. It is found that both the frequency and magnitude of normal type interactions increases with decreasing Lewis number. Counternormal type interactions become more likely as the Lewis number increases. The variation in both the frequency and the magnitude of the interactions is found to be caused by large-scale changes in flame wrinkling resulting from differences in the thermo-diffusive stability of the flames. During flame interactions, thermo-diffusive effects are found to be insignificant due to the separation of time scales. © 2013 Copyright Taylor and Francis Group, LLC.

Demonstration of a compact InGaAsP active crosspoint switch operating at 1.5 μm using novel reflective y-coupler components

An extremely compact active optoelectronic crosspoint switch, having overall dimensions of 400 μm×200 μm, is reported. The device provides unity facet-to-facet gain for both bar and cross state operation for TE or TM input signals.

Effects of Lewis number on scalar variance transport in premixed flames

The influences of differential diffusion rates of heat and mass on the transport of the variances of Favre fluctuations of reaction progress variable and non-dimensional temperature have been studied using three-dimensional simplified chemistry based Direct Numerical Simulation (DNS) data of statistically planar turbulent premixed flames with global Lewis number ranging from Le = 0.34 to 1.2. The Lewis number effects on the statistical behaviours of the various terms of the transport equations of variances of Favre fluctuations of reaction progress variable and non-dimensional temperature have been analysed in the context of Reynolds Averaged Navier Stokes (RANS) simulations. It has been found that the turbulent fluxes of the progress variable and temperature variances exhibit counter-gradient transport for the flames with Lewis number significantly smaller than unity whereas the extent of this counter-gradient transport is found to decrease with increasing Lewis number. The Lewis number is also shown to have significant influences on the magnitudes of the chemical reaction and scalar dissipation rate contributions to the scalar variance transport. The modelling of the unclosed terms in the scalar variance equations for the non-unity Lewis number flames have been discussed in detail. The performances of the existing models for the unclosed terms are assessed based on a-priori analysis of DNS data. Based on the present analysis, new models for the unclosed terms of the active scalar variance transport equations are proposed, whenever necessary, which are shown to satisfactorily capture the behaviours of unclosed terms for all the flames considered in this study. © 2010 Springer Science+Business Media B.V.

Response probability distribution of built-up vibro-acoustic systems

The vibro-acoustic response of built-up structures, consisting of stiff components with low modal density and flexible components with high modal density, is sensitive to small imperfections in the flexible components. In this paper, the uncertainty of the response is considered by modeling the low modal density master system as deterministic and the high modal density subsystems in a nonparametric stochastic way, i.e., carrying a diffuse wave field, and by subsequently computing the response probability density function. The master system's mean squared response amplitude follows a singular noncentral complex Wishart distribution conditional on the subsystem energies. For a single degree of freedom, this is equivalent to a chi-square or an exponential distribution, depending on the loading conditions. The subsystem energies follow approximately a chi-square distribution when their relative variance is smaller than unity. The results are validated by application to plate structures, and good agreement with Monte Carlo simulations is found. © 2012 Acoustical Society of America.

A new apparatus for modelling excavations

Underground space is commonly exploited both to maximise the utility of costly land in urban development and to reduce the vertical load acting on the ground. Deep excavations are carried out to construct various types of underground infrastructure such as deep basements, subways and service tunnels. Although the soil response to excavation is known in principle, designers lack practical calculation methods for predicting both short- and long-term ground movements. As the understanding of how soil behaves around an excavation in both the short and long term is insufficient and usually empirical, the judgements used in design are also empirical and serious accidents are common. To gain a better understanding of the mechanisms involved in soil excavation, a new apparatus for the centrifuge model testing of deep excavations in soft clay has been developed. This apparatus simulates the field construction sequence of a multi-propped retaining wall during centrifuge flight. A comparison is given between the new technique and the previously used method of draining heavy fluid to simulate excavation in a centrifuge model. The new system has the benefit of giving the correct initial ground conditions before excavation and the proper earth pressure distribution on the retaining structures during excavation, whereas heavy fluid only gives an earth pressure coefficient of unity and is unable to capture any changes in the earth pressure coefficient of soil inside the zone of excavation, for example owing to wall movements. Settlements of the ground surface, changes in pore water pressure, variations in earth pressure, prop forces and bending moments in the retaining wall are all monitored during excavation. Furthermore, digital images taken of a cross-section during the test are analysed using particle image velocimetry to illustrate ground deformation and soil-structure interaction mechanisms. The significance of these observations is discussed.

Comparison of the coherence properties of superradiance and laser emission in semiconductor structures

The coherence properties of a transient electron-hole state developing during superradiance emission in semiconductor laser structures have been studied experimentally using a Michelson interferometer and Young's classic double-slit configuration. The results demonstrate that, in the lasers studied, the first-order correlation function, which quantifies spatial coherence, approaches unity for superradiant emission and is 0.2-0.5 for laser emission. The supercoherence is due to long-range ordering upon the superradiant phase transition. © 2012 Kvantovaya Elektronika and Turpion Ltd.

Development of a new apparatus for modeling deep excavation related problems in geotechnical centrifuge

Underground space is commonly exploited both to maximise the utility of costly land in urban development and to reduce the vertical load acting on the ground. Deep excavations are carried out to construct various types of underground infrastructure such as deep basements, subways and service tunnels. Although the soil response to excavation is known in principle, designers lack practical calculation methods for predicting both short- and long-term ground movements. As the understanding of how soil behaves around an excavation in both the short and long term is insufficient and usually empirical, the judgements used in design are also empirical and serious accidents are common. To gain a better understanding of the mechanisms involved in soil excavation, a new apparatus for the centrifuge model testing of deep excavations in soft clay has been developed. This apparatus simulates the field construction sequence of a multi-propped retaining wall during centrifuge flight. A comparison is given between the new technique and the previously used method of draining heavy fluid to simulate excavation in a centrifuge model. The new system has the benefit of giving the correct initial ground conditions before excavation and the proper earth pressure distribution on the retaining structures during excavation, whereas heavy fluid only gives an earth pressure coefficient of unity and is unable to capture any changes in the earth pressure coefficient of soil inside the zone of excavation, for example owing to wall movements. Settlements of the ground surface, changes in pore water pressure, variations in earth pressure, prop forces and bending moments in the retaining wall are all monitored during excavation. Furthermore, digital images taken of a cross-section during the test are analysed using particle image velocimetry to illustrate ground deformation and soil–structure interaction mechanisms. The significance of these observations is discussed.

Balanced realisations of all-pass systems using exact arithmetic with application to the approximation of delay systems

Numerically well-conditioned state-space realisations for all-pass systems, such as Padé approximations to exp(-s), are derived that can be computed using exact integer arithmetic. This is then applied to the a series of functions of exp(-s). It is also shown that the H-infinity norm of the transfer function from the input to the state of a balanced realisation of the Padé approximation of exp(-s) is unity. © 2012 IEEE.

Flexible conversion ratio fast reactors: Overview

Conceptual designs of lead-cooled and liquid salt-cooled fast flexible conversion ratio reactors were developed. The performance achievable by the unity conversion ratio cores of these reactors was compared to an existing supercritical carbon dioxide-cooled (S-CO2) fast reactor design and an uprated version of an existing sodium-cooled fast reactor. All concepts have cores rated at 2400 MWt. The cores of the liquid-cooled reactors are placed in a large-pool-type vessel with dual-free level, which also contains four intermediate heat exchangers (IHXs) coupling a primary coolant to a compact and efficient supercritical CO2 Brayton cycle power conversion system. The S-CO2 reactor is directly coupled to the S-CO2 Brayton cycle power conversion system. Decay heat is removed passively using an enhanced reactor vessel auxiliary cooling system (RVACS) and a passive secondary auxiliary cooling system (PSACS). The selection of the water-cooled versus air-cooled heat sink for the PSACS as well as the analysis of the probability that the PSACS may fail to complete its mission was performed using risk-informed methodology. In addition to these features, all reactors were designed to be self-controllable. Further, the liquid-cooled reactors utilized common passive decay heat removal systems whereas the S-CO2 uses reliable battery powered blowers for post-LOCA decay heat removal to provide flow in well defined regimes and to accommodate inadvertent bypass flows. The multiple design limits and challenges which constrained the execution of the four fast reactor concepts are elaborated. These include principally neutronics and materials challenges. The neutronic challenges are the large positive coolant reactivity feedback, small fuel temperature coefficient, small effective delayed neutron fraction, large reactivity swing and the transition between different conversion ratio cores. The burnup, temperature and fluence constraints on fuels, cladding and vessel materials are elaborated for three categories of material - materials currently available, available on a relatively short time scale and available only with significant development effort. The selected fuels are the metallic U-TRU-Zr (10% Zr) for unity conversion ratio and TRU-Zr (75% Zr) for zero conversion ratio. The principal selected cladding and vessel materials are HT-9 and A533 or A508, respectively, for current availability, T-91 and 9Cr-1Mo steel for relatively short-term availability and oxide dispersion strengthened ferritic steel (ODS) available only with significant development. © 2009 Elsevier B.V. All rights reserved.

Flexible conversion ratio lead cooled reactor design

This paper presents the neutronic design of a lead cooled fast reactor with flexible conversion ratio. The main objective of the design is to accommodate interchangeably within the same reactor core a wide range of transuranic actinides management strategies: from pure burning to self-sustainable breeding. Two, the most limiting, core design options with unity and zero conversion ratios are described. Neutronic feasibility of both designs was demonstrated through calculation of reactivity control and fuel loading requirements, fluence limits, power peaking factors, and reactivity feedback coefficients.