Integrated Lean Six Sigma approach for patient flow improvement in hospital emergency department

Because of increased competition between healthcare providers, higher customer expectations, stringent checks on insurance payments and new government regulations, it has become vital for healthcare organisations to enhance the quality of the care they provide, to increase efficiency, and to improve the cost effectiveness of their services. Consequently, a number of quality management concepts and tools are employed in the healthcare domain to achieve the most efficient ways of using time, manpower, space and other resources. Emergency departments are designed to provide a high-quality medical service with immediate availability of resources to those in need of emergency care. The challenge of maintaining a smooth flow of patients in emergency departments is a global problem. This study attempts to improve the patient flow in emergency departments by considering Lean techniques and Six Sigma methodology in a comprehensive conceptual framework. The proposed research will develop a systematic approach through integration of Lean techniques with Six Sigma methodology to improve patient flow in emergency departments. The results reported in this paper are based on a standard questionnaire survey of 350 patients in the Emergency Department of Aseer Central Hospital in Saudi Arabia. The results of the study led us to determine the most significant variables affecting patient satisfaction with patient flow, including waiting time during patient treatment in the emergency department; effectiveness of the system when dealing with the patient’s complaints; and the layout of the emergency department. The proposed model will be developed within a performance evaluation metric based on these critical variables, to be evaluated in future work within fuzzy logic for continuous quality improvement.

Structure, magnetism and colour in simple bis­(phosphine)nickel(II) dihalide complexes : an experimental and theoretical investigation

The complex [1,2-bis­(di-tert-butyl­phosphan­yl)ethane-[kappa]2P,P']di­iodido­nickel(II), [NiI2(C18H40P2] or (dtbpe-[kappa]2P)NiI2, [dtbpe is 1,2-bis­(di-tert-butyl­phosphan­yl)ethane], is bright blue-green in the solid state and in solution, but, contrary to the structure predicted for a blue or green nickel(II) bis­(phos­phine) complex, it is found to be close to square planar in the solid state. The solution structure is deduced to be similar, because the optical spectra measured in solution and in the solid state contain similar absorptions. In solution at room temperature, no 31P{1H} NMR resonance is observed, but the very small solid-state magnetic moment at temperatures down to 4 K indicates that the weak paramagnetism of this nickel(II) complex can be ascribed to temperature independent paramagnetism, and that the complex has no unpaired electrons. The red [1,2-bis­(di-tert-butyl­phosphan­yl)ethane-[kappa]2P,P']di­chlorido­nickel(II), [NiCl2(C18H40P2] or (dtbpe-[kappa]2P)NiCl2, is very close to square planar and very weakly paramagnetic in the solid state and in solution, while the maroon [1,2-bis­(di-tert-butyl­phosphan­yl)ethane-[kappa]2P,P']di­bromido­nickel(II), [NiBr2(C18H40P2] or (dtbpe-[kappa]2P)NiBr2, is isostructural with the diiodide in the solid state, and displays paramagnetism inter­mediate between that of the dichloride and the diiodide in the solid state and in solution. Density functional calculations demonstrate that distortion from an ideal square plane for these complexes occurs on a flat potential energy surface. The calculations reproduce the observed structures and colours, and explain the trends observed for these and similar complexes. Although theoretical investigation identified magnetic-dipole-allowed excitations that are characteristic for temperature-independent paramagnetism (TIP), theory predicts the mol­ecules to be diamagnetic.

Design of physiological control and magnetic levitation systems for a total artificial heart

Total Artificial Hearts are mechanical pumps which can be used to replace the failing natural heart. This novel study developed a means of controlling a new design of pump to reproduce physiological flow bringing closer the realisation of a practical artificial heart. Using a mathematical model of the device, an optimisation algorithm was used to determine the best configuration for the magnetic levitation system of the pump. The prototype device was constructed and tested in a mock circulation loop. A physiological controller was designed to replicate the Frank-Starling like balancing behaviour of the natural heart. The device and controller provided sufficient support for a human patient while also demonstrating good response to various physiological conditions and events. This novel work brings the design of a practical artificial heart closer to realisation.

Correlating flow induced shear stress and chondrocytes activity in micro-porous scaffold using computational fluid dynamics and rapid prototyping

Flow induced shear stress plays an important role in regulating cell growth and distribution in scaffolds. This study sought to correlate wall shear stress and chondrocytes activity for engineering design of micro-porous osteochondral grafts based on the hypothesis that it is possible to capture and discriminate between the transmitted force and cell response at the inner irregularities. Unlike common tissue engineering therapies with perfusion bioreactors in which flow-mediated stress is the controlling parameter, this work assigned the associated stress as a function of porosity to influence in vitro proliferation of chondrocytes. D-optimality criterion was used to accommodate three pore characteristics for appraisal in a mixed level fractional design of experiment (DOE); namely, pore size (4 levels), distribution pattern (2 levels) and density (3 levels). Micro-porous scaffolds (n=12) were fabricated according to the DOE using rapid prototyping of an acrylic-based bio-photopolymer. Computational fluid dynamics (CFD) models were created correspondingly and used on an idealized boundary condition with a Newtonian fluid domain to simulate the dynamic microenvironment inside the pores. In vitro condition was reproduced for the 3D printed constructs seeded by high pellet densities of human chondrocytes and cultured for 72 hours. The results showed that cell proliferation was significantly different in the constructs (p<0.05). Inlet fluid velocity of 3×10-2mms-1 and average shear stress of 5.65×10-2 Pa corresponded with increased cell proliferation for scaffolds with smaller pores in hexagonal pattern and lower densities. Although the analytical solution of a Poiseuille flow inside the pores was found insufficient for the description of the flow profile probably due to the outside flow induced turbulence, it showed that the shear stress would increase with cell growth and decrease with pore size. This correlation demonstrated the basis for determining the relation between the induced stress and chondrocyte activity to optimize microfabrication of engineered cartilaginous constructs.

Mathematical modelling of counter flow v-grove solar air collector

Double-pass counter flow v-grove collector is considered one of the most efficient solar air-collectors. In this design of the collector, the inlet air initially flows at the top part of the collector and changes direction once it reaches the end of the collector and flows below the collector to the outlet. A mathematical model is developed for this type of collector and simulation is carried out using MATLAB programme. The simulation results were verified with three distinguished research results and it was found that the simulation has the ability to predict the performance of the air collector accurately as proven by the comparison of experimental data with simulation. The difference between the predicted and experimental results is, at maximum, approximately 7% which is within the acceptable limit considering some uncertainties in the input parameter values to allow comparison. A parametric study was performed and it was found that solar radiation, inlet air temperature, flow rate and length have a significant effect on the efficiency of the air collector. Additionally, the results are compared with single flow V-groove collector.

Hybrid model for motorway travel time estimation considering increased detector spacing

Travel time estimation and prediction on motorways has long been a topic of research. Prediction modeling generally assumes that the estimation is perfect. No matter how good is the prediction modeling- the errors in estimation can significantly deteriorate the accuracy and reliability of the prediction. Models have been proposed to estimate travel time from loop detector data. Generally, detectors are closely spaced (say 500m) and travel time can be estimated accurately. However, detectors are not always perfect, and even during normal running conditions few detectors malfunction, resulting in increase in the spacing between the functional detectors. Under such conditions, error in the travel time estimation is significantly large and generally unacceptable. This research evaluates the in-practice travel time estimation model during different traffic conditions. It is observed that the existing models fail to accurately estimate travel time during large detector spacing and congestion shoulder periods. Addressing this issue, an innovative Hybrid model that only considers loop data for travel time estimation is proposed. The model is tested using simulation and is validated with real Bluetooth data from Pacific Motorway Brisbane. Results indicate that during non free flow conditions and larger detector spacing Hybrid model provides significant improvement in the accuracy of travel time estimation.

Model-predictive control and closed-loop stability considerations for nonlinear plants described by local ARX-type models

In this paper, a model-predictive control (MPC) method is detailed for the control of nonlinear systems with stability considerations. It will be assumed that the plant is described by a local input/output ARX-type model, with the control potentially included in the premise variables, which enables the control of systems that are nonlinear in both the state and control input. Additionally, for the case of set point regulation, a suboptimal controller is derived which has the dual purpose of ensuring stability and enabling finite-iteration termination of the iterative procedure used to solve the nonlinear optimization problem that is used to determine the control signal.

The geography of travel journalism : mapping the flow of travel stories about foreign countries

While the study of foreign news flows has received considerable attention from communication scholars for quite some time, it has typically focused on political or ‘hard’ news, at the expense of other types of journalistic content. This article argues that, as the foreign news hole is shrinking, travel journalism is becoming an increasingly important source of information about foreign countries in the news media. It reports the results of a comparative study of newspaper travel sections in Australia, Canada, New Zealand, and the UK, and argues that travel journalism often replicates the imbalances found in foreign news flows. Well-known factors – such as regionalism, powerful nations, cultural proximity, the role played by big neighbours and the diversity of coverage – are also powerful determinants in travel journalism. At the same time, a country’s tourist behaviour also plays a role but is often overshadowed by other factors.

Autonomous multisensor calibration and closed-loop fusion for SLAM

The vast majority of current robot mapping and navigation systems require specific well-characterized sensors that may require human-supervised calibration and are applicable only in one type of environment. Furthermore, if a sensor degrades in performance, either through damage to itself or changes in environmental conditions, the effect on the mapping system is usually catastrophic. In contrast, the natural world presents robust, reasonably well-characterized solutions to these problems. Using simple movement behaviors and neural learning mechanisms, rats calibrate their sensors for mapping and navigation in an incredibly diverse range of environments and then go on to adapt to sensor damage and changes in the environment over the course of their lifetimes. In this paper, we introduce similar movement-based autonomous calibration techniques that calibrate place recognition and self-motion processes as well as methods for online multisensor weighting and fusion. We present calibration and mapping results from multiple robot platforms and multisensory configurations in an office building, university campus, and forest. With moderate assumptions and almost no prior knowledge of the robot, sensor suite, or environment, the methods enable the bio-inspired RatSLAM system to generate topologically correct maps in the majority of experiments.

A phase-locked-loop design for the smooth operation of a hybrid microgrid

A microgrid contains both distributed generators (DGs) and loads and can be viewed by a controllable load by utilities. The DGs can be either inertial synchronous generators or non-inertial converter interfaced. Moreover, some of them can come online or go offline in plug and play fashion. The combination of these various types of operation makes the microgrid control a challenging task, especially when the microgrid operates in an autonomous mode. In this paper, a new phase locked loop (PLL) algorithm is proposed for smooth synchronization of plug and play DGs. A frequency droop for power sharing is used and a pseudo inertia has been introduced to non-inertial DGs in order to match their response with inertial DGs. The proposed strategy is validated through PSCAD simulation studies.

Go with the flow : optimal AUV path planning in coastal environments

This paper describes a novel optimum path planning strategy for long duration AUV operations in environments with time-varying ocean currents. These currents can exceed the maximum achievable speed of the AUV, as well as temporally expose obstacles. In contrast to most other path planning strategies, paths have to be defined in time as well as space. The solution described here exploits ocean currents to achieve mission goals with minimal energy expenditure, or a tradeoff between mission time and required energy. The proposed algorithm uses a parallel swarm search as a means to reduce the susceptibility to large local minima on the complex cost surface. The performance of the optimisation algorithms is evaluated in simulation and experimentally with the Starbug AUV using a validated ocean model of Brisbane’s Moreton Bay.

Distribution state estimation based on particle swarm and doubly loop mutant optimization (DLM-PSO)

This paper presents a novel algorithm based on particle swarm optimization (PSO) to estimate the states of electric distribution networks. In order to improve the performance, accuracy, convergence speed, and eliminate the stagnation effect of original PSO, a secondary PSO loop and mutation algorithm as well as stretching function is proposed. For accounting uncertainties of loads in distribution networks, pseudo-measurements is modeled as loads with the realistic errors. Simulation results on 6-bus radial and 34-bus IEEE test distribution networks show that the distribution state estimation based on proposed DLM-PSO presents lower estimation error and standard deviation in comparison with algorithms such as WLS, GA, HBMO, and original PSO.

Editorial : Loop

This time last year we proposed the theme of the 'loop' issue to the M/C collective because it sounded deeply cool, satisfying our poststructuralist posturings about reflexivity and representation, while also tapping into everyday cultural objects and practices. We expected that the 'loop' issue would generate some interesting and varied responses, and it did. We received submissions about music, visual art, language, child development, pop-cultural artefacts, mathematics and culture in general. These explorations of disparate fields seemed, however, to be tied together by a common thread: the concept of "generation" itself. Each article in the 'loop' issue describes a loop that does not simply repeat an original operation, but that through iteration creates new possibilities and new meanings...

Damage evaluation based on a wave energy flow map using multiple PZT sensors

A new wave energy flow (WEF) map concept was proposed in this work. Based on it, an improved technique incorporating the laser scanning method and Betti’s reciprocal theorem was developed to evaluate the shape and size of damage as well as to realize visualization of wave propagation. In this technique, a simple signal processing algorithm was proposed to construct the WEF map when waves propagate through an inspection region, and multiple lead zirconate titanate (PZT) sensors were employed to improve inspection reliability. Various damages in aluminum and carbon fiber reinforced plastic laminated plates were experimentally and numerically evaluated to validate this technique. The results show that it can effectively evaluate the shape and size of damage from wave field variations around the damage in the WEF map.

Using performance-based evaluation to close the loop between biological and robotic navigation

In this paper we describe the benefits of a performance-based approach to modeling biological systems for use in robotics. Specifically, we describe the RatSLAM system, a computational model of the navigation processes thought to drive navigation in a part of the rodent brain called the hippocampus. Unlike typical computational modeling approaches, which focus on biological fidelity, RatSLAM’s development cycle has been driven primarily by performance evaluation on robots navigating in a wide variety of challenging, real world environments. We briefly describe three seminal results, two in robotics and one in biology. In addition, we present current research on brain-inspired learning algorithms with the aim of enabling a robot to autonomously learn how best to use its sensor suite to navigate, without requiring any specific knowledge of the robot, sensor types or environment characteristics. Our aim is to drive discussion on the merits of practical, performance-focused implementations of biological models in robotics.