Strategic Emergency department design: An approach to capacity planning in healthcare provision in overcrowded emergency rooms

Healthcare professionals and the public have increasing concerns about the ability of emergency departments to meet current demands. Increased demand for emergency services, mainly caused by a growing number of minor and moderate injuries has reached crisis proportions, especially in the United Kingdom. Numerous efforts have been made to explore the complex causes because it is becoming more and more important to provide adequate healthcare within tight budgets. Optimisation of patient pathways in the emergency department is therefore an important factor. This paper explores the possibilities offered by dynamic simulation tools to improve patient pathways using the emergency department of a busy university teaching hospital in Switzerland as an example.

Reliability of intraoperative high-resolution 2D ultrasound as an alternative to high-field strength MR imaging for tumor resection control: a prospective comparative study

OBJECT: Ultrasound may be a reliable but simpler alternative to intraoperative MR imaging (iMR imaging) for tumor resection control. However, its reliability in the detection of tumor remnants has not been definitely proven. The aim of the study was to compare high-field iMR imaging (1.5 T) and high-resolution 2D ultrasound in terms of tumor resection control. METHODS: A prospective comparative study of 26 consecutive patients was performed. The following parameters were compared: the existence of tumor remnants after presumed radical removal and the quality of the images. Tumor remnants were categorized as: detectable with both imaging modalities or visible only with 1 modality. RESULTS: Tumor remnants were detected in 21 cases (80.8%) with iMR imaging. All large remnants were demonstrated with both modalities, and their image quality was good. Two-dimensional ultrasound was not as effective in detecting remnants<1 cm. Two remnants detected with iMR imaging were missed by ultrasound. In 2 cases suspicious signals visible only on ultrasound images were misinterpreted as remnants but turned out to be a blood clot and peritumoral parenchyma. The average time for acquisition of an ultrasound image was 2 minutes, whereas that for an iMR image was approximately 10 minutes. Neither modality resulted in any procedure-related complications or morbidity. CONCLUSIONS: Intraoperative MR imaging is more precise in detecting small tumor remnants than 2D ultrasound. Nevertheless, the latter may be used as a less expensive and less time-consuming alternative that provides almost real-time feedback information. Its accuracy is highest in case of more confined, deeply located remnants. In cases of more superficially located remnants, its role is more limited.

The critical linkage between online and offline media - An approach to researching the conditions of issue spill-over

In this article we argue that it is pressing to study the “hybrid media system” at the intersection of online and offl ine communication and its potential for agenda building. The topic is relevant because it is argued that the internet off ers new opportunities of public infl uence for challengers without access to political decision making. Except for single case studies, little is known about the conditions under which these actors succeed. Informed by the research on agenda building we tackle with the mechanisms of online-offline media agenda building and the conditions under which challengers succeed to produce issue spill-over into conventional mass media. We develop a theoretical framework for investigating the linkage between online communication and traditional mass media and discuss how our model translates into empirical research. We conclude that the nature of online networks is critical for spill-over, but also the issue itself and the structure of the political system.

Index-Oriented Methodologies for Landslide Consequence Analysis: An Application to a Mountain Community in the French Alps

Consequence analysis is a key aspect of anchoring assessment of landslide impacts to present and long-term development planning. Although several approaches have been developed over the last decade, some of them are difficult to apply in practice, mainly because of the lack of valuable data on historical damages or on damage functions. In this paper, two possible consequence indicators based on a combination of descriptors of the exposure of the elements at risk are proposed in order to map the potential impacts of landslides and highlight the most vulnerable areas. The first index maps the physical vulnerability due to landslide; the second index maps both direct damage (physical, structural, functional) and indirect damage (socio-economic impacts) of landslide hazards. The indexes have been computed for the 200 km2 area of the Barcelonnette Basin (South French Alps), and their potential applications are discussed.

Spectral bounds and basis results for non-self-adjoint pencils, with an application to Hagen-Poiseuille flow

We obtain eigenvalue enclosures and basisness results for eigen- and associated functions of a non-self-adjoint unbounded linear operator pencil A−λBA−λB in which BB is uniformly positive and the essential spectrum of the pencil is empty. Both Riesz basisness and Bari basisness results are obtained. The results are applied to a system of singular differential equations arising in the study of Hagen–Poiseuille flow with non-axisymmetric disturbances.

A new methodological approach for studying intergenerational mobility with an application to Swiss data

Despite the widespread interest in the topic and a vast international literature, very little is known about the development of intergenerational mobility in Switzerland. Based on a new harmonized database for Switzerland (comprising various surveys such as different waves of the ISSP, EVS, and the ESS), we provide a systematic account of changes in the link between social origin and destination over time (covering birth cohorts from around 1935 to 1980). We analyze effects of parental education and class on own educational achievement and social class for both men and women, using a refined variant of the methodological approach proposed by Jann and Combet (2012). The approach is based on the concept of proportional reduction of error (PRE) and features a number of advantages over more traditional approaches. For example, it provides smooth estimates of changes in social mobility that have a clear interpretation and it can easily incorporate control variables and multiple dimensions of parental characteristics. To evaluate the validity of our approach, we employ the oft-used log-multiplicative layer effect (a.k.a Unidiff) model (Xie 1992, Erikson and Goldthorpe 1992) as a benchmark. Results indicate that our approach performs well and produces qualitatively similar findings as Xie's model. For both men and women, effects of social origin initially decreased, but then, towards the end of the observation period, increased again. This u-shaped pattern, which can be observed with respect to both education and class, appears to be more pronounced for women than for men.

An Architecture to offer Cloud-Based Radio Access Network as a Service

This paper addresses the novel notion of offering a radio access network as a service. Its components may be instantiated on general purpose platforms with pooled resources (both radio and hardware ones) dimensioned on-demand, elastically and following the pay-per-use principle. A novel architecture is proposed that supports this concept. The architecture's success is in its modularity, well-defined functional elements and clean separation between operational and control functions. By moving much processing traditionally located in hardware for computation in the cloud, it allows the optimisation of hardware utilization and reduction of deployment and operation costs. It enables operators to upgrade their network as well as quickly deploy and adapt resources to demand. Also, new players may easily enter the market, permitting a virtual network operator to provide connectivity to its users.

Voluntary ingestion of antiparasitic drugs emulsified in honey represents an alternative to gavage in mice

The oral route is the most frequently used method of drug intake in humans. Oral administration of drugs to laboratory animals such as mice typically is achieved through gavage, in which a feeding needle is introduced into the esophagus and the drug is delivered directly into the stomach. This method requires technical skill, is stressful for animals, and introduces risk of injury, pain and morbidity. Here we investigated another method of drug administration. The benzimidazole derivative albendazole was emulsified in commercially available honey and administered to mice by voluntary feeding or gavage. Mice that received albendazole by either gavage or honey ingestion had virtually identical levels of serum albendazole sulfoxide, indicating that uptake and metabolism of albendazole was similar for both administration techniques. In addition, dosing mice with the albendazole-honey mixture for 8 wk had antiparasitic activity comparable to earlier studies using gavage for drug administration. Compared with gavage, voluntary ingestion of a drug in honey is more rapid, less stressful to the animal, and less technically demanding for the administrator. Because of its low cost and ready availability, honey presents a viable vehicle for drug delivery.