Measuring patient flow variations : a cross-organisational process mining approach

Variations that exist in the treatment of patients (with similar symptoms) across different hospitals do substantially impact the quality and costs of healthcare. Consequently, it is important to understand the similarities and differences between the practices across different hospitals. This paper presents a case study on the application of process mining techniques to measure and quantify the differences in the treatment of patients presenting with chest pain symptoms across four South Australian hospitals. Our case study focuses on cross-organisational benchmarking of processes and their performance. Techniques such as clustering, process discovery, performance analysis, and scientific workflows were applied to facilitate such comparative analyses. Lessons learned in overcoming unique challenges in cross-organisational process mining, such as ensuring population comparability, data granularity comparability, and experimental repeatability are also presented.

Boundary and internal conditions for adjoint fluid-flow problems

The ever-increasing robustness and reliability of flow-simulation methods have consolidated CFD as a major tool in virtually all branches of fluid mechanics. Traditionally, those methods have played a crucial role in the analysis of flow physics. In more recent years, though, the subject has broadened considerably, with the development of optimization and inverse design applications. Since then, the search for efficient ways to evaluate flow-sensitivity gradients has received the attention of numerous researchers. In this scenario, the adjoint method has emerged as, quite possibly, the most powerful tool for the job, which heightens the need for a clear understanding of its conceptual basis. Yet, some of its underlying aspects are still subject to debate in the literature, despite all the research that has been carried out on the method. Such is the case with the adjoint boundary and internal conditions, in particular. The present work aims to shed more light on that topic, with emphasis on the need for an internal shock condition. By following the path of previous authors, the quasi-1D Euler problem is used as a vehicle to explore those concepts. The results clearly indicate that the behavior of the adjoint solution through a shock wave ultimately depends upon the nature of the objective functional.

Boundary layer and wake modifications to compressor design systems : the effect of blade-to-blade flow variations on the mean flow field of a transonic rotor : final report, 01 September 1976-31 August 1978 /

"AFAPL-TR-79-2010."

Observations of spatial flow patterns at the coral colony scale on a shallow reef flat

Although small-scale spatial flow variability can affect both larger-scale circulation patterns and biological processes on coral reefs, there are few direct measurements of spatial flow patterns across horizontal scales <100 m. Here flow patterns on a shallow reef flat were measured at scales from a single colony to several adjacent colonies using an array of acoustic Doppler velocimeters on a diver-operated traverse. We observed recirculation zones immediately behind colonies, reduced currents and elevated dissipation rates in turbulent wakes up to 2 colony diameters downstream and enhanced Reynolds stresses in shear layers around wake peripheries. Flow acceleration zones were observed above and between colonies. Coherent flow structures varied with incident flow speeds; recirculation zones were stronger and wakes were more turbulent in faster flows. Low-frequency (<0.03 Hz) flow variations, for which water excursions were large compared with the colony diameters (Keulegan-Carpenter number, KC >1), had similarspatial patterns to wakes, while higher-frequency variations (0.05-0.1 Hz, KC<1) had no observable spatial structure. On the reef flat, both drag and inertial forces exerted by coral colonies could have significant effects on flow, but within different frequency ranges; drag dominates for low-frequency flow variations and inertial forces dominate for higher frequency variations, including the wave band. Our scaling analyses suggest that spatial flow patterns at colony and patch scales could have important implications or both physical and biological processes at larger reef scales through their effects on forces exerted on the flow, turbulent mixing, and dispersion. © 2013. American Geophysical Union. All Rights Reserved.

Pharmacologie des variations de débit sanguin oculaires chez le rat au moyen de la débitmétrie au laser par effet Doppler

La débitmétrie au laser à effet Doppler (LDF) constitue une méthode prometteuse et non-invasive pour l'étude du débit sanguin local dans l'œil. Cette technique est basée sur un changement de fréquence subi par la lumière lors du mouvement des globules rouges dans les vaisseaux. Une nouvelle sonde LDF a été testée pour sa sensibilité à évaluer la circulation rétinienne/choroïdienne sous des conditions hypercapniques et en présence de diverses substances vasoactives ou suivant la photocoagulation des artères rétiniennes chez le rat. Après dilatation pupillaire, la sonde LDF a été placée en contact avec la cornée de rats anesthésiés et parallèle à l'axe optique. L'hypercapnie a été provoquée par inhalation de CO2 (8% dans de l'air médical), alors que les agents pharmacologiques ont été injectés de façon intravitréenne. La contribution relative à la circulation choroïdienne a été évaluée à la suite de la photocoagulation des artères rétiniennes. Le débit sanguin s'est trouvé significativement augmenté à la suite de l'hypercanie (19%), de l'adénosine (14%) ou du nitroprusside de sodium (16%) comparativement au niveau de base, alors que l'endothéline-1 a provoqué une baisse du débit sanguin (11%). La photocoagulation des artères rétiniennes a significativement diminué le débit sanguin (33%). Des mesures en conditions pathologiques ont ensuite été obtenues après l'injection intravitréenne d'un agoniste sélectif du récepteur B1 (RB1). Ce récepteur des kinines est surexprimé dans la rétine des rats rendus diabétiques avec la streptozotocine (STZ) en réponse à l'hyperglycémie et au stress oxydatif. Les résultats ont montré que le RB1 est surexprimé dans la rétine chez les rats diabétiques-STZ à 4 jours et 6 semaines. À ces moments, le débit sanguin rétinien/choroïdien a été significativement augmenté (15 et 18 %) après l'injection de l'agoniste, suggérant un effet vasodilatateur des RB1 dans l'œil diabétique. Bien que la circulation choroïdienne contribue probablement au signal LDF, les résultats démontrent que le LDF représente une technique efficace et non-invasive pour l'étude de la microcirculation rétinienne in-vivo en continu. Cette méthode peut donc être utilisée pour évaluer de façon répétée les réponses du débit sanguin pendant des modifications métaboliques ou pharmacologiques dans des modèles animaux de maladies oculaires.

Air flow influences on local climate: observed and simulated mean relationships for the United Kingdom

Synoptic-scale air flow variability over the United Kingdom is measured on a daily time scale by following previous work to define 3 indices: geostrophic flow strength, vorticity and direction. Comparing the observed distribution of air flow index values with those determined from a simulation with the Hadley Centre’s global climate model (HadCM2) identifies some minor systematic biases in the model’s synoptic circulation but demonstrates that the major features are well simulated. The relationship between temperature and precipitation from parts of the United Kingdom and these air flow indices (either singly or in pairs) is found to be very similar in both the observations and model output; indeed the simulated and observed precipitation relationships are found to be almost interchangeable in a quantitative sense. These encouraging results imply that some reliability can be assumed for single grid-box and regional output from this climate model; this applies only to those grid boxes evaluated here (which do not have high or complex orography), only to the portion of variability that is controlled by synoptic air flow variations, and only to those surface variables considered here (temperature and precipitation).

Continuous enzymatic interesterification of lard and soybean oil blend: Effects of different flow rates on physical properties and acyl migration

Continuous enzymatic interesterification is an alternative to chemical interesterification for lipid modification technology which is economically viable for large scale use. A blend of 70% lard and 30% soybean oil was submitted to continuous enzymatic interesterification in a glass tubular bioreactor at flow rate ranging from 0.5 to 4.5 mL/min. The original mixture and the reaction products obtained were examined to determine melting and crystallization behavior by DSC, and analyzed for regiospecific fatty acid distribution. Continuous enzymatic interesterification changed the mixture, forming a new triacylglycerol composition, verified by DSC curves and variation in enthalpy of melting values. The regiospecific distribution of fatty acids was changed by flow variations in the reactor. In the continuous enzymatic interesterification reaction the flow rate of 4.5 mL/min, was more advantageous than slower flow rates, reducing acyl migration and increasing process productivity. (C) 2011 Elsevier B.V. All rights reserved.

Flow and pressure drop on the shellside of cylindrical heat exchangers

This work presents pressure distributions and fluid flow patterns on the shellside of a cylindrical shell-and-tube heat exchanger. The apparatus used was constructed from glass enabling direct observation of the flow using a dye release technique and had ten traversable pressure instrumented tubes permitting detailed pressure distributions to be obtained. The `exchanger' had a large tube bundle (278 tubes) and main flow areas typical of practical designs. Six geometries were studied: three baffle spacings both with and without baffle leakage. Results are also presented of three-dimensional modelling of shellside flows using the Harwell Laboratory's FLOW3D code. Flow visualisation provided flow patterns in the central plane of the bundle and adjacent to the shell wall. Comparison of these high-lighted significant radial flow variations. In particular, separated regions, originating from the baffle tips, were observed. The size of these regions was small in the bundle central plane but large adjacent to the shell wall and extended into the bypass lane. This appeared to reduce the bypass flow area and hence the bypass flow fraction. The three-dimensional flow modelling results were presented as velocity vector and isobar maps. The vector maps illustrated regions of high and low velocity which could be prone to tube vibration and fouling. Separated regions were also in evidence. A non-uniform crossflow was discovered with, in general, higher velocities in the central plane of the bundle than near the shell wall._The form of the isobar maps calculated by FLOW3D was in good agreement with experimental results. In particular, larger pressure drops occurred across the inlet than outlet of a crossflow region and were higher near the upstream than downstream baffle face. The effect of baffle spacing and baffle leakage on crossflow and window pressure drop measurements was identified. Agreement between the current measurements, previously obtained data and commonly used design correlations/models was, in general, poor. This was explained in terms of the increased understanding of shellside flow. The bulk of previous data, which dervies from small-scale rigs with few tubes, have been shown to be unrepresentative of typical commerical units. The Heat Transfer and Fluid Flow Service design program TASC provided the best predictions of the current pressure drop results. However, a number of simple one-dimensional models in TASC are, individually, questionable. Some revised models have been proposed.

A body force-based method for prediction of multiple-pure-tone noise: Validation

Emissions, fuel burn, and noise are the main drivers for innovative aircraft design. Embedded propulsion systems, such as for example used in hybrid-wing body aircraft, can offer fuel burn and noise reduction benefits but the impact of inlet flow distortion on the generation and propagation of turbomachinery noise has yet to be assessed. A novel approach is used to quantify the effects of non-uniform flow on the creation and propagation of multiple pure tone (MPT) noise. The ultimate goal is to conduct a parametric study of S-duct inlets to quantify the effects of inlet design parameters on the acoustic signature. The key challenge is that the effects of distortion transfer, noise source generation and propagation through the non-uniform flow field are inherently coupled such that a simultaneous computation of the aerodynamics and acoustics is required to capture the mechanisms at play. The technical approach is based on a body force description of the fan blade row that is able to capture the distortion transfer and the blade-to-blade flow variations that cause the MPT noise while reducing computational cost. A single, 3-D full-wheel CFD simulation, in which the Euler equations are solved to second-order spatial and temporal accuracy, simultaneously computes the MPT noise generation and its propagation in distorted inlet flow. A new method of producing the blade-to-blade variations in the body force field for MPT noise generation has been developed and validated. The numerical dissipation inherent to the solver is quantified and used to correct for non-physical attenuation in the far-field noise spectra. Source generation, acoustic propagation and acoustic energy transfer between modes is examined in detail. The new method is validated on NASA's Source Diagnostic Test fan and inlet, showing good agreement with experimental data for aerodynamic performance, acoustic source generation, and far-field noise spectra. The next steps involve the assessment of MPT noise in serpentine inlet ducts and the development of a reduced order formulation suitable for incorporation into NASA's ANOPP framework. © 2010 by Jeff Defoe, Alex Narkaj & Zoltan Spakovszky.

Reactive Hyperemia as endothelial function determinant using plethysmography methods

L’atteinte de la fonction endothéliale représente une phase précoce de l’athérosclérose, un stade où les patients sont généralement asymptomatiques. Il existe donc un intérêt certain à détecter la dysfonction endothéliale. Nous avons développé une technique de mesure des variations de flot artériel au niveau des membres supérieurs, basée sur la spectroscopie proche infrarouge (NIRS). Cette approche permettrait d’étudier le niveau d’atteinte vasculaire et probablement de quantifier le degré de dysfonction endothéliale périphérique lors d’une hyperémie réactive. L'expérience a été exécutée sur deux cohortes de 13 et de 15 patients et a été comparée à la pléthysmographie par jauge de contrainte (SGP) qui est considérée comme une méthode de référence. Par la suite, nous avons caractérisé la réponse endothéliale par modélisation de la courbe hyperémique du flot artériel. Des études préliminaires avaient démontré que la réponse hyperémique adoptait majoritairement une forme bi-modale. Nous avons tenté de séparer les composantes endothéliales-dépendantes et endothéliales-indépendantes de l’hyperémie. La quantification des deux composantes de la réaction hyperémique permet de calculer un indice de la ‘santé’ du système endothélial local. Cet indice est nommé le ηfactor. Les résultats montrent une forte corrélation des mesures de flots entre la technique développée et la méthode de référence (r=0.91). Nous avons conclu que NIRS est une approche précise pour la mesure non-invasive du flot artériel. Nous avons obtenu une bonne répétabilité (ICC = 0.9313) pour le ηfactor indiquant sa robustesse. Cependant des études supplémentaires sont nécessaires pour valider la valeur de diagnostic du facteur défini. Mots clés: hyperémie réactive, réponse myogénique, oxyde nitrique, athérosclérose, spectroscopie proche infrarouge

Paramétrisation de la rétrodiffusion ultrasonore érythrocytaire haute fréquence et pertinence comme facteur de risque de la thrombose veineuse

L’agrégation érythrocytaire est le principal facteur responsable des propriétés non newtoniennes sanguines pour des conditions d’écoulement à faible cisaillement. Lorsque les globules rouges s’agrègent, ils forment des rouleaux et des structures tridimensionnelles enchevêtrées qui font passer la viscosité sanguine de quelques mPa.s à une centaine de mPa.s. Cette organisation microstructurale érythrocytaire est maintenue par des liens inter-globulaires de faible énergie, lesquels sont brisés par une augmentation du cisaillement. Ces propriétés macroscopiques sont bien connues. Toutefois, les liens étiologiques entre ces propriétés rhéologiques générales et leurs effets pathophysiologiques demeurent difficiles à évaluer in vivo puisque les propriétés sanguines sont dynamiques et fortement tributaires des conditions d’écoulement. Ainsi, à partir de propriétés rhéologiques mesurées in vitro dans des conditions contrôlées, il devient difficile d’extrapoler leurs valeurs dans un environnement physiologique. Or, les thrombophlébites se développent systématiquement en des loci particuliers du système cardiovasculaire. D’autre part, plusieurs études cliniques ont établi que des conditions hémorhéologiques perturbées constituent des facteurs de risque de thrombose veineuse mais leurs contributions étiologiques demeurent hypothétiques ou corrélatives. En conséquence, un outil de caractérisation hémorhéologique applicable in vivo et in situ devrait permettre de mieux cerner et comprendre ces implications. Les ultrasons, qui se propagent dans les tissus biologiques, sont sensibles à l’agrégation érythrocytaire. De nature non invasive, l’imagerie ultrasonore permet de caractériser in vivo et in situ la microstructure sanguine dans des conditions d’écoulements physiologiques. Les signaux ultrasonores rétrodiffusés portent une information sur la microstructure sanguine reflétant directement les perturbations hémorhéologiques locales. Une cartographie in vivo de l’agrégation érythrocytaire, unique aux ultrasons, devrait permettre d’investiguer les implications étiologiques de l’hémorhéologie dans la maladie thrombotique vasculaire. Cette thèse complète une série de travaux effectués au Laboratoire de Biorhéologie et d’Ultrasonographie Médicale (LBUM) du centre de recherche du Centre hospitalier de l’Université de Montréal portant sur la rétrodiffusion ultrasonore érythrocytaire et menant à une application in vivo de la méthode. Elle se situe à la suite de travaux de modélisation qui ont mis en évidence la pertinence d’un modèle particulaire tenant compte de la densité des globules rouges, de la section de rétrodiffusion unitaire d’un globule et du facteur de structure. Ce modèle permet d’établir le lien entre la microstructure sanguine et le spectre fréquentiel du coefficient de rétrodiffusion ultrasonore. Une approximation au second ordre en fréquence du facteur de structure est proposée dans ces travaux pour décrire la microstructure sanguine. Cette approche est tout d’abord présentée et validée dans un champ d’écoulement cisaillé homogène. Une extension de la méthode en 2D permet ensuite la cartographie des propriétés structurelles sanguines en écoulement tubulaire par des images paramétriques qui mettent en évidence le caractère temporel de l’agrégation et la sensibilité ultrasonore à ces phénomènes. Une extrapolation menant à une relation entre la taille des agrégats érythrocytaires et la viscosité sanguine permet l’établissement de cartes de viscosité locales. Enfin, il est démontré, à l’aide d’un modèle animal, qu’une augmentation subite de l’agrégation érythrocytaire provoque la formation d’un thrombus veineux. Le niveau d’agrégation, la présence du thrombus et les variations du débit ont été caractérisés, dans cette étude, par imagerie ultrasonore. Nos résultats suggèrent que des paramètres hémorhéologiques, préférablement mesurés in vivo et in situ, devraient faire partie du profil de risque thrombotique.

Events of enhanced convection and related dayside auroral activity

In this paper we study the high-latitude plasma flow variations associated with a periodic (∼8 min) sequence of auroral forms moving along the polar cap boundary, which appear to be the most regularly occuring dayside auroral phenomenon under conditions of southward directed interplanetary magnetic field. Satellite data on auroral particle precipitation and ionospheric plasma drifts from DMSP F10 and F11 are combined with ground-based optical and ion flow measurements for January 7, 1992. Ionospheric flow measurements of 10-s resolution over the range of invariant latitudes from 71° to 76° were obtained by operating both the European incoherent scatter (EISCAT) UHF and VHF radars simultaneously. The optical site (Ny Ålesund, Svalbard) and the EISCAT radar field of view were located in the postnoon sector during the actual observations. The West Greenland magnetometers provided information about temporal variations of high-latitude convection in the prenoon sector. Satellite observations of polar cap convection in the northern and southern hemispheres show a standard two-cell pattern consistent with a prevailing negative By component of the interplanetary magnetic field. The 630.0 nm auroral forms located poleward of the persistent cleft aurora and the flow reversal boundary in the ∼1440–1540 MLT sector were observed to coincide with magnetosheath-like particle precipitation and a secondary population of higher energy ions, and they propagated eastward/tailward at speeds comparable with the convection velocity. It is shown that these optical events were accompanied by bursts of sunward (return) flow at lower latitudes in both the morning and the afternoon sectors, consistent with a modulation of Dungey cell convection. The background level of convection was low in this case (Kp =2+). The variability of the high-latitude convection may be explained as resulting from time-varying reconnection at the magnetopause. In that case this study indicates that time variations of the reconnection rate effectively modulates ionospheric convection.

Model to increase the lateral line length of drip irrigation systems

Non-pressure compensating drip hose is widely used for irrigation of vegetables and orchards. One limitation is that the lateral line length must be short to maintain uniformity due to head loss and slope. Any procedure to increase the length is appropriate because it represents low initial cost of the irrigation system. The hypothesis of this research is that it is possible to increase the lateral line length combining two points: using a larger spacing between emitters at the beginning of the lateral line and a smaller one after a certain distance; and allowing a higher pressure variation along the lateral line under an acceptable value of distribution uniformity. To evaluate this hypothesis, a nonlinear programming model (NLP) was developed. The input data are: diameter, roughness coefficient, pressure variation, emitter operational pressure, relationship between emitter discharge and pressure. The output data are: line length, discharge and length of the each section with different spacing between drippers, total discharge in the lateral line, multiple outlet adjustment coefficient, head losses, localized head loss, pressure variation, number of emitters, spacing between emitters, discharge in each emitter, and discharge per linear meter. The mathematical model developed was compared with the lateral line length obtained with the algebraic solution generated by the Darcy-Weisbach equation. The NLP model showed the best results since it generated the greater gain in the lateral line length, maintaining the uniformity and the flow variation under acceptable standards. It had also the lower flow variation, so its adoption is feasible and recommended.