Emergency Department Efficiency in an Academic Hospital: A Simulation Study

Gemstone Team HOPE (Hospital Optimal Productivity Enterprise)

An active learning approach for rapid characterization of endothelial cells in human tumors.

Currently, no available pathological or molecular measures of tumor angiogenesis predict response to antiangiogenic therapies used in clinical practice. Recognizing that tumor endothelial cells (EC) and EC activation and survival signaling are the direct targets of these therapies, we sought to develop an automated platform for quantifying activity of critical signaling pathways and other biological events in EC of patient tumors by histopathology. Computer image analysis of EC in highly heterogeneous human tumors by a statistical classifier trained using examples selected by human experts performed poorly due to subjectivity and selection bias. We hypothesized that the analysis can be optimized by a more active process to aid experts in identifying informative training examples. To test this hypothesis, we incorporated a novel active learning (AL) algorithm into FARSIGHT image analysis software that aids the expert by seeking out informative examples for the operator to label. The resulting FARSIGHT-AL system identified EC with specificity and sensitivity consistently greater than 0.9 and outperformed traditional supervised classification algorithms. The system modeled individual operator preferences and generated reproducible results. Using the results of EC classification, we also quantified proliferation (Ki67) and activity in important signal transduction pathways (MAP kinase, STAT3) in immunostained human clear cell renal cell carcinoma and other tumors. FARSIGHT-AL enables characterization of EC in conventionally preserved human tumors in a more automated process suitable for testing and validating in clinical trials. The results of our study support a unique opportunity for quantifying angiogenesis in a manner that can now be tested for its ability to identify novel predictive and response biomarkers.

Patient-derived endothelial progenitor cells improve vascular graft patency in a rodent model.

Late outgrowth endothelial progenitor cells (EPCs) derived from the peripheral blood of patients with significant coronary artery disease were sodded into the lumens of small diameter expanded polytetrafluoroethylene (ePTFE) vascular grafts. Grafts (1mm inner diameter) were denucleated and sodded either with native EPCs or with EPCs transfected with an adenoviral vector containing the gene for human thrombomodulin (EPC+AdTM). EPC+AdTM was shown to increase the in vitro rate of graft activated protein C (APC) production 4-fold over grafts sodded with untransfected EPCs (p<0.05). Unsodded control and EPC-sodded and EPC+AdTM-sodded grafts were implanted bilaterally into the femoral arteries of athymic rats for 7 or 28 days. Unsodded control grafts, both with and without denucleation treatment, each exhibited 7 day patency rates of 25%. Unsodded grafts showed extensive thrombosis and were not tested for patency over 28 days. In contrast, grafts sodded with untransfected EPCs or EPC+AdTM both had 7 day patency rates of 88-89% and 28 day patency rates of 75-88%. Intimal hyperplasia was observed near both the proximal and distal anastomoses in all sodded graft conditions but did not appear to be the primary occlusive failure event. This in vivo study suggests autologous EPCs derived from the peripheral blood of patients with coronary artery disease may improve the performance of synthetic vascular grafts, although no differences were observed between untransfected EPCs and TM transfected EPCs.

Fabrication of Poly (D,L-Lactic-Co-Glycolic Acid) Microparticles for Improved Human Papillomavirus Vaccine Delivery

Human papillomavirus (HPV) is the leading cause of cervical cancer and the most prevalent sexually transmitted disease worldwide. HPV vaccines require a multi-dose regimen to provide immunity, contributing to low patient compliance. We addressed this problem by formulating biodegradable poly(D,L-lactic-co-glycolic acid) (PLGA) microparticles and assessing their viability for use in controlled-release vaccines. We hypothesized that we could alter fabrication parameters to produce 1-10 μm microparticles in order to encapsulate ovalbumin (OVA) and HPV virus-like particles (VLPs). Microparticles were fabricated using a double emulsion method and used to elicit an immune response in JAWSII cells. Our results contribute to knowledge of vaccine delivery mechanisms and controlled-release technology, and could contribute to the creation of a viable controlled-release HPV vaccine.

Ovarian function and spontaneous pregnancy after combined heterotopic and orthotopic cryopreserved ovarian tissue transplantation in a patient previously treated with bone marrow transplantation: case report

Cryopreservation of ovarian tissue has been proposed for storing gametes of young patients at high risk of premature ovarian failure. Autotransplantation has recently provided some promising results and is still the unique option to restore ovarian function from cryopreserved ovarian tissue in humans. In this article, we analyse data from the combined orthotopic and heterotopic transplantation of cryopreserved ovarian tissue that restored the ovarian function and fertility. Orthotopic transplantation of cryopreserved ovarian tissue at ovarian and peritoneal sites, together with a heterotopic transplantation at the abdominal subcutaneous site, was performed to restore the ovarian function of a 29-year-old woman previously treated with bone marrow transplantation (BMT) for Hodgkin's disease. Ovarian reserve markers progressively suppress within values 5 months after the transplantation (basal FSH 5 mUI/ml and inhibin B 119 ng/ml). Follicular development was observed at all transplantation sites but was predominant at the ovarian site. Six natural cycles were fully documented and analysed. The patient became spontaneously pregnant following the sixth cycle, but unfortunately she later miscarried. Combined orthotopic and heterotopic transplantations succeeded in the restoration of normal spontaneous cycles. Furthermore, this spontaneous pregnancy confirmed the efficiency of this procedure for restoring human fertility.

Computer modelling of human behaviour in aircraft fire accidents

The mathematical simulation of the evacuation process has a wide and largely untapped scope of application within the aircraft industry. The function of the mathematical model is to provide insight into complex behaviour by allowing designers, legislators, and investigators to ask ‘what if’ questions. Such a model, EXODUS, is currently under development, and this paper describes its evolution and potential applications. EXODUS is an egress model designed to simulate the evacuation of large numbers of individuals from an enclosure, such as an aircraft. The model tracks the trajectory of each individual as they make their way out of the enclosure or are overcome by fire hazards, such as heat and toxic gases. The software is expert system-based, the progressive motion and behaviour of each individual being determined by a set of heuristics or rules. EXODUS comprises five core interacting components: (i) the Movement Submodel — controls the physical movement of individual passengers from their current position to the most suitable neighbouring location; (ii) the Behaviour Submodel — determines an individual's response to the current prevailing situation; (iii) the Passenger Submodel — describes an individual as a collection of 22 defining attributes and variables; (iv) the Hazard Submodel — controls the atmospheric and physical environment; and (v) the Toxicity Submodel — determines the effects on an individual exposed to the fire products, heat, and narcotic gases through the Fractional Effective Dose calculations. These components are briefly described and their capabilities and limitations are demonstrated through comparison with experimental data and several hypothetical evacuation scenarios.

The application of fire and evacuation simulation in ship design

Fire and evacuation models with features such as the ability to realistically simulate the spread of heat and smoke and the human response to fire as well as the capability to model human performance in heeled orientations linked to a virtual reality environment that produces realistic visualisation of the modelled scenarios are now available and can be used to aid the engineer in assessing ship design and procedures. This paper describes the maritimeEXODUS ship evacuation and the SMARTFIRE fire simulation model and provides an example application demonstrating the use of the models used in pperforming fire and evacuation analysis for a large passenger ship partially based on the requirements of MSC circular 1033.

Fire safety engineering and ship design using advanced fire and evacuation simulation

When designing a new passenger ship or modifying an existing design, how do we ensure that the proposed design and crew emergency procedures are safe from an evacuation resulting from fire or other incident? In the wake of major maritime disasters such as the Scandinavian Star, Herald of Free Enterprise, Estonia and in light of the growth in the number of high density, high-speed ferries and large capacity cruise ships, issues concerning the evacuation of passengers and crew at sea are receiving renewed interest. Fire and evacuation models with features such as the ability to realistically simulate the spread of heat and smoke and the human response to fire as well as the capability to model human performance in heeled orientations linked to a virtual reality environment that produces realistic visualisations of the modelled scenarios are now available and can be used to aid the engineer in assessing ship design and procedures. This paper describes the maritimeEXODUS ship evacuation and the SMARTFIRE fire simulation model and provides an example application demonstrating the use of the models in performing fire and evacuation analysis for a large passenger ship partially based on the requirements of MSC circular 1033

The simulation of ship evacuation under fire conditions

When designing a new passenger ship or modifying an existing design, how do we ensure that the proposed design and crew emergency procedures are safe from an evacuation resulting from fire or other incident? In the wake of major maritime disasters such as the Scandinavian Star, Herald of Free Enterprise, Estonia and in light of the growth in the numbers of high density, high-speed ferries and large capacity cruise ships, issues concerning the evacuation of passengers and crew at sea are receiving renewed interest. Fire and evacuation models with features such as the ability to realistically simulate the spread of fire and fire suppression systems and the human response to fire as well as the capability to model human performance in heeled orientations linked to a virtual reality environment that produces realistic visualisations of the modelled scenarios are now available and can be used to aid the engineer in assessing ship design and procedures. This paper describes the maritimeEXODUS ship evacuation and the SMARTFIRE fire simulation model and provides an example application demonstrating the use of the models in performing fire and evacuation analysis for a large passenger ship partially based, but exceeding the requirements of MSC circular 1033.

A preliminary investigation of the evacuation of the WTC North Tower using computer simulation

This paper concerns a preliminary numerical simulation study of the evacuation of the World Trade Centre North Tower on 11 September 2001 using the buildingEXODUS evacuation simulation software. The analysis makes use of response time data derived from a study of survivor accounts appearing in the public domain. While exact geometric details of the building were not available for this study, the building geometry was approximated from descriptions available in the public domain. The study attempts to reproduce the events of 11 September 2001 and pursue several ‘what if’ questions concerning the evacuation. In particular, the study explores the likely outcome had a single staircase survived in tact from top to bottom.

Advanced evacuation simulation software and its use in warships

The newly formed Escape and Evacuation Naval Authority regulates the provision of abandonment equipment and procedures for all Ministry of Defence Vessels. As such, it assures that access routes on board are evaluated early in the design process to maximize their efficiency and to eliminate, as far as possible, any congestion that might occur during escape. This analysis can be undertaken using a computer-based simulation for given escape scenarios and replicates the layout of the vessel and the interactions between each individual and the ship structure. One such software tool that facilitates this type of analysis is maritimeEXODUS. This tool, through large scale testing and validation, emulates human shipboard behaviour during emergency scenarios; however it is largely based around the behaviour of civilian passengers and fixtures and fittings of merchant vessels. Hence there existed a clear requirement to understand the behaviour of well-trained naval personnel as opposed to civilian passengers and be able to model the fixtures and fittings that are exclusive to warships, thus allowing improvements to both maritimeEXODUS and other software products. Human factor trials using the Royal Navy training facilities at Whale Island, Portsmouth were recently undertaken to collect data that improves our understanding of the aforementioned differences. It is hoped that this data will form the basis of a long-term improvement package that will provide global validation of these simulation tools and assist in the development of specific Escape and Evacuation standards for warships. © 2005: Royal Institution of Naval Architects.

Integrating personnel movement simulation into preliminary ship design

Traditionally, when designing a ship the driving issues are seen to be powering, stability, strength and seakeeping. Issues related to ship operations and evolutions are investigated later in the design process, within the constraint of a fixed layout. This can result in operational inefficiencies and limitations, excessive crew numbers and potentially hazardous situations. University College London and the University of Greenwich are in the final year of a three year EPSRC funded research project to integrate the simulation of personnel movement into early stage ship design. This allows the assessment of onboard operations while the design is still amenable to change. The project brings together the University of Greenwich developed maritimeEXODUS personnel movement simulation software and the SURFCON implementation of the Design Building Block approach to early stage ship design, which originated with the UCL Ship Design Research team. Central to the success of this project is the definition of a suitable series of Naval Combatant Human Performance Metrics which can be used to assess the performance of the design in different operational scenarios. The paper outlines the progress made on deriving the human performance metric from human factors criteria measured in simulations and their incorporation into a Behavioural Matrix for analysis. It describes the production of a series of SURFCON ship designs based on the RN Type 22 Batch 3 frigate, and their analysis using the PARAMARINE and maritimeEXODUS software. Conclusions to date will be presented on the integration of personnel movement simulation into the preliminary ship design process.

A systematic methodology to assess the impact of human factors in ship design

Evaluating ship layout for human factors (HF) issues using simulation software such as maritimeEXODUS can be a long and complex process. The analysis requires the identification of relevant evaluation scenarios; encompassing evacuation and normal operations; the development of appropriate measures which can be used to gauge the performance of crew and vessel and finally; the interpretation of considerable simulation data. Currently, the only agreed guidelines for evaluating HFs performance of ship design relate to evacuation and so conclusions drawn concerning the overall suitability of a ship design by one naval architect can be quite different from those of another. The complexity of the task grows as the size and complexity of the vessel increases and as the number and type of evaluation scenarios considered increases. Equally, it can be extremely difficult for fleet operators to set HFs design objectives for new vessel concepts. The challenge for naval architects is to develop a procedure that allows both accurate and rapid assessment of HFs issues associated with vessel layout and crew operating procedures. In this paper we present a systematic and transparent methodology for assessing the HF performance of ship design which is both discriminating and diagnostic. The methodology is demonstrated using two variants of a hypothetical naval ship.

Integrating personnel movement simulation into prelimary ship design

Traditionally, when designing a ship the driving issues are seen to be powering, stability, strength and seakeeping. Issues related to ship operations and evolutions are investigated later in the design process, within the constraint of a fixed layout. This can result in operational inefficiencies and limitations, excessive crew numbers and potentially hazardous situations. This paper summarises work by University College London and the University of Greenwich prior to the completion of a three year EPSRC funded research project to integrate the simulation of personnel movement into early stage ship design. This integration is intended to facilitate the assessment of onboard operations while the design is still highly amenable to change. The project brings together the University of Greenwich developed maritimeEXODUS personnel movement simulation software and the SURFCON implementation of the Design Building Block approach to early stage ship design, which originated with the UCL Ship Design Research team and has been implemented within the PARAMARINE ship design system produced by Graphics Research Corporation. Central to the success of this project is the definition of a suitable series of Performance Measures (PM) which can be used to assess the human performance of the design in different operational scenarios. The paper outlines the progress made on deriving the PM from human dynamics criteria measured in simulations and their incorporation into a Human Performance Metric (HPM) for analysis. It describes the production of a series of SURFCON ship designs, based on the Royal Navy’s Type 22 Batch 3 frigate, and their analysis using the PARAMARINE and maritimeEXODUS software. Conclusions on the work to date and for the remainder of the project are presented addressing the integration of personnel movement simulation into the preliminary ship design process.

Investigating the use of elevators for high-rise building evacuation through computer simulation

This paper presents a description of a new agent based elevator sub-model developed as part of the buildingEXODUS software intended for both evacuation and circulation applications. A description of each component of the newly developed model is presented, including the elevator kinematics and associated pedestrian behaviour. The elevator model is then used to investigate a series of full building evacuation scenarios based on a hypothetical 50 floor building with four staircases and a population of 7,840 agents. The analysis explores the relative merits of using up to 32 elevators (arranged in four banks) and various egress strategies to evacuate the entire building population. Findings from the investigation suggest that the most efficient evacuation strategy utilises a combination of elevators and stairs to empty the building and clear the upper half of the building in minimum time. Combined stair elevator evacuation times have been shown to be as much as 50% faster than stair only evacuation times.