Emergency department crowding: prioritising quantified crowding measures using a Delphi study.

AimsEmergency department (ED) crowding has been associated with a number of negative health outcomes, including unnecessary deaths, increased waiting times and a decrease in care quality. Despite the seriousness of this issue, there is little agreement on appropriate crowding measures to assess crowding effects on ED operations. The objective of this study was to prioritise a list of quantified crowding measures that would assess the current state of a department.MethodsA three round Delphi study was conducted via email and an Internet based survey tool. The panel consisted of 40 professionals who had exposure to and expertise in crowding. Participants submitted quantified crowding measures which, through three rounds, were evaluated and ranked to assess participant agreement for inclusion.ResultsThe panel identified 27 measures of which eight (29.6%) reached consensus at the end of the study. These measures comprised: (1) ability of ambulances to offload; (2) patients who leave without being seen or treated; (3) time until triage; (4) ED occupancy rate; (5) patients' total length of stay in the ED; (6) time to see a physician; (7) ED boarding time; and (8) number of patients boarding in the ED.ConclusionsThis study resulted in the identification of eight quantified crowding measures, which present a comprehensive view of how crowding is affecting ED operations, and highlighted areas of concern. These quantified measures have the potential to make a considerable contribution to decision making by ED management and to provide a basis for learning across different departments.

Stress on the ward: evidence of safety tipping points in hospitals

Do hospitals experience safety tipping points as utilization increases, and if so, what are the implications for hospital operations management? We argue that safety tipping points occur when managerial escalation policies are exhausted and workload variability buffers are depleted. Front-line clinical staff is forced to ration resources and, at the same time, becomes more error prone as a result of elevated stress hormone levels. We confirm the existence of safety tipping points for in-hospital mortality using the discharge records of 82,280 patients across six high-mortality-risk conditions from 256 clinical departments of 83 German hospitals. Focusing on survival during the first seven days following admission, we estimate a mortality tipping point at an occupancy level of 92.5%. Among the 17% of patients in our sample who experienced occupancy above the tipping point during the first seven days of their hospital stay, high occupancy accounted for one in seven deaths. The existence of a safety tipping point has important implications for hospital management. First, flexible capacity expansion is more cost-effective for safety improvement than rigid capacity, because it will only be used when occupancy reaches the tipping point. In the context of our sample, flexible staffing saves more than 40% of the cost of a fully staffed capacity expansion, while achieving the same reduction in mortality. Second, reducing the variability of demand by pooling capacity in hospital clusters can greatly increase safety in a hospital system, because it reduces the likelihood that a patient will experience occupancy levels beyond the tipping point. Pooling the capacity of nearby hospitals in our sample reduces the number of deaths due to high occupancy by 34%.

Building performance simulation for the management of thermal performance risks in buildings subject to climate change

This paper reports on research that uses building performance simulation and uncertainty analysis to assess the risks that projected climate change poses to the thermal performance of buildings, and to their critical functions. The work takes meteorological climate change predictions as a starting point, but also takes into account developments and uncertainties in technology, occupancy, intervention and renovation, and others. Four cases are studied in depth to explore the prospects of the quantification of said climate change risks. The research concludes that quantification of the risks posed by climate change is possible, but only with many restrictive assumptions on the input side.

A bottom-up energy analysis across a diverse urban building portfolio: Retrofits for the buildings at the Royal Botanic Gardens, Kew, UK

A methodology for the analysis of building energy retrofits has been developed for a diverse set of buildings at the Royal Botanic Gardens (RBG), Kew in southwest London, UK. The methodology requires selection of appropriate building simulation tools dependent on the nature of the principal energy demand. This has involved the development of a stand-alone model to simulate the heat flow in botanical glasshouses, as well as stochastic simulation of electricity demand for buildings with high equipment density and occupancy-led operation. Application of the methodology to the buildings at RBG Kew illustrates the potential reduction in energy consumption at the building scale achievable from the application of retrofit measures deemed appropriate for heritage buildings and the potential benefit to be gained from onsite generation and supply of energy. © 2014 Elsevier Ltd.

First-principles LDA plus U and GGA plus U study of neptunium dioxide

We have performed a systematic first-principles investigation to calculate the electronic structures, mechanical properties, and phonon-dispersion curves of NpO2. The local-density approximation+U and the generalized gradient approximation+U formalisms have been used to account for the strong on-site Coulomb repulsion among the localized Np 5f electrons. By choosing the Hubbard U parameter around 4 eV, the orbital occupancy characters of Np 5f and O 2p are in good agreement with recent experiments [A. Seibert, T. Gouder, and F. Huber, J. Nucl. Mater. 389, 470 (2009)]. Comparing to our previous study of ThO2, we note that stronger covalency exists in NpO2 due to the more localization behavior of 5f electrons of Np in line with the localization-delocalization trend exhibited by the actinides series.

Analysis of leakage current in GaAs micro-solar cell arrays

The output characteristics of micro-solar cell arrays are analyzed on the basis of a modified model in which the shunt resistance between cell lines results in current leakage. The modification mainly consists of adding a shunt resistor network to the traditional model. The obtained results agree well with the reported experimental results. The calculation results demonstrate that leakage current in substrate affects seriously the performance of GaAs micro- solar cell arrays. The performance of arrays can be improved by reducing the number of cells per line. In addition, at a certain level of integration, an appropriate space occupancy rate of the single cell is recommended for ensuring high open circuit voltages, and it is more appropriate to set the rates at 80%-90% through the calculation.

Analysis of leakage current in GaAs micro-solar cell arrays

The output characteristics of micro-solar cell arrays are analyzed on the basis of a modified model in which the shunt resistance between cell lines results in current leakage. The modification mainly consists of adding a shunt resistor network to the traditional model. The obtained results agree well with the reported experimental results. The calculation results demonstrate that leakage current in substrate affects seriously the performance of GaAs micro- solar cell arrays. The performance of arrays can be improved by reducing the number of cells per line. In addition, at a certain level of integration, an appropriate space occupancy rate of the single cell is recommended for ensuring high open circuit voltages, and it is more appropriate to set the rates at 80%-90% through the calculation.

Theoretical study of p-d hybridization in Co perovskite

The real-space recursion method and unrestricted Hartree-Fock approximation have been applied to calculate the density of states of various Co perovskite, CeCoO3, SrCoO3 and Sr1-xCexCoO3. We have studied the magnetically ordered states of these Co perovskites in an enlarged double cell, and find its various magnetic structures due to the occupancy of 3d band and its interaction with neighboring Co ions. In this study, we have studied the p-d hybridization of the three Co perovskites, we find t(2g) electrons are localized and the flat e(g) band is responsible for the itinerant behavior, and although the rare earth elements itself contribute little to the DOS at the Fermi energy, the DOS at Fermi energy and the magnetic moment changed consequently because of different valence of Co ions in these compounds and p-d hybridization effect is very important. (C) 2009 Elsevier B.V. All rights reserved.

基于栅格地图的多化学羽流源定位

本文研究了移动机器人在湍流环境中定位多个化学羽流源的问题。利用粒子随机行走方法建立动态羽流模型。在此环境中机器人进行梳状搜索并采集羽流数据,使用一种基于后验概率独立假设的改进贝叶斯算法融合这些传感器数据建立一张羽流源位置的概率地图,地图中具有高概率值的栅格指出了羽流源可能的位置。仿真结果说明了该方法的有效性,通过与标准贝叶斯算法的比较说明了该方法优点。

AUV海底热液喷口探测方法研究

自1979年海底热液喷口被首次发现以来，因其巨大的经济和科研价值引起了科学界的巨大关注。海底热液喷口释放的热液与周围海水混合，形成热液羽流，其范围可以达到数千米。热液羽流的存在使在几千米深的海底定位范围只有几米的热液喷口成为可能。湍流的作用使热液羽流与喷口位置存在不确定性，而在搜索区域中包含多个热液源会增加这种不确定性，这是海底热液喷口探测需要克服的难题之一。 本文主要研究了使用AUV探测海底热液喷口的方法。这个问题从更大范畴来说属于机器人化学羽流源定位问题（也称为移动机器人气源/味源定位），其潜在应用包括污染与环境监测，化学工厂安全，搜索与救援，反恐，麻醉品控制，爆炸物清除，以及热液喷口探测等。 首先，从AUV探测的角度研究了海底热液羽流的特性，分析了海底热液羽流的模型并根据模型对羽流进行了动态仿真。 从化学羽流源定位的角度研究了两种海底热液喷口探测策略──梯度搜索策略和构建占据栅格地图(Occupancy Grid Mapping，OGM)的策略。并利用仿真羽流环境验证了上述两种定位策略的可行性。 梯度搜索策略通过基于行为的方法实现，将梯度搜索任务分解为五个行为，并设计了行为间的转换规则，AUV按此规则在不同的行为间转化，跟踪羽流浓度梯度的方向，最终到达浓度极值点。 通过将每个栅格的二值状态重新定义为是否存在一个活跃的热液源，可以将OGM应用于热液源定位。融合传感器数据得到的后验概率地图可以反映每个栅格中存在热液源的可能性。本文采用基于贝叶斯规则的算法融合传感器数据。由于热液源的数量稀少，使用标准贝叶斯方法往往对栅格的占据概率做出过高估计，无法清晰的定位热液源。为此，又研究了一种精确算法和一种基于后验独立假设（Independence of Posteriors，IP）的近似算法，并分析了三种算法的优缺点。 最后，将占据栅格地图应用于分阶段海底热液喷口探测，利用栅格地图帮助实现探测的自主嵌套。

The application of computer modelling to develop a methodology for ‘existing building’ upgrades to move towards carbon-neutral buildings

The retrofitting of existing buildings for decreased energy usage, through increased energy efficiency and for minimum carbon dioxide emissions throughout their remaining lifetime is a major area of research. This research area requires development to provide building professionals with more efficient building retrofit solution determination tools. The overarching objective of this research is to develop a tool for this purpose through the implementation of a prescribed methodology. This has been achieved in three distinct steps. Firstly, the concept of using the degree-days modelling method as an adequate means of basing retrofit decision upon was analysed and the results illustrated that the concept had merit. Secondly, the concept of combining the degree-days modelling method and the Genetic Algorithms optimisation method is investigated as a method of determining optimal thermal energy retrofit solutions. Thirdly, the combination of the degree-days modelling method and the Genetic Algorithms optimisation method were packaged into a building retrofit decision-support tool and named BRaSS (Building Retrofit Support Software). The results demonstrate clearly that, fundamental building information, simplified occupancy profiles and weather data used in a static simulation modelling method is a sufficient and adequate means to base retrofitting decisions upon. The results also show that basing retrofit decisions upon energy analysis results are the best means to guide a retrofit project and also to achieve results which are optimum for a particular building. The results also indicate that the building retrofit decision-support tool, BRaSS, is an effective method to determine optimum thermal energy retrofit solutions.

Receptor and G betagamma isoform-specific interactions with G protein-coupled receptor kinases.

The G protein-coupled receptor (GPCR) kinases (GRKs) phosphorylate and desensitize agonist-occupied GPCRs. GRK2-mediated receptor phosphorylation is preceded by the agonist-dependent membrane association of this enzyme. Previous in vitro studies with purified proteins have suggested that this translocation may be mediated by the recruitment of GRK2 to the plasma membrane by its interaction with the free betagamma subunits of heterotrimeric G proteins (G betagamma). Here we demonstrate that this mechanism operates in intact cells and that specificity is imparted by the selective interaction of discrete pools of G betagamma with receptors and GRKs. Treatment of Cos-7 cells transiently overexpressing GRK2 with a beta-receptor agonist promotes a 3-fold increase in plasma membrane-associated GRK2. This translocation of GRK2 is inhibited by the carboxyl terminus of GRK2, a known G betagamma sequestrant. Furthermore, in cells overexpressing both GRK2 and G beta1 gamma2, activation of lysophosphatidic acid receptors leads to the rapid and transient formation of a GRK/G betagamma complex. That G betagamma specificity exists at the level of the GPCR and the GRK is indicated by the observation that a GRK2/G betagamma complex is formed after agonist occupancy of the lysophosphatidic acid and beta-adrenergic but not thrombin receptors. In contrast to GRK2, GRK3 forms a G betagamma complex after stimulation of all three GPCRs. This G betagamma binding specificity of the GRKs is also reflected at the level of the purified proteins. Thus the GRK2 carboxyl terminus binds G beta1 and G beta2 but not G beta3, while the GRK3 fusion protein binds all three G beta isoforms. This study provides a direct demonstration of a role for G betagamma in mediating the agonist-stimulated translocation of GRK2 and GRK3 in an intact cellular system and demonstrates isoform specificity in the interaction of these components.

Different Mechanisms Confer Gradual Control and Memory at Nutrient- and Stress-Regulated Genes in Yeast.

Cells respond to environmental stimuli by fine-tuned regulation of gene expression. Here we investigated the dose-dependent modulation of gene expression at high temporal resolution in response to nutrient and stress signals in yeast. The GAL1 activity in cell populations is modulated in a well-defined range of galactose concentrations, correlating with a dynamic change of histone remodeling and RNA polymerase II (RNAPII) association. This behavior is the result of a heterogeneous induction delay caused by decreasing inducer concentrations across the population. Chromatin remodeling appears to be the basis for the dynamic GAL1 expression, because mutants with impaired histone dynamics show severely truncated dose-response profiles. In contrast, the GRE2 promoter operates like a rapid off/on switch in response to increasing osmotic stress, with almost constant expression rates and exclusively temporal regulation of histone remodeling and RNAPII occupancy. The Gal3 inducer and the Hog1 mitogen-activated protein (MAP) kinase seem to determine the different dose-response strategies at the two promoters. Accordingly, GAL1 becomes highly sensitive and dose independent if previously stimulated because of residual Gal3 levels, whereas GRE2 expression diminishes upon repeated stimulation due to acquired stress resistance. Our analysis reveals important differences in the way dynamic signals create dose-sensitive gene expression outputs.

The effect of spatial scale on interactions between two weevils and their parasitoid

1. The effect of spatial scale on the interactions between three hymenopteran parasitoids and their weevil hosts was investigated. The parasitoid Mesopolobus incultus (Walker) parasitised Gymnetron pascuorum Gyll.; the parasitoids Entodon sparetus (Walker) and Bracon sp. parasitised Mecinus pyraster Herbst. Both of these weevils develop inside the seedhead of Plantago lanceolata L. but occupy different niches. Seedheads were sampled annually from 162 plants at each of two experimental sites consisting of a series of habitat patches of two distinct sizes. Data were analysed from three site-years. 2. Parasitoid densities at each site-year were closely related to the abundance of their respective weevil hosts. The overall proportion of hosts parasitised was more variable for M. incultus than for E. sparetus and Bracon sp. 3. Changes in spatial scale affected the variability of parasitoid densities. For M. incultus, there was generally a greater degree of additional heterogeneity for all increases of scale; for E. sparetus, this was true only at the largest scales; for Bracon sp., all components of variance were negative. 4. The rate of parasitism was related to host density in different ways at different spatial scales. Mesopolobus incultus exhibited inverse density dependence at the finest (seedhead) scale, direct density dependence at the intermediate (plant) scale, and density independence at the large (habitat area 729 m2) scale. Entodon sparetus showed no response to variation in host density at any spatial scale. Bracon sp. showed direct density dependence only at the intermediate and largest scales. 5. Parasitoids E. sparetus and Bracon sp. seemed able to detect more than one M. pyraster individual in seedheads with multiple host occupancy; a greater incidence of conspecific parasitoids than expected emerged from such seedheads.

Virtual assignments: breach of covenant against parting with or sharing of possession

Comments on the Chancery Division decision in Clarence House Ltd v National Westminster Bank Plc on whether the alienation covenant in a lease of commercial premises had been breached by the tenant effecting a virtual assignment of it, under which all the economic benefits and burdens of the lease were transferred to a third party without there being any actually assignment of the leasehold interest or change in occupancy.