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%.

Detection of large-scale concrete columns for automated bridge inspection

There are over 600,000 bridges in the US, and not all of them can be inspected and maintained within the specified time frame. This is because manually inspecting bridges is a time-consuming and costly task, and some state Departments of Transportation (DOT) cannot afford the essential costs and manpower. In this paper, a novel method that can detect large-scale bridge concrete columns is proposed for the purpose of eventually creating an automated bridge condition assessment system. The method employs image stitching techniques (feature detection and matching, image affine transformation and blending) to combine images containing different segments of one column into a single image. Following that, bridge columns are detected by locating their boundaries and classifying the material within each boundary in the stitched image. Preliminary test results of 114 concrete bridge columns stitched from 373 close-up, partial images of the columns indicate that the method can correctly detect 89.7% of these elements, and thus, the viability of the application of this research.

The pursuit of academic excellence and business engagement: Is it irreconcilable?

Universities currently need to satisfy the demands of different audiences. In light of the increasing policy emphasis on "third mission" activities, universities are attempting to incorporate these into their traditional missions of teaching and research. University strategies to accomplishing its traditional missions are well-honed and routinized, but the incorporation of the third mission is posing important strategic and managerial challenges for universities. This study explores the relationship between university-business collaborations and academic excellence in order to examine the extent to which academic institutions can balance these objectives. Based on data from the UK Research Assessment Exercise 2001 at the level of the university department, we find no systematic positive or negative relationship between scientific excellence and engagement with industry. Across the disciplinary fields reported in the 2001 Research Assessment Exercise (i. e. engineering, hard sciences, biomedicine, social sciences and the humanities) the relationship between academic excellence and engagement with business is largely contingent on the institutional context of the university department. This paper adds to the growing body of literature on university engagement with business by examining this activity for the social sciences and the humanities. Our findings have important implications for the strategic management of university departments and for higher education policy related to measuring the performance of higher education research institutions. © 2013 Akadémiai Kiadó, Budapest, Hungary.

Stakeholder challenges in purchasing medical devices for patient safety.

OBJECTIVE: This study identifies the stakeholders who have a role in medical device purchasing within the wider system of health-care delivery and reports on their particular challenges to promote patient safety during purchasing decisions. METHODS: Data was collected through observational work, participatory workshops, and semi-structured qualitative interviews, which were analyzed and coded. The study takes a systems-based and engineering design approach to the study. Five hospitals took part in this study, and the participants included maintenance, training, clinical end-users, finance, and risk departments. RESULTS: The main stakeholders for purchasing were identified to be staff from clinical engineering (Maintenance), device users (Clinical), device trainers (Training), and clinical governance for analyzing incidents involving devices (Risk). These stakeholders display varied characteristics in terms of interpretation of their own roles, competencies for selecting devices, awareness and use of resources for purchasing devices, and attitudes toward the purchasing process. The role of "clinical engineering" is seen by these stakeholders to be critical in mediating between training, technical, and financial stakeholders but not always recognized in practice. CONCLUSIONS: The findings show that many device purchasing decisions are tackled in isolation, which is not optimal for decisions requiring knowledge that is currently distributed among different people within different departments. The challenges expressed relate to the wider system of care and equipment management, calling for a more systemic view of purchasing for medical devices.

中国畜牧业现状与可持续发展措施的研究

畜牧业是否成长为农村经济的支柱产业,是衡量一个国家农业发达程度的主要标志。现阶段.我国畜牧业的增长方式、发展路径、动力、市场和地位都发生了重大变化,给畜牧业的可持续发展提出了许多新问题和新挑战。近年来.我国畜牧业的发展取得了举世嘱目的成就,促进了国民经济的快速发展,丰富了城乡人民物质和文化生活的需要。随着经济的发展和人们生活水平的逐步提高.对畜牧产品的需求将有较大增长,大力加强和发展畜牧业将是我国农业的最终方向。依据现有统计资料,结合我国畜牧业的实际情况,根据"十一五"规划和建设社会主义新农村的要求,文章分析了畜牧业发展的地位,探讨了畜牧业存在的问题.并提出了相应的对策和建议。

中国土壤侵蚀影响因素及其危害分析

该文从降雨、地貌、植被、土壤及人为因素等方面对中国土壤侵蚀的影响因素进行了系统分析 ,研究了土壤侵蚀使中国土地资源破坏、粮食减产、灾害发生、土壤肥力下降、水资源环境污染、库塘湖泊淤积、城市安全受到威胁等一系列危害 ,可供水土保持及环境整治决策作参考

Industrial development and land use/cover change and their effects on local environment: a case study of Changshu in eastern coastal China

The interactions among industrial development, land use/cover change (LUCC), and environmental effects in Changshu in the eastern coastal China were analyzed using high-resolution Landsat TM data in 1990, 1995, 2000, and 2006, socio-economic data and water environmental quality monitoring data from research institutes and governmental departments. Three phases of industrial development in Changshu were examined (i.e., the three periods of 1990 to 1995, 1995 to 2000, and 2000 to 2006). Besides industrial development and rapid urbanization, land use/cover in Changshu had changed drastically from 1990 to 2006. This change was characterized by major replacements of farmland by urban and rural settlements, artificial ponds, forested and constructed land. Industrialization, urbanization, agricultural structure adjustment, and rural housing construction were the major socio-economic driving forces of LUCC in Changshu. In addition, the annual value of ecosystem services in Changshu decreased slightly during 1990-2000, but increased significantly during 2000-2006. Nevertheless, the local environmental quality in Changshu, especially in rural areas, has not yet been improved significantly. Thus, this paper suggests an increased attention to fully realize the role of land supply in adjustment of environment-friendly industrial structure and urban-rural spatial restructuring, and translating the land management and environmental protection policies into an optimized industrial distribution and land-use pattern.

职业兴趣的测量研究及大学科系的职业兴趣类型图初探

In these studies the following questions are examined: considering the wide fitness of Holland's vocational interest theory, Holland's Self-Directed Search to make it suitable to Chinese subjects is revised. To guarantee the revised inventory possessing Holland's RIASEC theory, the inventory's construct validity is cross-validated, and the fitness of Holland's Hexagonal Model to Chinese subjects is examined. The feasibility of building up the map of unversities' departments are also examined, according to the vocational interest.

Student use of electronic information services in further education

Urquhart,C., Thomas, R., Spink, S., Fenton, R., Yeoman, A., Lonsdale, R., Armstrong, C., Banwell, L., Ray, K., Coulson, G. & Rowley, J. (2005). Student use of electronic information services in further education. International Journal of Information Management, 25(4), 347-362. Sponsorship: JISC

Qualitative evaluation of KA24 (Knowledge Access 24)

Durbin, J. & Urquhart, C. (2003). Qualitative evaluation of KA24 (Knowledge Access 24). Aberystwyth: Department of Information Studies, University of Wales Aberystwyth. Sponsorship: Knowledge Access 24 (NHS)

Assessing training and professional development needs of library staff. Report for National Library of Health

Urquhart, C., Spink, S. & Thomas, R., Assessing training and professional development needs of library staff. Report for National Library of Health. (2005). Aberystwyth: Department of Information Studies, University of Wales Aberystwyth Sponsorship: National Library for Health (NHS Information Authority)

JUSTEIS: JISC Usage Surveys: Trends in Electronic Information Services Final report 2003/2004 Cycle Five

Urquhart, C., Spink, S., Thomas, R., Yeoman, A., Durbin, J., Turner, J., Fenton, R. & Armstrong, C. (2004). JUSTEIS: JISC Usage Surveys: Trends in Electronic Information Services Final report 2003/2004 Cycle Five. Aberystwyth: Department of Information Studies, University of Wales Aberystwyth. Sponsorship: JISC

JUSTEIS (JISC Usage Surveys: Trends in Electronic Information Services) Strand A: survey of end users of all electronic information services (HE and FE), with Action research report. Final report 2002/2003 Cycle Four.

Urquhart, C. (editor for JUSTEIS team), Spink, S., Thomas, R., Yeoman, A., Durbin, J., Turner, J., Armstrong, A., Lonsdale, R. & Fenton, R. (2003). JUSTEIS (JISC Usage Surveys: Trends in Electronic Information Services) Strand A: survey of end users of all electronic information services (HE and FE), with Action research report. Final report 2002/2003 Cycle Four. Aberystwyth: Department of Information Studies, University of Wales Aberystwyth with Information Automation Ltd (CIQM). Sponsorship: JISC

Ignorance is no Defence but is Inaccessibility? On the Accessibility of National Laws to Foreign Online Publishers

Kohl, U. (2005). Ignorance is no Defence but is Inaccessibility? On the Accessibility of National Laws to Foreign Online Publishers. Information & Communities Technology Law, 14 (1), 25-41. RAE2008 Information & Communications Technology Law Volume 14, Issue 1, 2005 Special Issue: GATED COMMUNITIES