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%.

Comparison of Image-Based and Time-of-Flight-Based Technologies for 3D Reconstruction of Infrastructure

Image-based (i.e., photo/videogrammetry) and time-of-flight-based (i.e., laser scanning) technologies are typically used to collect spatial data of infrastructure. In order to help architecture, engineering, and construction (AEC) industries make cost-effective decisions in selecting between these two technologies with respect to their settings, this paper makes an attempt to measure the accuracy, quality, time efficiency, and cost of applying image-based and time-of-flight-based technologies to conduct as-built 3D reconstruction of infrastructure. In this paper, a novel comparison method is proposed, and preliminary experiments are conducted. The results reveal that if the accuracy and quality level desired for a particular application is not high (i.e., error < 10 cm, and completeness rate > 80%), image-based technologies constitute a good alternative for time-of-flight-based technologies and significantly reduce the time and cost needed for collecting the data on site.

Comparison of Image-Based and Time-of-Flight-Based Technologies for Three-Dimensional Reconstruction of Infrastructure

Image-based (i.e., photo/videogrammetry) and time-of-flight-based (i.e., laser scanning) technologies are typically used to collect spatial data of infrastructure. In order to help architecture, engineering, and construction (AEC) industries make cost-effective decisions in selecting between these two technologies with respect to their settings, this paper makes an attempt to measure the accuracy, quality, time efficiency, and cost of applying image-based and time-of-flight-based technologies to conduct as-built 3D reconstruction of infrastructure. In this paper, a novel comparison method is proposed, and preliminary experiments are conducted. The results reveal that if the accuracy and quality level desired for a particular application is not high (i.e., error < 10 cm, and completeness rate > 80%), image-based technologies constitute a good alternative for time-of-flight-based technologies and significantly reduce the time and cost needed for collecting the data on site.

Polymer waveguide-based backplanes for board-level optical interconnects

Optical interconnects are increasingly considered for use in high-performance electronic systems. Multimode polymer waveguides are a promising technology for the formation of optical backplane as they enable cost-effective integration of optical links onto standard printed circuit boards. In this paper, two different types of polymer waveguide-based optical backplanes are presented. The first one implements a passive shuffle architecture enabling non-blocking on-board optical interconnection between different cards/modules, while the second one deploys a regenerative bus architecture allowing the interconnection of an arbitrary number of electrical cards over a common optical bus. The polymer materials and the multimode waveguide components used to form the optical backplanes are presented, while details of the interconnection architectures and design of the backplanes are described. Proof-of-principle demonstrators fabricated onto low-cost FR4 substrates, including a 10-card 1 Tb/s-capacity passive shuffle router and 4-channel 3-card polymeric bus modules, are reported and their optical performance characteristics are presented. Low-loss, low-crosstalk on-board interconnection is achieved and error-free (BER10 12) 10 Gb/s communication between different card/module interfaces is demonstrated in both polymeric backplane systems. © 2012 IEEE.

Ion beam, focused ion beam, and plasma discharge machining

Non-conventional methods of machining are used for many engineering applications where the traditional processes fail to be cost-effective. Such processes include Ion Beam Machining (IBM), focused ion beam (FIB) machining and plasma discharge machining. The mechanisms of material removal and associated hardware and software developed for industrial applications of these fascinating electro-physical and chemical machining processes are reviewed together with the latest research findings. © 2009 CIRP.

Sintered metal foams for acoustic absorption

Metal foams fabricated via sintering offer novel mechanical and acoustic properties. Previously, polymer foams have been used as a means of absorbing acoustic energy. However, the structural applications of these foams are limited. The metal sintering approach offers a cost-effective means for the mass-production of open-cell metal foams. The static flow resistance of sintered metal foams was characterized for a range of practical pore sizes and porosities. The measured values for the flow resistance were subsequently used in a phenomenological acoustic model to predict the impedances and propagation constants of the foams. The predictions were then compared to acoustic measurements. At low frequencies (0-1000Hz), the phenomenological model captures the magnitude and frequency dependence of the absorption. At higher frequencies, as expected, the phenomenological model underpredicted the acoustic properties of the foams. However, an alternative microstructural model demonstrated good correlation to the measured results in this frequency range. The effects of foam type and arrangement on the absorption pattern were examined. General trends were identified for enhancing the low frequency performance of an acoustic absorber incorporating sintered foams.

A Novel System for Reducing Turbo-Lag by Injection of Compressed Gas into the Exhaust Manifold

A key challenge in achieving good transient performance of highly boosted engines is the difficulty of accelerating the turbocharger from low air flow conditions (“turbo lag”). Multi-stage turbocharging, electric turbocharger assistance, electric compressors and hybrid powertrains are helpful in the mitigation of this deficit, but these technologies add significant cost and integration effort. Air-assist systems have the potential to be more cost-effective. Injecting compressed air into the intake manifold has received considerable attention, but the performance improvement offered by this concept is severely constrained by the compressor surge limit. The literature describes many schemes for generating the compressed gas, often involving significant mechanical complexity and/or cost. In this paper we demonstrate a novel exhaust assist system in which a reservoir is charged during braking. Experiments have been conducted using a 2.0 litre light-duty Diesel engine equipped with exhaust gas recirculation (EGR) and variable geometry turbine (VGT) coupled to an AC transient dynamometer, which was controlled to mimic engine load during in-gear braking and acceleration. The experimental results confirm that the proposed system reduces the time to torque during the 3rd gear tip-in by around 60%. Such a significant improvement was possible due to the increased acceleration of turbocharger immediately after the tip-in. Injecting the compressed gas into the exhaust manifold circumvents the problem of compressor surge and is the key enabler of the superior performance of the proposed concept.

Fabrication, densification, and replica molding of 3D carbon nanotube microstructures

The introduction of new materials and processes to microfabrication has, in large part, enabled many important advances in microsystems, labon- a-chip devices, and their applications. In particular, capabilities for cost-effective fabrication of polymer microstructures were transformed by the advent of soft lithography and other micromolding techniques 1,2, and this led a revolution in applications of microfabrication to biomedical engineering and biology. Nevertheless, it remains challenging to fabricate microstructures with well-defined nanoscale surface textures, and to fabricate arbitrary 3D shapes at the micro-scale. Robustness of master molds and maintenance of shape integrity is especially important to achieve high fidelity replication of complex structures and preserving their nanoscale surface texture. The combination of hierarchical textures, and heterogeneous shapes, is a profound challenge to existing microfabrication methods that largely rely upon top-down etching using fixed mask templates. On the other hand, the bottom-up synthesis of nanostructures such as nanotubes and nanowires can offer new capabilities to microfabrication, in particular by taking advantage of the collective self-organization of nanostructures, and local control of their growth behavior with respect to microfabricated patterns. Our goal is to introduce vertically aligned carbon nanotubes (CNTs), which we refer to as CNT "forests", as a new microfabrication material. We present details of a suite of related methods recently developed by our group: fabrication of CNT forest microstructures by thermal CVD from lithographically patterned catalyst thin films; self-directed elastocapillary densification of CNT microstructures; and replica molding of polymer microstructures using CNT composite master molds. In particular, our work shows that self-directed capillary densification ("capillary forming"), which is performed by condensation of a solvent onto the substrate with CNT microstructures, significantly increases the packing density of CNTs. This process enables directed transformation of vertical CNT microstructures into straight, inclined, and twisted shapes, which have robust mechanical properties exceeding those of typical microfabrication polymers. This in turn enables formation of nanocomposite CNT master molds by capillary-driven infiltration of polymers. The replica structures exhibit the anisotropic nanoscale texture of the aligned CNTs, and can have walls with sub-micron thickness and aspect ratios exceeding 50:1. Integration of CNT microstructures in fabrication offers further opportunity to exploit the electrical and thermal properties of CNTs, and diverse capabilities for chemical and biochemical functionalization 3. © 2012 Journal of Visualized Experiments.

Engineering of micro- and nanostructured surfaces with anisotropic geometries and properties

Widespread approaches to fabricate surfaces with robust micro- and nanostructured topographies have been stimulated by opportunities to enhance interface performance by combining physical and chemical effects. In particular, arrays of asymmetric surface features, such as arrays of grooves, inclined pillars, and helical protrusions, have been shown to impart unique anisotropy in properties including wetting, adhesion, thermal and/or electrical conductivity, optical activity, and capability to direct cell growth. These properties are of wide interest for applications including energy conversion, microelectronics, chemical and biological sensing, and bioengineering. However, fabrication of asymmetric surface features often pushes the limits of traditional etching and deposition techniques, making it challenging to produce the desired surfaces in a scalable and cost-effective manner. We review and classify approaches to fabricate arrays of asymmetric 2D and 3D surface features, in polymers, metals, and ceramics. Analytical and empirical relationships among geometries, materials, and surface properties are discussed, especially in the context of the applications mentioned above. Further, opportunities for new fabrication methods that combine lithography with principles of self-assembly are identified, aiming to establish design principles for fabrication of arbitrary 3D surface textures over large areas. Copyright © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Fabrication of high-aspect-ratio polymer microstructures and hierarchical textures using carbon nanotube composite master molds

Scalable and cost effective patterning of polymer structures and their surface textures is essential to engineer material properties such as liquid wetting and dry adhesion, and to design artificial biological interfaces. Further, fabrication of high-aspect-ratio microstructures often requires controlled deep-etching methods or high-intensity exposure. We demonstrate that carbon nanotube (CNT) composites can be used as master molds for fabrication of high-aspect-ratio polymer microstructures having anisotropic nanoscale textures. The master molds are made by growth of vertically aligned CNT patterns, capillary densification of the CNTs using organic solvents, and capillary-driven infiltration of the CNT structures with SU-8. The composite master structures are then replicated in SU-8 using standard PDMS transfer molding methods. By this process, we fabricated a library of replicas including vertical micro-pillars, honeycomb lattices with sub-micron wall thickness and aspect ratios exceeding 50:1, and microwells with sloped sidewalls. This process enables batch manufacturing of polymer features that capture complex nanoscale shapes and textures, while requiring only optical lithography and conventional thermal processing. © 2011 The Royal Society of Chemistry.

PCB-integrated optical waveguide sensors: An ammonia gas sensor

This paper presents a novel platform for the formation of cost-effective PCB-integrated optical waveguide sensors. The sensor design relies on the use of multimode polymer waveguides that can be formed directly on standard PCBs and commercially-available chemical dyes, enabling the integration of all essential sensor components (electronic, photonic, chemical) on low-cost substrates. Moreover, it enables the detection of multiple analytes from a single device by employing waveguide arrays functionalised with different chemical dyes. The devices can be manufactured with conventional methods of the PCB industry, such as solder-reflow processes and pick-and-place assembly techniques. As a proof of principle, a PCB-integrated ammonia gas sensor is fabricated on a FR4 substrate. The sensor operation relies on the change of the optical transmission characteristics of chemically functionalised optical waveguides in the presence of ammonia molecules. The fabrication and assembly of the sensor unit, as well as fundamental simulation and characterisation studies, are presented. The device achieves a sensitivity of approximately 30 ppm and a linear response up to 600 ppm at room temperature. Finally, the potential to detect multiple analytes from a single device is demonstrated using principal-component analysis. © 1983-2012 IEEE.

A survey of alternative once-through fast reactor core designs

Reprocessing of Light Water Reactor (LWR) spent fuel to recover plutonium or transuranics for use in Sodium cooled Fast Reactors (SFRs) is a distant prospect in the U.S.A. This has motivated our evaluation of potentially cost-effective operation of uranium startup fast reactors (USFRs) in a once-through mode. This review goes beyond findings reported earlier based on a UC fueled MgO reflected SFR to describe a broader parametric study of options. Cores were evaluated for a variety of fuel/coolant/reflector combinations: UC/UZr/UO 2/UN;Na/Pb; MgO/SS/Zr. The challenge is achieving high burnup while minimizing enrichment and respecting both cladding fluence/dpa and reactivity lifetime limits. These parametric studies show that while UC fuel is still the leading contender, UO 2 fuel and ZrH 1.7 moderated metallic fuel are also attractive if UC proves to be otherwise inadequate. Overall, these findings support the conclusion that a competitive fuel cycle cost and uranium utilization compared to LWRs is possible for SFRs operated on a once-through uranium fueled fuel cycle. In addition, eventual transition to TRU recycle mode is studied, as is a small test reactor to demonstrate key features.

Novel ZnO nanorod films by chemical solution deposition for planar device applications.

Smooth and continuous ZnO films consisting of densely packed ZnO nanorods (NRs), which can be used for electronic device fabrication, were synthesized using a hydro-thermo-chemical solution deposition method. Such devices would have the novelty of high performance, benefiting from the inherited unique properties of the nanomaterials, and can be fabricated on these smooth films using a conventional, low cost planar process. Photoluminescence measurements showed that the NR films have much stronger shallow donor to valence band emissions than those from discrete ZnO NRs, and hence have the potential for the development of ZnO light emission diodes and lasers, etc. The NR films have been used to fabricate large area surface acoustic wave devices by conventional photolithography. These demonstrated two well-defined resonant peaks and their potential for large area device applications. The chemical solution deposition method is simple, reproducible, scalable and economic. These NR films are suitable for large scale production on cost-effective substrates and are promising for various fields such as sensing systems, renewable energy and optoelectronic applications.

A novel system for reducing turbo-lag by injection of compressed gas into the exhaust manifold

A key challenge in achieving good transient performance of highly boosted engines is the difficulty of accelerating the turbocharger from low air flow conditions (turbo lag). Multi-stage turbocharging, electric turbocharger assistance, electric compressors and hybrid powertrains are helpful in the mitigation of this deficit, but these technologies add significant cost and integration effort. Air-assist systems have the potential to be more cost-effective. Injecting compressed air into the intake manifold has received considerable attention, but the performance improvement offered by this concept is severely constrained by the compressor surge limit. The literature describes many schemes for generating the compressed gas, often involving significant mechanical complexity and/or cost. In this paper we demonstrate a novel exhaust assist system in which a reservoir is charged during braking. Experiments have been conducted using a 2.0 litre light-duty Diesel engine equipped with exhaust gas recirculation (EGR) and variable geometry turbine (VGT) coupled to an AC transient dynamometer, which was controlled to mimic engine load during in-gear braking and acceleration. The experimental results confirm that the proposed system reduces the time to torque during the 3rd gear tip-in by around 60%. Such a significant improvement was possible due to the increased acceleration of turbocharger immediately after the tip-in. Injecting the compressed gas into the exhaust manifold circumvents the problem of compressor surge and is the key enabler of the superior performance of the proposed concept. Copyright © 2013 SAE International.

A polymer waveguide-based 40 Gb/s optical bus backplane for board-level optical interconnects

Optical interconnects are increasingly considered for use in high-performance electronic systems. Multimode polymer waveguides are a promising technology for the formation of optical backplanes as they enable cost-effective integration of optical links onto standard printed circuit boards. In this paper, we present a 40 Gb/s optical backplane demonstrator based on the use of polymer multimode waveguides and a regenerative shared bus architecture. The system allows bus extension by cascading multiple polymeric bus modules through 3R regenerator units enabling the connection of an arbitrary number of electrical cards onto the bus. The proof-ofprinciple demonstrator reported here is formed with low-cost, commercially-available active devices and electronic components mounted on conventional FR4 substrates and achieves error-free 4×10 Gb/s optical interconnection between any two card interfaces on the bus. © 2013 IEEE.