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.

Uncooled DWDM transmission system using tunable laser sources with anti-mode-hop control protocol

We propose an uncooled DWDM system where errors from uncontrolled laser mode-hopping are avoided by using a control protocol based on monitoring SMSR. We describe a proof-of-principle demonstration of a novel uncooled 50GHz DWDM system. © 2011 IEEE.

Transport of anti-sperm monoclonal IGA and IGC into murine male and female genital tracts from blood - Effect of sex hormones

Ab levels in the genital tract may be important in fertility and in preventing sexually transmitted diseases, In this study, I-125-labeled polymer or monomer mAb IgA (C4pIgA or C4mIgA) and IgC2b (C4IgC) to murine lactate dehydrogenase C4 and a polymer mAb IgA (npIgA) not cross-reacting with mouse sperm were intravenously injected into BALB/c mice, and the relative distribution of these Abs was determined. Polymer IgA was transported much more efficiently into the genital tract, trachea, and duodenum of both sexes than C4IgG and C4 mIgA (p < 0.01), The transport of polymer IgA (C4pIgA and npIgA) into the male genital tract greatly increased following orchiectomy (p < 0.01); this change was not affected by testosterone, suggesting that the unknown regulatory factor(s) from the testis may suppress polymer IgA transport, However, the transport of polymer IgA into female genital tissues was significantly decreased by ovariectomy (p < 0.01); this decline can be rectified by P-estradiol but not progesterone treatment, suggesting that estradiol may stimulate polymer IgA transport, Furthermore, the transport of C4IgG into tissues of the Fallopian tubes and the uterus was significantly decreased by treatment with progesterone (p < 0.01). Together, these findings indicate that serum polymer IgA can be transported selectively into the genital tracts of both sexes, that this transport is strongly under the control of gonads, and that transport of Ige into the Fallopian tubes and uterus is downregulated by progesterone.

An improved microtiter assay for evaluating anti-HIV-I neutralizing antibodies from sera or plasma

Background: The anti-HIV-1 neutralizing antibody assay is widely used in AIDS vaccine research and other experimental and clinical studies. The vital dye staining method applied in the detection of anti-HIV-1 neutralizing antibody has been used in many laboratories. However, the unknown factor(s) in sera or plasma affected cell growth and caused protection when the tested sera or plasma was continuously maintained in cell culture. In addition, the poor solubility of neutral red in medium (such as RPMI-1640) also limited the use of this assay. Methods: In this study, human T cell line C8166 was used as host cells, and 3-(4,5-Dimethyl-2-thiazolyl)- 2,5-diphenyl-2H-tetrazolium bromide (MTT) instead of neutral red was used as vital dye. In order to avoid the effect of the unknown factor( s), the tested sera or plasma was removed by a washout procedure after initial 3 - 6 h culture in the assay. Result: This new assay eliminated the effect of the tested sera or plasma on cell growth, improved the reliability of detection of anti-HIV-1 neutralizing antibody, and showed excellent agreement with the p24 antigen method. Conclusion: The results suggest that the improved assay is relatively simple, highly duplicable, cost-effective, and well reliable for evaluating anti-HIV-1 neutralizing antibodies from sera or plasma.

In vitro anti-HIV and -HSV activity and safety of sodium rutin sulfate as a microbicide candidate

Sodium rutin sulfate (SRS) is a sulfated rutin modified from the natural flavonol glycoside rutin. Here, we investigated its in vitro anti-HIV and -HSV activities and its cytotoxic profile. Fifty percent inhibitory concentration (IC50) values of SRS against HIV-1 X4 virus IIIB, HIV-1 R5 isolates Ada-M and Ba-L were 2.3 +/- 0.2, 4.5 +/- 2.0 and 8.5 +/- 3.8 mu M with a selectivity index (SI) of 563, 575 and 329, respectively. Its IC50 against primary R5 HIV-1 isolate from Yunnan province in China was 13.1 +/- 5.5 mu M, with a Sl of 197. In contrast, unsulfated rutin had no activity against any of the HIV-1 isolates tested. Further study indicated that SRS blocked viral entry and virus-cell fusion likely through interacting with the HIV- I envelope glycoprotein. SRS also demonstrated some activity against human herpes simplex virus (HSV) with an IC50 of 88.3 +/- 0.1 mu M and a Sl of 30. The 50% cytotoxicity concentration (CC50) of SRS was >3.0 mM, as determined in human genital ME 180, HeLa and primary human foreskin fibroblast cells. Minimum inhibitory concentration of SRS for vaginal lactobacilli was >3.0 mM. These results collectively indicate that SRS represents a novel candidate for anti-HIV-1/HSV microbicide development. (C) 2007 Elsevier B.V. All rights reserved.

Copula-based Kernel Dependency Measures

The paper presents a new copula based method for measuring dependence between random variables. Our approach extends the Maximum Mean Discrepancy to the copula of the joint distribution. We prove that this approach has several advantageous properties. Similarly to Shannon mutual information, the proposed dependence measure is invariant to any strictly increasing transformation of the marginal variables. This is important in many applications, for example in feature selection. The estimator is consistent, robust to outliers, and uses rank statistics only. We derive upper bounds on the convergence rate and propose independence tests too. We illustrate the theoretical contributions through a series of experiments in feature selection and low-dimensional embedding of distributions.

Closing the Energy Efficiency Gap: A study linking demographics with barriers to adopting energy efficiency measures in the home

This paper presents a study which linked demographic variables with barriers affecting the adoption of domestic energy efficiency measures in large UK cities. The aim was to better understand the 'Energy Efficiency Gap' and improve the effectiveness of future energy efficiency initiatives. The data for this study was collected from 198 general population interviews (1.5-10 min) carried out across multiple locations in Manchester and Cardiff. The demographic variables were statistically linked to the identified barriers using a modified chi-square test of association (first order Rao-Scott corrected to compensate for multiple response data), and the effect size was estimated with an odds-ratio test. The results revealed that strong associations exist between demographics and barriers, specifically for the following variables: sex; marital status; education level; type of dwelling; number of occupants in household; residence (rent/own); and location (Manchester/Cardiff). The results and recommendations were aimed at city policy makers, local councils, and members of the construction/retrofit industry who are all working to improve the energy efficiency of the domestic built environment. © 2012 Elsevier Ltd.

Ventilation effectiveness measures based on heat removal: Part 2. Application to natural ventilation flows

The three effectiveness measures based on the ability of a flow to flush buoyancy from a ventilated space proposed by Coffey and Hunt [Ventilation effectiveness measures based on heat removal-part 1. Definitions. Building and Environment, in press, doi:10.1016/j.buildenv.2006.03.016.] are applied to assess and compare two fundamental natural ventilation flows. We focus on the limiting cases of passive displacement and passive mixing ventilation flows during transient conditions. These transient flows occur when, for example, heat is purged from a building at night. Whilst it is widely recognised that mixing flows are less efficient at purging heat than displacement flows, our results indicate that, when a particular zone of a room is considered, displacement ventilation can result in lower effectiveness than mixing ventilation. When a room is considered as a whole, displacement ventilation yields higher effectiveness than mixing ventilation and we quantify these differences in terms of the geometry of the space and opening area. The proposed theoretical predictions are compared with effectiveness deduced from measurements made during laboratory experiments and show good agreement. © 2006 Elsevier Ltd. All rights reserved.

Ventilation effectiveness measures based on heat removal: Part 1. Definitions

The effectiveness of ventilation flows is considered from the perspective of buoyancy (or heat) removal from a space. This perspective is distinct from the standard in which the effectiveness is based on the concentrations of a neutrally buoyant contaminant/passive tracer. Three new measures of effectiveness are proposed based on the ability of a flow to flush buoyancy from a ventilated space. These measures provide estimates of instantaneous and time-averaged effectiveness for the entire space, and local effectiveness at any height of interest. From a generalisation of the latter, a vertical profile of effectiveness is defined. These measures enable quantitative comparisons to be made between different flows and they are applicable when there is a difference in density (as is typical due to temperature differences) between the interior environment and the replacement air. Applications, therefore, include natural ventilation, hybrid ventilation and a range of forced ventilation flows. Finally, we demonstrate how the ventilation effectiveness of a room may be assessed from simple traces of temperature versus time. © 2006 Elsevier Ltd. All rights reserved.

New ventilation efficiency measures based on buoyancy removal

New measures for estimating the efficiency of transient ventilation flows are proposed. These measures are developed by considering how effectively a ventilation system removes buoyancy from a space. This approach is distinct from standard efficiency measures which are, in general, based on the removal of a neutrally-buoyant passive tracer. Our new measures, based on (active) buoyancy removal, allow both the instantaneous and time-averaged efficiency of the entire space, or of any region within it, to be determined. In addition, expressions for determining vertical profiles of efficiency are proposed. These new measures enable the effectiveness of different flows to be compared directly and are applicable providing density (temperature) differences exist between the interior environment and the replacement air. Thus, they may be used to contrast the effectiveness of a broad range of building ventilation flows including natural, hybrid and forced ventilation.

N-gram posterior probability confidence measures for statistical machine translation: An empirical study

We report an empirical study of n-gram posterior probability confidence measures for statistical machine translation (SMT). We first describe an efficient and practical algorithm for rapidly computing n-gram posterior probabilities from large translation word lattices. These probabilities are shown to be a good predictor of whether or not the n-gram is found in human reference translations, motivating their use as a confidence measure for SMT. Comprehensive n-gram precision and word coverage measurements are presented for a variety of different language pairs, domains and conditions. We analyze the effect on reference precision of using single or multiple references, and compare the precision of posteriors computed from k-best lists to those computed over the full evidence space of the lattice. We also demonstrate improved confidence by combining multiple lattices in a multi-source translation framework. © 2012 The Author(s).

Anti-counterfeiting and supply chain security

Counterfeit trade developed into a severe problem for many industries. While established security features such as holograms, micro printings or chemical markers do not seem to efficiently avert trade in illicit imitation products, RFID technology, with its potential to automate product authentications, may become a powerful tool to enhance brand and product protection. The following contribution contains an overview on the implication of product counterfeiting on affected companies, provides a starting point for a structured requirements definition for RFID-based anti-counterfeiting systems, and outlines several principal solution approaches that are discussed in greater detail in the subsequent chapters. © 2008 Springer-Verlag Berlin Heidelberg.

Demonstration of multi-casting in a 1 × 9 LCOS wavelength selective switch

A multi-functional 1 × 9 wavelength selective switch based on liquid crystal on silicon (LCOS) spatial light modulator technology and anamorphic optics was tested at a channel spacing of 100 and 200 GHz, including dynamic data measurements on both single beam deflection and multi-casting to two ports. The multi-casting holograms were optimized using a modified Gerchberg-Saxton routine to design the core hologram, followed by a simulated annealing routine to reduce crosstalk at non-switched ports. The effect of clamping the magnitude of phase changes between neighboring pixels during optimization was investigated, with experimental results for multi-casting to two ports resulting in a signal insertion loss of-7.6 dB normalized to single port deflection, a uniformity of ±0.6%, and a worst case crosstalk of-19.4 dB, which can all be improved further by using a better anti-reflection coating on the LCOS SLM coverplate and other measures. © 2013 IEEE.