Physicians in leadership: the association between medical director involvement and staff-to-patient ratios

In a hospital environment that demands a careful balance between commercial and clinical interests, the extent to which physicians are involved in hospital leadership varies greatly. This paper assesses the influence of the extent of this involvement on staff-to-patient ratios. Using data gathered from 604 hospitals across Germany, this study evidences the positive relationship between a full-time medical director (MD) or heavily involved part-time MD and a higher staff-to-patient ratio. The data allows us to control for a range of confounding variables, such as size, rural/urban location, ownership structure, and case-mix. The results contribute to the sparse body of empirical research on the effect of clinical leadership on organizational outcomes.

Experimental study into the flow physics of three-dimensional shock control bumps

This paper describes a fundamental experimental study of the flow structure around a single three-dimensional (3D) transonic shock control bump (SCB) mounted on a flat surface in a wind tunnel. Tests have been carried out with a Mach 1.3 normal shock wave located at a number of streamwise positions relative to the SCB. Details of the flow have been studied using the experimental techniques of schlieren photography, surface oil flow visualization, pressure sensitive paint, and laser Doppler anemometry. The results of the work build on the findings of previous researchers and shed new light on the flow physics of 3D SCBs. It is found that spanwise pressure gradients across the SCB ramp and the shape of the SCB sides affect the magnitude and uniformity of flow turning generated by the bump, which can impact on the spanwise propagation of the quasi-two-dimensional (2D) shock structure produced by a 3DSCB. At the bump crest, vortices can form if the pressure on the crest is significantly lower than at either side of the bump. The trajectories of these vortices, which are relatively weak, are strongly influenced by any spanwise pressure gradients across the bump tail. Asignificant difference between 2D and 3D SCBs highlighted by the study is the impact of spanwise pressure gradients on 3D SCB performance. The magnitude of these spanwise pressure gradients is determined largely by SCB geometry and shock position. Copyright © 2011 by the American Institute of Aeronautics and Astronautics, Inc.

Fluid Dynamics in Physics, Engineering and Environmental Applications

The book contains invited lectures and selected contributions presented at the Enzo Levi and XVII Annual Meeting of the Fluid Dynamic Division of the Mexican Physical Society in 2011.

FPGA, physics-based modeling of IGBT and pin diode for hardware co-simulation of complex power electronic converters and systems

This paper presents the steps and the challenges for implementing analytical, physics-based models for the insulated gate bipolar transistor (IGBT) and the PIN diode in hardware and more specifically in field programmable gate arrays (FPGAs). The models can be utilised in hardware co-simulation of complex power electronic converters and entire power systems in order to reduce the simulation time without compromising the accuracy of results. Such a co-simulation allows reliable prediction of the system's performance as well as accurate investigation of the power devices' behaviour during operation. Ultimately, this will allow application-specific optimisation of the devices' structure, circuit topologies as well as enhancement of the control and/or protection schemes.

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.

Flow physics of a normal-hole bled supersonic turbulent boundary layer

An experimental study on normal hole bleed in a supersonic turbulent boundary layer has been conducted. A combination of LDV, Schlieren imagery and oil flow visualization were used to provide a better understanding of the three-dimensional flow field surrounding a supersonic bleed array. Experiments were performed at Mach numbers of 1.8 and 2.5, while previously published results at Mach numbers of 1.3 and 1.5 were also incorporated. The bleed system was capable of removing up to approximately 10% of the incoming boundary layer through a tunnel-spanning array of discrete holes with diameters the same order of magnitude of boundary layer displacement thickness. Inspection of boundary layer profiles downstream of the bleed region indicates that vorticity generated by the discrete holes can have a substantial influence on changes to the boundary layer shape factor and skin friction coefficient, through modification of the lower 20% of the boundary layer. This vorticity was visualized through oil-flow visualization, and LDV measurements, showing the development of two vortices off each bleed hole, and corresponding upwash and downwash regions with far-reaching three dimensional effects. © 2013 by J. M. Oorebeek and H. Babinsky.

Flipped physics

This paper defines flipped learning and then examines its practical implementation in AS and A2 level physics classes, that is, classes for 16-18 year olds. The effect of this teaching style on student learning behaviour and its impact on test results are evaluated. The paper recounts the difficulties of implementing it and evaluates student preferences. It concludes with comments about this teaching style's appropriateness for various groups of students and identifies those for whom it is not suitable. A list of useful websites is included. © 2013 IOP Publishing Ltd.

Exploring an effective model of new product development in medical devices: A knowledge cluster approach

This study proposes a new product development (NPD) model that aims to improve the effectiveness of innovative NPD in the medical devices. By adopting open innovation theory and applying an in-depth investigation methodology, this paper proposes a knowledge cluster that improves the integration of interdisciplinary human resources and enhances the acquirement of innovative technologies. A knowledge cluster approach helps gather, organise, synthesise, and accumulate knowledge in order to become the impetus for innovation. Although enterprises are no longer the principals of research and development, they should still be capable of integrating professional physicians, external groups, and individuals through the knowledge cluster platform. However, in order to support an effective NPD model, enterprises should provide adequate incentives and trust to external individuals or groups willing to contribute their expertise and knowledge to this knowledge cluster platform. Copyright © 2013 Inderscience Enterprises Ltd.

Development of a nanoporous and multilayer drug-delivery platform for medical implants.

Biodegradable polymers can be applied to a variety of implants for controlled and local drug delivery. The aim of this study is to develop a biodegradable and nanoporous polymeric platform for a wide spectrum of drug-eluting implants with special focus on stent-coating applications. It was synthesized by poly(DL-lactide-co-glycolide) (PLGA 65:35, PLGA 75:25) and polycaprolactone (PCL) in a multilayer configuration by means of a spin-coating technique. The antiplatelet drug dipyridamole was loaded into the surface nanopores of the platform. Surface characterization was made by atomic force microscopy (AFM) and spectroscopic ellipsometry (SE). Platelet adhesion and drug-release kinetic studies were then carried out. The study revealed that the multilayer films are highly nanoporous, whereas the single layers of PLGA are atomically smooth and spherulites are formed in PCL. Their nanoporosity (pore diameter, depth, density, surface roughness) can be tailored by tuning the growth parameters (eg, spinning speed, polymer concentration), essential for drug-delivery performance. The origin of pore formation may be attributed to the phase separation of polymer blends via the spinodal decomposition mechanism. SE studies revealed the structural characteristics, film thickness, and optical properties even of the single layers in the triple-layer construct, providing substantial information for drug loading and complement AFM findings. Platelet adhesion studies showed that the dipyridamole-loaded coatings inhibit platelet aggregation that is a prerequisite for clotting. Finally, the films exhibited sustained release profiles of dipyridamole over 70 days. These results indicate that the current multilayer phase therapeutic approach constitutes an effective drug-delivery platform for drug-eluting implants and especially for cardiovascular stent applications.

Biofunctionalization of PET/SiO2 surfaces for single molecule experiments and medical applications

PET/SiO2 layers were chemically modified to maintain immobilization of functional single molecules. GFP molecules provide an ideal system due to their stability and intrinsic fluorescence. GFP in vivo biotinylated within its NH2-terminal region and attached on the substrate via the biotinstreptavidin bond was further investigated with confocal microscopy, atomic force microscopy (AFM) and spectroscopic ellipsometry (SE). AFM revealed monolayered donut-like structures representing assemblies of biotinstreptavidinbiotinGFP immobilized onto PET/SiO2 surfaces via mPEG. In particular, regions with an approximate height of 12 nm, which approaches the molecular dimensions of the above complex given by molecular modeling, could be detected. The dimensions of the donut-like structures suggest a close-to-each-other positioning of the GFP molecules - which, however, retain their functionality, as evidenced by confocal microscopy. © 2011 World Scientific Publishing Company.