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%.

Robust pairwise matching of interest points with complex wavelets

We present a matching framework to find robust correspondences between image features by considering the spatial information between them. To achieve this, we define spatial constraints on the relative orientation and change in scale between pairs of features. A pairwise similarity score, which measures the similarity of features based on these spatial constraints, is considered. The pairwise similarity scores for all pairs of candidate correspondences are then accumulated in a 2-D similarity space. Robust correspondences can be found by searching for clusters in the similarity space, since actual correspondences are expected to form clusters that satisfy similar spatial constraints in this space. As it is difficult to achieve reliable and consistent estimates of scale and orientation, an additional contribution is that these parameters do not need to be determined at the interest point detection stage, which differs from conventional methods. Polar matching of dual-tree complex wavelet transform features is used, since it fits naturally into the framework with the defined spatial constraints. Our tests show that the proposed framework is capable of producing robust correspondences with higher correspondence ratios and reasonable computational efficiency, compared to other well-known algorithms. © 1992-2012 IEEE.

Machine Vision-Based Infrastructure As-Built Documentation Using Edge Points

The existing machine vision-based 3D reconstruction software programs provide a promising low-cost and in some cases automatic solution for infrastructure as-built documentation. However in several steps of the reconstruction process, they only rely on detecting and matching corner-like features in multiple views of a scene. Therefore, in infrastructure scenes which include uniform materials and poorly textured surfaces, these programs fail with high probabilities due to lack of feature points. Moreover, except few programs that generate dense 3D models through significantly time-consuming algorithms, most of them only provide a sparse reconstruction which does not necessarily include required points such as corners or edges; hence these points have to be manually matched across different views that could make the process considerably laborious. To address these limitations, this paper presents a video-based as-built documentation method that automatically builds detailed 3D maps of a scene by aligning edge points between video frames. Compared to corner-like features, edge points are far more plentiful even in untextured scenes and often carry important semantic associations. The method has been tested for poorly textured infrastructure scenes and the results indicate that a combination of edge and corner-like features would allow dealing with a broader range of scenes.

Finite element analysis of compressor disc heat transfer using the transient conduction method with sparse boundary collocation points

Surface temperature measurements from two discs of a gas turbine compressor rig are used as boundary conditions for the transient conduction solution (inverse heat transfer analysis). The disc geometry is complex, and so the finite element method is used. There are often large radial temperature gradients on the discs, and the equations are therefore solved taking into account the dependence of thermal conductivity on temperature. The solution technique also makes use of a multigrid algorithm to reduce the solution time. This is particularly important since a large amount of data must be analyzed to obtain correlations of the heat transfer. The finite element grid is also used for a network analysis to calculate the radiant heat transfer in the cavity formed between the two compressor discs. The work discussed here proved particularly challenging as the disc temperatures were only measured at four different radial locations. Four methods of surface temperature interpolation are examined, together with their effect on the local heat fluxes. It is found that the choice of interpolation method depends on the available number of data points. Bessel interpolation gives the best results for four data points, whereas cubic splines are preferred when there are considerably more data points. The results from the analysis of the compressor rig data show that the heat transfer near the disc inner radius appears to be influenced by the central throughflow. However, for larger radii, the heat transfer from the discs and peripheral shroud is found to be consistent with that of a buoyancy-induced flow.

An Arbitrary Lagrangian Eulerian Method for Three-Phase Flows with Triple Junction Points

We present a moving mesh method suitable for solving two-dimensional and axisymmetric three-liquid flows with triple junction points. This method employs a body-fitted unstructured mesh where the interfaces between liquids are lines of the mesh system, and the triple junction points (if exist) are mesh nodes. To enhance the accuracy and the efficiency of the method, the mesh is constantly adapted to the evolution of the interfaces by refining and coarsening the mesh locally; dynamic boundary conditions on interfaces, in particular the triple points, are therefore incorporated naturally and accurately in a Finite- Element formulation. In order to allow pressure discontinuity across interfaces, double-values of pressure are necessary for interface nodes and triple-values of pressure on triple junction points. The resulting non-linear system of mass and momentum conservation is then solved by an Uzawa method, with the zero resultant condition on triple points reinforced at each time step. The method is used to investigate the rising of a liquid drop with an attached bubble in a lighter liquid.

Global modes with multiple saddle points

Significant progress has been made towards understanding the global stability of slowly-developing shear flows. The WKBJ theory developed by Patrick Huerre and his co-authors has proved absolutely central, with the result that both the linear and the nonlinear stability of a wide range of flows can now be understood in terms of their local absolute/convective instability properties. In many situations, the local absolute frequency possesses a single dominant saddle point in complex X-space (where X is the slow streamwise coordinate of the base flow), which then acts as a single wavemaker driving the entire global linear dynamics. In this paper we consider the more complicated case in which multiple saddles may act as the wavemaker for different values of some control parameter. We derive a frequency selection criterion in the general case, which is then validated against numerical results for the linearized third-order Ginzburg-Landau equation (which possesses two saddle points). We believe that this theory may be relevant to a number of flows, including the boundary layer on a rotating disk and the eccentric Taylor-Couette-Poiseuille flow. © 2014 Elsevier Masson SAS. All rights reserved.

An algorithm of analysis tools on points distribution in high dimension space: The distance of a point and an infinite sub-space

This paper discusses the algorithm on the distance from a point and an infinite sub-space in high dimensional space With the development of Information Geometry([1]), the analysis tools of points distribution in high dimension space, as a measure of calculability, draw more attention of experts of pattern recognition. By the assistance of these tools, Geometrical properties of sets of samples in high-dimensional structures are studied, under guidance of the established properties and theorems in high-dimensional geometry.

3D Pose from Three Corresponding Points Under Weak-Perspective Projection

Model-based object recognition commonly involves using a minimal set of matched model and image points to compute the pose of the model in image coordinates. Furthermore, recognition systems often rely on the "weak-perspective" imaging model in place of the perspective imaging model. This paper discusses computing the pose of a model from three corresponding points under weak-perspective projection. A new solution to the problem is proposed which, like previous solutins, involves solving a biquadratic equation. Here the biquadratic is motivate geometrically and its solutions, comprised of an actual and a false solution, are interpreted graphically. The final equations take a new form, which lead to a simple expression for the image position of any unmatched model point.

The topological behaviour of 3D null points in the Sun's corona

Brown D. S. and Priest E. R. 2001, The topological behaviour of 3D null points in the Sun's corona, Astronomy and Astrophysics, 367, 339-346

Contour Generator Points for Threshold Selection and a Novel Photo-Consistency Measure for Space Carving

Space carving has emerged as a powerful method for multiview scene reconstruction. Although a wide variety of methods have been proposed, the quality of the reconstruction remains highly-dependent on the photometric consistency measure, and the threshold used to carve away voxels. In this paper, we present a novel photo-consistency measure that is motivated by a multiset variant of the chamfer distance. The new measure is robust to high amounts of within-view color variance and also takes into account the projection angles of back-projected pixels. Another critical issue in space carving is the selection of the photo-consistency threshold used to determine what surface voxels are kept or carved away. In this paper, a reliable threshold selection technique is proposed that examines the photo-consistency values at contour generator points. Contour generators are points that lie on both the surface of the object and the visual hull. To determine the threshold, a percentile ranking of the photo-consistency values of these generator points is used. This improved technique is applicable to a wide variety of photo-consistency measures, including the new measure presented in this paper. Also presented in this paper is a method to choose between photo-consistency measures, and voxel array resolutions prior to carving using receiver operating characteristic (ROC) curves.

Evaluation of tumor response, disease control, progression-free survival, and time to progression as potential surrogate end points in metastatic breast cancer.

PURPOSE: Overall survival (OS) can be observed only after prolonged follow-up, and any potential effect of first-line therapies on OS may be confounded by the effects of subsequent therapy. We investigated whether tumor response, disease control, progression-free survival (PFS), or time to progression (TTP) could be considered a valid surrogate for OS to assess the benefits of first-line therapies for patients with metastatic breast cancer. PATIENTS AND METHODS: Individual patient data were collected on 3,953 patients in 11 randomized trials that compared an anthracycline (alone or in combination) with a taxane (alone or in combination with an anthracycline). Surrogacy was assessed through the correlation between the end points as well as through the correlation between the treatment effects on the end points. RESULTS: Tumor response (survival odds ratio [OR], 6.2; 95% CI, 5.3 to 7.0) and disease control (survival OR, 5.5; 95% CI, 4.8 to 6.3) were strongly associated with OS. PFS (rank correlation coefficient, 0.688; 95% CI, 0.686 to 0.690) and TTP (rank correlation coefficient, 0.682; 95% CI, 0.680 to 0.684) were moderately associated with OS. Response log ORs were strongly correlated with PFS log hazard ratios (linear coefficient [rho], 0.96; 95% CI, 0.73 to 1.19). Response and disease control log ORs and PFS and TTP log hazard ratios were poorly correlated with log hazard ratios for OS, but the confidence limits of rho were too wide to be informative. CONCLUSION: No end point could be demonstrated as a good surrogate for OS in these trials. Tumor response may be an acceptable surrogate for PFS.

Maximum curves and isolated points of entire functions

Given M(r; f) =maxjzj=r (jf(z)j) , curves belonging to the set of points M = fz : jf(z)j = M(jzj; f)g were de�ned by Hardy to be maximum curves. Clunie asked the question as to whether the set M could also contain isolated points. This paper shows that maximum curves consist of analytic arcs and determines a necessary condition for such curves to intersect. Given two entire functions f1(z) and f2(z), if the maximum curve of f1(z) is the real axis, conditions are found so that the real axis is also a maximum curve for the product function f1(z)f2(z). By means of these results an entire function of in�nite order is constructed for which the set M has an in�nite number of isolated points. A polynomial is also constructed with an isolated point.