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.

Modulation of pain ratings by expectation and uncertainty: Behavioral characteristics and anticipatory neural correlates.

Expectations about the magnitude of impending pain exert a substantial effect on subsequent perception. However, the neural mechanisms that underlie the predictive processes that modulate pain are poorly understood. In a combined behavioral and high-density electrophysiological study we measured anticipatory neural responses to heat stimuli to determine how predictions of pain intensity, and certainty about those predictions, modulate brain activity and subjective pain ratings. Prior to receiving randomized laser heat stimuli at different intensities (low, medium or high) subjects (n=15) viewed cues that either accurately informed them of forthcoming intensity (certain expectation) or not (uncertain expectation). Pain ratings were biased towards prior expectations of either high or low intensity. Anticipatory neural responses increased with expectations of painful vs. non-painful heat intensity, suggesting the presence of neural responses that represent predicted heat stimulus intensity. These anticipatory responses also correlated with the amplitude of the Laser-Evoked Potential (LEP) response to painful stimuli when the intensity was predictable. Source analysis (LORETA) revealed that uncertainty about expected heat intensity involves an anticipatory cortical network commonly associated with attention (left dorsolateral prefrontal, posterior cingulate and bilateral inferior parietal cortices). Relative certainty, however, involves cortical areas previously associated with semantic and prospective memory (left inferior frontal and inferior temporal cortex, and right anterior prefrontal cortex). This suggests that biasing of pain reports and LEPs by expectation involves temporally precise activity in specific cortical networks.

Microfabries of lacustrine sediments to pollutant adsorption from a polluted Eutrophic lake, the Yangtze delta region

Two types of microfabrics relating to pollutant adsorption were studied in the scanning electronic microscope (SEM) in a polluted, eutrophic lake, the Yangtze delta region. Agglutinational texture or the aggregates of small particles are composed of clay minerals and fine organic fragments among the silty grains and the coatings with a thickness about 1 mu m were on the surfaces of the silty grains in the sediments. The chemical constituents of the aggregates and the coatings are K, Na, Ca, Mg, Si, Al, O, Fe, Ti, C, N and P determined in X-ray energy spectrometry connected with the SEM. In some cases, Pb was detected in the aggregates in the top sediment. It is suggested that nutrients and metals are adsorbed to the aggregates, which were formed by electrostatic attraction of physicochemical floes. The coatings on the surface of quartz grains were formed by the interaction of dissociated Al, Si, Fe, etc from silicates with dissolved N, P and C nutrients in interstitial water, which was aroused by human pollution to the lake in recent two decades.

黔西南Au—As—Hg—Tl矿化区毒害金属元素的水地球化学

研究了黔西南典型Ａｕ－Ａｓ－Ｈｇ－Ｔｌ矿化区内毒害金属元素在采矿活动和自然状态影响下的水地球化学特征及其环境效应。结果表明，已开采的Ｈｇ－Ｔｌ矿区地下水和地表水中均有很高的毒害金属元素，煤采区地下水中亦表现出类似的特征，而Ｈｇ－Ｔｌ矿区外围地下水中金属元素保持在较低的水平。Ｈｇ－Ｔｌ矿区地素水中Ａｓ和Ｔｌ的分布模式表明，其含量的变化受矿区地下水排泄和尾矿淋滤作用的控制。在尚未开采的金矿区，浅层地下水中金属元素的含量没有明显的富集，尚未构成环境问题。采矿活动扰动下的地下水和暴露于地表的尾矿及矿山废物是水中毒害金属元素的主要来源，水环境研究对采矿活动造成的环境影响具有良好的指示效果。

The s-mote: a versatile heterogeneous multi-radio platform for wireless sensor networks applications

This paper presents a novel architecture and its implementation for a versatile, miniaturised mote which can communicate concurrently using a variety of combinations of ISM bands, has increased processing capability, and interoperability with mainstream GSM technology. All these features are integrated in a small form factor platform. The platform can have many configurations which could satisfy a variety of applications’ constraints. To the best of our knowledge, it is the first integrated platform of this type reported in the literature. The proposed platform opens the way for enhanced levels of Quality of Service (QoS), with respect to reliability, availability and latency, in addition to facilitating interoperability and power reduction compared to existing platforms. The small form factor also allows potential of integration with other mobile platforms including smart phones.

Towards persistent structural health monitoring through sustainable wireless sensor networks

This paper documents the design, implementation and characterisation of a wireless sensor node (GENESI Node v1.0), applicable to long-term structural health monitoring. Presented is a three layer abstraction of the hardware platform; consisting of a Sensor Layer, a Main Layer and a Power Layer. Extended operational lifetime is one of the primary design goals, necessitating the inclusion of supplemental energy sources, energy awareness, and the implementation of optimal components (microcontroller(s), RF transceiver, etc.) to achieve lowest-possible power consumption, whilst ensuring that the functional requirements of the intended application area are satisfied. A novel Smart Power Unit has been developed; including intelligence, ambient available energy harvesting (EH), storage, electrochemical fuel cell integration, and recharging capability, which acts as the Power Layer for the node. The functional node has been prototyped, demonstrated and characterised in a variety of operational modes. It is demonstrable via simulation that, under normal operating conditions within a structural health monitoring application, the node may operate perpetually.

GENESI: Wireless sensor networks for structural monitoring

The GENESI project has the ambitious goal of bringing WSN technology to the level where it can provide the core of the next generation of systems for structural health monitoring that are long lasting, pervasive and totally distributed and autonomous. This goal requires embracing engineering and scientific challenges never successfully tackled before. Sensor nodes will be redesigned to overcome their current limitations, especially concerning energy storage and provisioning (we need devices with virtually infinite lifetime) and resilience to faults and interferences (for reliability and robustness). New software and protocols will be defined to fully take advantage of the new hardware, providing new paradigms for cross-layer interaction at all layers of the protocol stack and satisfying the requirements of a new concept of Quality of Service (QoS) that is application-driven, truly reflecting the end user perspective and expectations. The GENESI project will develop long lasting sensor nodes by combining cutting edge technologies for energy generation from the environment (energy harvesting) and green energy supply (small form factor fuel cells); GENESI will define models for energy harvesting, energy conservation in super-capacitors and supplemental energy availability through fuel cells, in addition to the design of new algorithms and protocols for dynamic allocation of sensing and communication tasks to the sensors. The project team will design communication protocols for large scale heterogeneous wireless sensor/actuator networks with energy-harvesting capabilities and define distributed mechanisms for context assessment and situation awareness. This paper presents an analysis of the GENESI system requirements in order to achieve the ambitious goals of the project. Extending from the requirements presented, the emergent system specification is discussed with respect to the selection and integration of relevant system components.The resulting integrated system will be evaluated and characterised to ensure that it is capable of satisfying the functional requirements of the project

Investigating the influence of the sulfur oxidation state on solid state conformation

Design, synthesis and structural characterization of a series of diphenylacetylene derivatives bearing organosulfur, amide and amine moieties has been achieved in which the molecular conformation is controlled through variation of the hydrogen bond properties on alteration of the oxidisation level of sulfur.

A novel and miniaturized 433/868MHz multi-band wireless sensor platform for body sensor network applications

Body Sensor Network (BSN) technology is seeing a rapid emergence in application areas such as health, fitness and sports monitoring. Current BSN wireless sensors typically operate on a single frequency band (e.g. utilizing the IEEE 802.15.4 standard that operates at 2.45GHz) employing a single radio transceiver for wireless communications. This allows a simple wireless architecture to be realized with low cost and power consumption. However, network congestion/failure can create potential issues in terms of reliability of data transfer, quality-of-service (QOS) and data throughput for the sensor. These issues can be especially critical in healthcare monitoring applications where data availability and integrity is crucial. The addition of more than one radio has the potential to address some of the above issues. For example, multi-radio implementations can allow access to more than one network, providing increased coverage and data processing as well as improved interoperability between networks. A small number of multi-radio wireless sensor solutions exist at present but require the use of more than one radio transceiver devices to achieve multi-band operation. This paper presents the design of a novel prototype multi-radio hardware platform that uses a single radio transceiver. The proposed design allows multi-band operation in the 433/868MHz ISM bands and this, together with its low complexity and small form factor, make it suitable for a wide range of BSN applications.

Thomas Wolfe and the genre question: Beyond the "charge of autobiography"

The North Carolinian author Thomas Wolfe (1900‐1938) has long suffered under the “charge of autobiography,” which lingers to this day in critical assessments of his work. Criticism of Wolfe is frequently concerned with questions of generic classification, but since the 1950s, re‐assessments of Wolfe’s work have suggested that Wolfe’s “autobiographical fiction” exhibits a complexity that merits further investigation. Strides in autobiographical and narrative theory have prompted reconsiderations of texts that defy the artificial boundaries of autobiography and fiction. Wolfe has been somewhat neglected in the canon of American fiction of his era, but deserves to be reconsidered in terms of how he engages with the challenges and contradictions of writing about or around the self. This thesis investigates why Wolfe’s work has been the source of considerable critical discomfort and confusion with regard to the relationship between Wolfe’s life and his writing. It explores this issue through an examination of elements of Wolfe’s work that problematise categorisation. Firstly, it investigates the concept of Wolfe as “storyteller.” It explores the motivations and philosophies that underpin Wolfe’s work and his concept of himself as a teller of tales, and examines aspects of Wolfe’s writing process that have their roots in medieval traditions of the memorisation and recitation of tales. The thesis then conducts a detailed examination of how Wolfe describes the process of transforming his memory into narrative through writing. The latter half of the thesis examines narrative techniques used by Wolfe, firstly analysing his extensive use of the iterative and pseudo‐iterative modes, and then his unusual deployment of narrators and focalization. This project sheds light on elements of Wolfe’s approach to writing and narrative strategies that he employs that have previously been overlooked, and that have created considerable critical confusion with regard to the supposedly “autobiographical” genesis of his work.

A policy analysis of key employability interventions for the educationally disadvantaged in further education: Comparative insights for Irish education

The aim of this study is to garner comparative insights so as to aid the development of the discourse on further education (FE) conceptualisation and the relationship of FE with educational disadvantage and employability. This aim is particularly relevant in Irish education parlance amidst the historical ambiguity surrounding the functioning of FE. The study sets out to critically engage with the education/employability/economy link (eee link). This involves a critique of issues relevant to participation (which extends beyond student activity alone to social relations generally and the dialogic participation of the disadvantaged), accountability (which extends beyond performance measures alone to encompass equality of condition towards a socially just end) and human capital (which extends to both collective and individual aspects within an educational culture). As a comparative study, there is a strong focus on providing a way of conceptualising and comparatively analysing FE policy internationally. The study strikes a balance between conceptual and practical concerns. A critical comparative policy analysis is the methodology that structures the study which is informed and progressed by a genealogical method to establish the context of each of the jurisdictions of England, the United States and the European Union. Genealogy allows the use of history to diagnose the present rather than explaining how the past has caused the present. The discussion accentuates the power struggles within education policy practice using what Fairclough calls a strategic critique as well as an ideological critique. The comparative nature of the study means that there is a need to be cognizant of the diverse cultural influences on policy deliberation. The study uses the theoretical concept of paradigmatic change to critically analyse the jurisdictions. To aid with the critical analysis, a conceptual framework for legislative functions is developed so as to provide a metalanguage for educational legislation. The specific contribution of the study, while providing a manner for understanding and progressing FE policy development in a globalized Ireland, is to clear the ground for a more well-defined and critically reflexive FE sector to operate and suggests a number of issues for further deliberation.