Expanding a performance improvement initiative in critical care from hospital to system

BACKGROUND: Concern about the expense and effects of intensive care prompted the development and implementation of a hospital-based performance improvement initiative in critical care at North Shore University Hospital, Manhasset, New York, a 730-bed acute care teaching hospital. THE HOSPITAL-BASED PERFORMANCE IMPROVEMENT INITIATIVE IN CRITICAL CARE: The initiative was intended to use a uniform set of measurements and guidelines to improve patient care and resource utilization in the intensive care units (ICUs), to establish and implement best practices (regarding admission and discharge criteria, nursing competency, unplanned extubations, and end-of-life care), and to improve performance in the other hospitals in the North Shore-Long Island Jewish Health System. In the medical ICU, the percentage of low-risk (low-acuity) patients was reduced from 42% to 22%. ICU length of stay was reduced from 4.6 days to 4.1 days. IMPLEMENTING THE CRITICAL CARE PROJECT SYSTEMWIDE: A system-level critical care committee was convened in 1996 and charged with replicating the initiative. By and large, system efforts to integrate and implement policies have been successful. The critical care initiative has provided important comparative data and information from which to gauge individual hospital performance. DISCUSSION: Changing the critical care delivered on multiple units at multiple hospitals required sensitivity to existing organizational cultures and leadership styles. Merging organizational cultures is most successful when senior leadership set clear expectations that support the need for change. The process of collecting, trending, and communicating quality data has been instrumental in improving care practices and fostering a culture of safety throughout the health care system.     

The effect of sintering time on the densification and mechanical properties of a mechanically alloyed Cr–Mn–N stainless steel

Sintering is an essential stage in powder metallurgy, which affects the final microstructure and performance of the part. This study is concerned with the sintering and mechanical behaviors of Fe–18Cr–8Mn–0.9N stainless steel prepared from mechanically alloyed amorphous/nanocrystalline powders. The contribution of sintering time to the densification at 1100 °C is considered and a sluggish densification is found for the alloy. Furthermore, the correlation between the microstructure and mechanical properties of the fabricated porous parts is studied. It is found that the yield stress is affected by both porosity and the material’s intrinsic yield strength. Nonetheless, the effect of porosity on the overall hardness typically prevails over the effect of matrix hardness. Interestingly, even after sintering at 1100 °C for up to 20 h, the nanometric structure of the material is retained.     

CFD study of non-premixed swirling burners: Effect of turbulence models

This research investigates a numerical simulation of swirling turbulent non-premixed combustion. The effects on the combustion characteristics are examined with three turbulence models: namely as the Reynolds stress model, spectral turbulence analysis and Re-Normalization Group. In addition, the P-1 and discrete ordinate (DO) models are used to simulate the radiative heat transfer in this model. The governing equations associated with the required boundary conditions are solved using the numerical model. The accuracy of this model is validated with the published experimental data and the comparison elucidates that there is a reasonable agreement between the obtained values from this model and the corresponding experimental quantities. Among different models proposed in this research, the Reynolds stress model with the Probability Density Function (PDF) approach is more accurate (nearly up to 50%) than other turbulent models for a swirling flow field. Regarding the effect of radiative heat transfer model, it is observed that the discrete ordinate model is more precise than the P-1 model in anticipating the experimental behavior. This model is able to simulate the subcritical nature of the isothermal flow as well as the size and shape of the internal recirculation induced by the swirl due to combustion.     

Controlled release from polyurethane films: Drug release mechanisms

In this study, polyurethane-films loaded with diclofenac were used to analyze the drug release kinetics and mechanisms. For this purpose, the experimental procedures were developed under static and dynamic conditions with different initial drug loads of 10, 20, and 30%. In the dynamic condition, to better simulate the biological flow, drug release measurements were investigated at flow rates of 7.5 and 23.5 ml/s. These values indicate the flow rate of the internal carotid artery (ICA) for a normal state of a body and for a person during the exercise, respectively. The experimental data were analyzed and adjusted by Higuchi, Korsmeyer–Peppas, First-order, zero-order, and Peppas–Sahlin models in order to understand the mechanisms contributed. Finally, drug release mechanisms were specified by investigating the model correlation coefficients. Experimental results showed that increasing the flow rate and initial drug loads enhance drug liberation. In addition, the rate of release is more influenced by the drug dosage in the static state. The analysis revealed that diffusion, burst, and osmotic pressure are the principal mechanisms contributed. Moreover, Fickian type was the dominant mechanism at all duration of release. However, it was discovered using Peppas–Sahlin model that the contribution of the diffusion mechanism decreases with increasing flow rate and initial dosage. Furthermore, the tests at different drug dosages showed that the number of stages in medication release profile is independent of the flow rate and the medicine percentage. One can conclude that the drug release kinetic in static state is more influenced by drug dosage compared with dynamic state.     

Instability analysis of bi-axial micro-scanner under electromagnetic actuation including small scale and damping effects

Microsystem Technologies - The objective of this work is to create an analytical framework to study the problem of instability and squeezed film damping in bi-axial micro-scanners under...     

Elbs反应合成的多核芳香族化合物先驱体的碳化研究

研究了芘与甲基苯甲酰氯或２，５－二甲基对苯二甲酰氯通过Ｅｌｂｓ反应合成的先驱体的碳化．与其它方法相比，用此种新方法可得高质、高产的碳。     

A theoretical and experimental study of mutual coupling inmicrostrip antenna arrays

Each microstrip antenna element in the array is replaced by an equivalent magnetic current source distribution over a grounded dielectric slab derived from the electric field on the walls of the element as given by the cavity model. A dyadic Green's function is developed for a grounded dielectric slab, using the rectangular vector wave functions. The function is used to calculate the magnetic field due to the magnetic current distributions. The formula for mutual impedance based on the reaction concept is used to calculate the mutual coupling in arrays of antenna elements. Some measurements have been conducted for mutual coupling between two rectangular patches in the C-band. Calculated results are in excellent agreement with measurements, including those of other authors     

Spectral analysis of GFDM modulated signal under nonlinear behavior of power amplifier

Wireless Networks - Generalized frequency division multiplexing (GFDM) is a flexible non-orthogonal waveform candidate for 5G which can offer some advantages such as low out-of-band emission and...     

Multiple human 3D pose estimation from multiview images

Multimedia Tools and Applications - Multiple human 3D pose estimation is a challenging task. It is mainly because of large variations in the scale and pose of humans, fast motions, multiple persons...     

Adaptive green traffic signal controlling using vehicular communication

The importance of using adaptive traffic signal control for figuring out the unpredictable traffic congestion in today’s metropolitan life cannot be overemphasized. The vehicular ad hoc network (VANET), as an integral component of intelligent transportation systems (ITSs), is a new potent technology that has recently gained the attention of academics to replace traditional instruments for providing information for adaptive traffic signal controlling systems (TSCSs). Meanwhile, the suggestions of VANET-based TSCS approaches have some weaknesses: (1) imperfect compatibility of signal timing algorithms with the obtained VANET-based data types, and (2) inefficient process of gathering and transmitting vehicle density information from the perspective of network quality of service (QoS). This paper proposes an approach that reduces the aforementioned problems and improves the performance of TSCS by decreasing the vehicle waiting time, and subsequently their pollutant emissions at intersections. To achieve these goals, a combination of vehicle-to-vehicle (V2V) and vehicle-to-infrastructure (V2I) communications is used. The V2V communication scheme incorporates the procedure of density calculation of vehicles in clusters, and V2I communication is employed to transfer the computed density information and prioritized movements information to the road side traffic controller. The main traffic input for applying traffic assessment in this approach is the queue length of vehicle clusters at the intersections. The proposed approach is compared with one of the popular VANET-based related approaches called MC-DRIVE in addition to the traditional simple adaptive TSCS that uses the Webster method. The evaluation results show the superiority of the proposed approach based on both traffic and network QoS criteria.