Mixing methodologies to enhance the implementation of healthcare operational research

Healthcare Operational Research (OR) has had limited success in achieving a sufficient level of stakeholder acceptance to lead to implementation of results. This research study is aimed at combining OR methodologies to achieve greater acceptance of results for organizational change. Patient flow delays in the Paediatric intensive care unit (PICU) at Children's Hospital of Wisconsin were identified using case studies. Patient flow was modelled using hard OR (simulation) using case study findings, with active stakeholder participation, and enhanced with outcomes research. Outcomes research allowed achieving greater clinical relevance of OR findings. Results from hard OR, particularly for politically sensitive issues, were persuasive but inadequate to result in change. Soft OR (cognitive mapping) was used to identify new issues and enhance results. Consequently, the planned PICU expansion was deferred, and resources focused on improving staffing strategies identified independently from both hard and soft OR. These findings suggest that: (1) Outcomes research can play a unique role to enhance results in healthcare OR. (2) After obtaining a holistic understanding of the system using hard and soft OR, stakeholders are willing to implement results from each independently, supporting the development of a common form of knowledge, which is consistent with Mixed-Mode Modelling. (3) Hard OR, enhanced with outcomes research, with active stakeholder participation, and combined with soft OR, results in greater acceptance and sustained organizational change.     

Acute Triangulations of Flat Mobius Strips

In this paper we investigate the acute triangulations of flat Mobius strips. We find out that we can always triangulate a flat Mobius strip with at most nine acute triangles, and sometimes (but not always) that many triangles are really needed.     

THE DIMENSION FOR RANDOM SUB-SELF-SIMILAR SET

In this article,the Hausdorff dimension and exact Hausdorff measure function of any random sub-self-similar set are obtained under some reasonable conditions.Several examples are given at the end.     

Coupled Thermo-Hydro-Mechanical and Chemical Analysis of Expansive Clay Subjected to Heating and Hydration

A fully coupled formulation combining reactive transport and an existing thermo-hydro-mechanical (THM) code is presented. Special attention has been given to phenomena likely to be encountered in clay barriers used as part of containment systems of nuclear waste. The types of processes considered include hydrolysis, complex formation, oxidation/reduction reactions, acid/base reactions, precipitation/dissolution of minerals and cation exchange. Both kinetically-controlled and equilibrium-controlled reactions have been incorporated. The total analytical concentrations (including precipitated minerals) are adopted as basic transport variables and chemical equilibrium is achieved by minimizing Gibbs Free Energy. The formulation has been incorporated in a general purpose computer code capable of performing numerical analysis of engineering problems. A validation exercise concerning a laboratory experiment involving the heating and hydration of an expansive compacted clay is described.     

Second order evolution equations with time-dependent subdifferentials

We study an abstract second order nonlinear evolution equation in a real Hilbert space. We consider time-dependent convex functions and their subdifferentials operating on the first derivative of the unknown function. Introducing appropriate assumptions on the convex functions and other data, we prove the existence and uniqueness of a strong solution, and give some applications of the abstract theorem to hyperbolic variational inequalities with time-dependent constraints.      

Analysis of Metabolites in Allantoic Fluid of Chicken Embryo by 900 MHz NMR Spectroscopy

900 MHz ¹H NMR (nuclear magnetic resonance) spectroscopy was used to analyze metabolites in allantoic fluid of the chicken embryo in the 9th incubation day without any chemical or physical sample separation. The result showed that superhigh spectral dispersion and sensitivity at 900 MHz are useful in directly analyzing a complex mixture, particularly in resolving the overlapped NMR resonances. In this study, we had assigned 61 metabolites and 26 chemical fragments in the allantoic fluid. The relative concentrations of the major metabolites were also measured. Among the assigned metabolites, some were detected by NMR in chicken embryo allantoic fluids for the first time. The biological functions of these compounds were briefly discussed. Authors' address: Maili Liu, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan 430071, People's Republic of China