scholarly journals Long admission waiting list at the Orchard clinic-why?

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S287-S287
Author(s):  
Hannah Sayeed ◽  
Johanna Brown ◽  
Fionnbar Lenihan
Keyword(s):  
Traffic Flow ◽  
Clinical Pathways ◽  
Waiting List ◽  
Service Development ◽  
List Type ◽  
Bed Management ◽  
Forensic Research ◽  
Flow Through ◽  
Delayed Discharges ◽  
Main Factor

AimsThe Orchard clinic is one of the three medium secure units in Scotland. This project was completed: To gain an understanding of the causes of the Orchard clinic's long admission waiting list.To use this information to improve current clinical pathways, service development and further research and development.MethodTo study the longitudinal traffic flow through the clinic from January 2017 to December 2019, data were collected for this time retrospectively from electronic minutes of fortnightly bed management meetings at the Orchard clinic.This was cross checked with the Orchard clinic's record of admissions and discharges during this time and approved by the Forensic Research and Audit Group, NHS Lothian.ResultNovember 2018 onwards, a surge of 90% was observed in the admission waiting list.Looking at the trends of traffic flow through the clinic during this time, the following observations were made:1. More admissions than discharges, especially November 2018 onwards.2. New referrals for medium secure care at the Orchard clinic peaked twice during this time.3. Delayed discharges peaked in July 2018 and further in January 2019 running parallel to the surge in admission waiting list thereafter.4. 42% patients on the delayed discharge list belonged to other health boards awaiting local low secure/community placements.ConclusionDelayed discharges were identified as a constant parallel to the long waiting list and hence identified as the main factor contributing to it. Out of area (non-NHS Lothian) admissions were noted to be linked to these delayed discharges.Regular peaks in new referrals was also noted to be contributory.

scholarly journals Research on the impact of ship traffic flow on the restricted channel segment of the middle Yangtze River based on traffic wave theory

2021 ◽  
Vol 3 (8) ◽  
Author(s):  
Ting Liu ◽  
Gabriel Lodewijks
Keyword(s):  
Traffic Flow ◽  
Flow Rate ◽  
Flow Simulation ◽  
Wave Theory ◽  
Flow Density ◽  
List Type ◽  
Ship Traffic ◽  
Traffic Wave ◽  
The Impact ◽  
Channel Segment

Abstract Abstract On the basis of the influence of dry season on ship traffic flow, the gathering and dissipating process of ship traffic flow was researched with Greenshields linear flow—density relationship model, the intrinsic relationship between the ship traffic congestion state and traffic wave in the unclosed restricted channel segment was emphatically explored when the ship traffic flow in a tributary channel inflows, and the influence law of multiple traffic waves on the ship traffic flow characteristics in unclosed restricted segment is revealed. On this basis, the expressions of traffic wave speed and direction, dissipation time of queued ships and the number of ships affected were provided, and combined with Monte Carlo method, the ship traffic flow simulation model in the restricted channel segment was built. The simulation results show that in closed restricted channel segment the dissipation time of ships queued is mainly related to the ship traffic flow rate of segments A and C, and the total number of ships affected to the ship traffic flow rate of segment A. And in unclosed restricted channel segment, the dissipation time and the total number of ships affected are also determined by the meeting time of the traffic waves in addition to the ship traffic flow rate of segments. The research results can provide the theoretical support for further studying the ship traffic flow in unclosed restricted channel segment with multiple tributaries Article Highlights The inflow of tributaries' ship traffic flows has an obvious impact on the traffic conditions in the unenclosed restricted channel segment. The interaction and influence between multiple ship traffic waves and the mechanism of generating new traffic waves are explained. The expression of both dissipation time of queued ships and the total number of ships affected in the closed and unclosed restricted channel segment are given.

scholarly journals The Simulation of Sloped Bank Effect Influence on Container Ship Trajectory

2021 ◽  
Vol 9 (11) ◽  
pp. 1283
Author(s):  
Mate Baric ◽  
Robert Mohovic ◽  
Djani Mohovic ◽  
Vinko Pavic
Keyword(s):  
Traffic Flow ◽  
Significant Influence ◽  
Suez Canal ◽  
Container Ship ◽  
Design Standards ◽  
Bank Effect ◽  
Flow Through ◽  
External Forces ◽  
The Impact ◽  
Vessel Speed

The latest container vessel grounding in the Suez Canal, which occurred on 23 March 2021 (the Ever Given), raised many questions regarding the safety of navigation. The sudden concern about safety is due to fears that traffic flow through the Suez Canal could be blocked for longer periods of time. Besides external forces imposed by wind, in this case bank effect had a significant influence on the ship’s grounding. Bank effect occurs due to restricted water flow caused by narrow waterways. Many fairway design standards consider sloped banks such as those of the Suez Canal as unsubstantial in bank-effect forces. This paper analyses the impact of sloped banks on container ship trajectory and proposes minimal distances that may decrease bank-effect forces in order to reduce the risk of vessel grounding and increase the safety of navigation. However, this type of accident has happened before and may occur again due to a small sailing distance from the bank in cases where vessel speed is increased.

scholarly journals Two-pore channels at the intersection of endolysosomal membrane traffic

2015 ◽  
Vol 43 (3) ◽  
pp. 434-441 ◽  
Author(s):  
Jonathan S. Marchant ◽  
Sandip Patel
Keyword(s):  
Nicotinic Acid ◽  
Traffic Flow ◽  
Rab Proteins ◽  
Rab Gtpases ◽  
Ion Permeation ◽  
Voltage Gated ◽  
Proteomic Data ◽  
Flow Through ◽  
Acidic Organelles

Two-pore channels (TPCs) are ancient members of the voltage-gated ion channel superfamily that localize to acidic organelles such as lysosomes. The TPC complex is the proposed target of the Ca2+-mobilizing messenger NAADP, which releases Ca2+ from these acidic Ca2+ stores. Whereas details of TPC activation and native ion permeation remain unclear, a consensus has emerged around their function in regulating endolysosomal trafficking. This role is supported by recent proteomic data showing that TPCs interact with proteins controlling membrane organization and dynamics, including Rab GTPases and components of the fusion apparatus. Regulation of TPCs by PtdIns(3,5)P2 and/or NAADP (nicotinic acid adenine dinucleotide phosphate) together with their functional and physical association with Rab proteins provides a mechanism for coupling phosphoinositide and trafficking protein cues to local ion fluxes. Therefore, TPCs work at the regulatory cross-roads of (patho)physiological cues to co-ordinate and potentially deregulate traffic flow through the endolysosomal network. This review focuses on the native role of TPCs in trafficking and their emerging contributions to endolysosomal trafficking dysfunction.

Speed Limit Effects on the Multilane Traffic Flow Through a Bottleneck

1997 ◽  
Vol 30 (8) ◽  
pp. 1289-1294
Author(s):  
H. Sailer ◽  
K.F. Schoepf ◽  
R.D. Kühne
Keyword(s):  
Traffic Flow ◽  
Speed Limit ◽  
Flow Through

Optimization of Traffic Flow Through the Use of Running Lights

2000 ◽  
Vol 33 (9) ◽  
pp. 293-296 ◽  
Author(s):  
Dirk Ehmanns ◽  
Jens Ludmann
Keyword(s):  
Traffic Flow ◽  
Flow Through

scholarly journals Developing services for long Covid: lessons from a study of wounded healers

2020 ◽  
Author(s):  
Emma Ladds ◽  
Alex Rushforth ◽  
Sietse Wieringa ◽  
Sharon Taylor ◽  
Clare Rayner ◽  
...  
Keyword(s):  
Healthcare System ◽  
Healthcare Workers ◽  
Care Pathway ◽  
Service Design ◽  
Quality Standards ◽  
Service Development ◽  
Rehabilitation Service ◽  
List Type ◽  
Support Design ◽  
Persistent Symptoms

AbstractPersistent symptoms lasting longer than 3 weeks are thought to affect 10-20% of patients following Covid 19 infection. No formal guidelines exist in the United Kingdom for treating ‘long Covid’ patients and services are sporadic and variable, although additional funding is promised for their development.In this study narrative interviews and focus groups are used to explore the lived experience of 43 healthcare professionals with long Covid. These individuals see the healthcare system from both professional and patient perspectives thus represent an important wealth of expertise to inform service design.We present a set of co-designed quality standards highlighting equity and ease of access, minimal patient care burden, clinical responsibility, a multidisciplinary and evidence-based approach, and patient involvement and apply these to propose a potential care pathway model that could be adapted and translated to improve care of long Covid patients.Summary boxWhat is known?▪Persistent symptoms (“long Covid”) occur after Covid-19 in 10-20% of sufferers▪Services to manage and rehabilitate patients with long Covid are not yet optimal▪UK healthcare workers experience at least a threefold greater risk of Covid-19 infection and face significant occupational exposure▪Healthcare workers with long Covid can offer important insights into service design and developmentWhat is the question?▪What are the experiences of healthcare workers with long Covid and what are the implications from these for service development?What was found▪Healthcare workers experienced a confusing novel condition that imposed high levels of uncertainty and a significant personal and professional impact.▪Using professional contacts, patient- and professional Mindlines, support groups and Communities of Practice all helped to minimize this uncertainty and high quality therapeutic relationships were essential to cope with it.▪Many experienced a lack of compassion during interactions with the healthcare system and were frustrated by challenges accessing, or absence of, appropriate services.▪Suggestions for improvement included an integrated, multi-disciplinary assessment and rehabilitation service; a set of clinical quality standards; and co-created research and service development.What is the implication for practice now?▪This study supports and extends the principles outlined in recently-developed NHS long Covid quality standards and will inform and support design of dedicated long Covid services.

scholarly journals EFFECT OF CONVALESCENT PLASMA ON MORTALITY IN PATIENTS WITH COVID-19 PNEUMONIA

2020 ◽  
Author(s):  
Martín R. Salazar ◽  
Soledad E. González ◽  
Lorena Regairaz ◽  
Noelia S. Ferrando ◽  
Veronica V. González Martínez ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Neutralizing Antibodies ◽  
Protective Factor ◽  
Viral Infections ◽  
Preliminary Evidence ◽  
Buenos Aires Province ◽  
List Type ◽  
Bed Management ◽  
Key Points ◽  
Epidemiological Characteristics

AbstractBackgroundConvalescent plasma, widely utilized in viral infections that induce neutralizing antibodies, has been proposed for COVID-19, and preliminary evidence shows that it might have beneficial effect. Our objective was to compare epidemiological characteristics and outcomes between patients who received convalescent plasma for COVID-19 and those who did not, admitted to hospitals in Buenos Aires Province, Argentina, throughout the pandemic.MethodsThis is a multicenter, retrospective cohort study of 2-month duration beginning on June 1, 2020, including unselected, consecutive adult patients with diagnosed COVID-19, admitted to 215 hospitals with pneumonia. Epidemiological and clinical variables were registered in the Provincial Hospital Bed Management System. Convalescent plasma was supplied as part of a centralized, expanded access program.ResultsWe analyzed 3,529 patients with pneumonia, predominantly male, aged 62±17, with arterial hypertension and diabetes as main comorbidities; 51.4% were admitted to the ward, 27.1% to the Intensive Care Unit (ICU), and 21.7% to the ICU with mechanical ventilation requirement (ICU-MV). 28-day mortality was 34.9%; and was 26.3%, 30.1% and 61.4% for ward, ICU and ICU-MV patients. Convalescent plasma was administered to 868 patients (24.6%); their 28-day mortality was significantly lower (25.5% vs. 38.0%, p<0.001). No major adverse effects occurred.Logistic regression analysis identified age, ICU admission with and without MV requirement, diabetes and preexistent cardiovascular disease as independent predictors of 28-day mortality, whereas convalescent plasma administration acted as a protective factor.ConclusionsOur study suggests that the administration of convalescent plasma in COVID-19 pneumonia admitted to the hospital might be associated with decreased mortality.Key PointsPreliminary evidence showed that convalescent plasma might be beneficial in COVID-19.In a cohort of 3,529 patients with pneumonia due to COVID-19, convalescent plasma was administered to 868 patients, without major adverse effects.Convalescent plasma was independently associated with decreased mortality.

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