3 results
Evaluating variation in pre-operative evaluation and planning for children undergoing atrial or ventricular septal defect repair
- Catherine C. Dawson-Gore, Andrew Well, Scott Wallace, Elizabeth Teisberg, Christopher Born, Kathleen Carberry, Erin Gottlieb, Dudley Byron Holt, Charles D. Fraser, Jr., Carlos M. Mery
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- Journal:
- Cardiology in the Young / Volume 34 / Issue 1 / January 2024
- Published online by Cambridge University Press:
- 13 June 2023, pp. 164-170
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- Article
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Background:
CHD care is resource-intensive. Unwarranted variation in care may increase cost and result in poorer health outcomes. We hypothesise that process variation exists within the pre-operative evaluation and planning process for children undergoing repair of atrial septal defect or ventricular septal defect and that substantial variation occurs in a small number of care points.
Methods:From interviews with staff of an integrated congenital heart centre, an initial process map was constructed. A retrospective chart review of patients with isolated surgical atrial septal defect and ventricular septal defect repair from 7/1/2018 through 11/1/2020 informed revisions of the process map. The map was assessed for points of consistency and variability.
Results:Thirty-two surgical atrial septal defect/ventricular septal defect repair patients were identified. Ten (31%) were reviewed by interventional cardiology before surgical review. Of these, 6(60%) had a failed catheter-based closure and 4 (40%) were deemed inappropriate for catheter-based closure. Thirty (94%) were reviewed in case conference, all attended surgical clinic, and none were admitted prior to surgery. The process map from interviews alone identified surgery rescheduling as a point of major variability; however, chart review revealed this was not as prominent a source of variability as pre-operative interventional cardiology review.
Conclusions:Significant variation in the pre-operative evaluation and planning process for surgical atrial septal defect/ventricular septal defect patients was identified. If such process variation is widespread through CHD care, it may contribute to variations in outcome and cost previously documented within CHD surgery. Future research will focus on determining whether the variation is warranted or unwarranted, associated health outcomes and cost variation attributed to these variations in care processes.
Planetary science and exploration in the deep subsurface: results from the MINAR Program, Boulby Mine, UK
- Samuel J. Payler, Jennifer F. Biddle, Andrew J. Coates, Claire R. Cousins, Rachel E. Cross, David C. Cullen, Michael T. Downs, Susana O. L. Direito, Thomas Edwards, Amber L. Gray, Jac Genis, Matthew Gunn, Graeme M. Hansford, Patrick Harkness, John Holt, Jean-Luc Josset, Xuan Li, David S. Lees, Darlene S. S. Lim, Melissa Mchugh, David Mcluckie, Emma Meehan, Sean M. Paling, Audrey Souchon, Louise Yeoman, Charles S. Cockell
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- Journal:
- International Journal of Astrobiology / Volume 16 / Issue 2 / April 2017
- Published online by Cambridge University Press:
- 20 April 2016, pp. 114-129
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The subsurface exploration of other planetary bodies can be used to unravel their geological history and assess their habitability. On Mars in particular, present-day habitable conditions may be restricted to the subsurface. Using a deep subsurface mine, we carried out a program of extraterrestrial analog research – MINe Analog Research (MINAR). MINAR aims to carry out the scientific study of the deep subsurface and test instrumentation designed for planetary surface exploration by investigating deep subsurface geology, whilst establishing the potential this technology has to be transferred into the mining industry. An integrated multi-instrument suite was used to investigate samples of representative evaporite minerals from a subsurface Permian evaporite sequence, in particular to assess mineral and elemental variations which provide small-scale regions of enhanced habitability. The instruments used were the Panoramic Camera emulator, Close-Up Imager, Raman spectrometer, Small Planetary Linear Impulse Tool, Ultrasonic drill and handheld X-ray diffraction (XRD). We present science results from the analog research and show that these instruments can be used to investigate in situ the geological context and mineralogical variations of a deep subsurface environment, and thus habitability, from millimetre to metre scales. We also show that these instruments are complementary. For example, the identification of primary evaporite minerals such as NaCl and KCl, which are difficult to detect by portable Raman spectrometers, can be accomplished with XRD. By contrast, Raman is highly effective at locating and detecting mineral inclusions in primary evaporite minerals. MINAR demonstrates the effective use of a deep subsurface environment for planetary instrument development, understanding the habitability of extreme deep subsurface environments on Earth and other planetary bodies, and advancing the use of space technology in economic mining.
33 - Interactions with a fellow research engineer-economist
- Edited by Robert Leeson, Murdoch University, Western Australia
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- Book:
- A. W. H. Phillips: Collected Works in Contemporary Perspective
- Published online:
- 04 May 2010
- Print publication:
- 03 August 2000, pp 308-314
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Summary
Although born a world apart, Phillips' and my careers had striking parallels, warm interactions, and similar motivations. We both did research on electrical engineering, automatic control, computer simulation, economic stability, econometrics, and inflation-unemployment.
Control theory
We started corresponding in the summer of 1956 about bringing the tools of operations research and electrical engineering to bear on improving economic stability. Bill had already published several articles applying tools from electrical engineering to the stability of single loop economic models.
It was becoming clear, however, that economic stabilisation policy called for the analysis of economic systems incorporating multiple loops and multiple control variables. Fortunately operations research on industrial operations done at Carnegie Mellon University by a team composed of (in alphabetic order): Holt, Franco Modigliani, John F. Muth, and Herbert A. Simon, had shown that the optimal solution to that problem could be obtained under dynamic uncertainty (Holt et al. 1960). Where the criterion in a decision analysis could be adequately approximated with a quadratic function, and the dynamic system could be approximated by linear difference equations, the inversion of an infinite matrix would yield optimal linear decision rules. That model was discovered independently three times: by our operations research group, by economist Henri Theil, and by a group of process control engineers. Later it was adopted as the ‘classic’ model for engineering control.