Using simulation for long-term bed modelling in critical care

A simulation model of the University Hospital of Wales (UHW) Critical Care (CC) Department is presented. This is the first CC model that considers the impact of future demand on capacity, supporting planning decisions to build a new hospital. A combination of long-term demand trajectories and Discrete Event Simulation (DES) are used. The results suggest the unit will need at least 66 Intensive Care beds and 19 Post-Anaesthesia Care beds to fulfil predicted demand in 2040 while being at capacity less than 5% of the time. Non-critical care ward beds impact patient flow in CC, thus must be considered when planning a new hospital. This study’s findings directly impact on decision making at UHW, having informed capacity planning of the planned unit. This paper contributes by presenting an infrastructure planning project using simulation as a decision-making tool, with transferable insights applicable to the planning of other CC units

The Bacterial Fimbrial Tip Acts as a Mechanical Force Sensor

The subunits that constitute the bacterial adhesive complex located at the tip of the fimbria form a hook-chain that acts as a rapid force-sensitive anchor at high flow

Pediatric DXA: technique and interpretation

This article reviews dual X-ray absorptiometry (DXA) technique and interpretation with emphasis on the considerations unique to pediatrics. Specifically, the use of DXA in children requires the radiologist to be a “clinical pathologist” monitoring the technical aspects of the DXA acquisition, a “statistician” knowledgeable in the concepts of Z-scores and least significant changes, and a “bone specialist” providing the referring clinician a meaningful context for the numeric result generated by DXA. The patient factors that most significantly influence bone mineral density are discussed and are reviewed with respect to available normative databases. The effects the growing skeleton has on the DXA result are also presented. Most important, the need for the radiologist to be actively involved in the technical and interpretive aspects of DXA is stressed. Finally, the diagnosis of osteoporosis should not be made on DXA results alone but should take into account other patient factors