Mapping Process Research Articles

Hot deformation and processing map of in-situ graphene reinforced magnesium matrix nanocomposites

It is necessary to have a deep understanding of the deformation behavior of magnesium matrix nanocomposites to achieve precise control of components. In this work, the as-cast graphene reinforced magnesium matrix nanocomposites were produced by in-situ vapor-liquid reaction. The flow stress features of the nanocomposites were studied by isothermal compression. The constitutive equation and the processing map of nanocomposites were established under the given load conditions based on the stress-strain curve. The sample is in a stable processing state at a compression temperature of 350 ℃∼450 ℃ with a compression rate of 0.001 s−1 and a compression temperature of 350 ℃ with a compression rate of 0.01 s−1. Furthermore, graphene distributed within the grains facilitated the retention of high dislocation density, which increased the driving force of recrystallization. Recrystallized grains can be generated by the progressive rotation of subgrain due to grain boundary migration being inhibited by graphene. This work provides an important guideline for the optimization of deformation techniques of in-situ nanocomposites.

Integrating Audiovisual Immersion Into Pediatric Radiation Therapy Across Multiple Centers: Methodology, Timeliness, and Cost of the Audiovisual-Assisted Therapeutic Ambience in Radiation Therapy Prospective Multi-Institutional Trial

PurposeThe Audiovisual Assisted Therapeutic Ambience in Radiotherapy (AVATAR) trial was a prospective multicenter study (NCTXXXXXXXX) examining the combination of video immersion with radiotherapy and was successfully conducted through the collaboration of pediatric radiation oncology teams at 10 institutions independent of any preexisting consortium. We sought to analyze and report the methodology of trial conception and development, process map, and cost. Methods and MaterialsThe study enrolled patients aged 3-10 years preparing to undergo radiation therapy, integrated the combination of AVATAR-based video immersion during radiation therapy at each institution, and offered AVATAR use as an alternative to anesthesia, with rates of anesthesia use and outcomes of serial standardized anxiety and quality of life assessments assessed among the 81 children enrolled. A process map was created based on the trial timeline with the following components: study development time (time from conception of the trial to accrual of first patient, including design phase, agreement and approval phase and site preparation phase), and accrual duration time (time from the first to last accrual). Costs and institutional success rates were calculated. ResultsTime from inception of study to last accrual was 3.6 years (1313 days). The study development time was 417 days (31.7%) and accrual duration time was 896 days (68.3%), with the final 50% of accrual occurring in less than 6 months. Equipment cost was approximately $550 per institution and was covered by funding from the lead study institution. All 10 centers were successful with AVATAR implementation, defined as ≥50% of patients able to avoid anesthesia with use of AVATAR, including centers with both photon and proton therapy. ConclusionsThis report elaborates on the methodology and timeline of trial conception and development using data from a previously published supportive care study combining video immersion with radiotherapy among 10 cooperating pediatric oncology institutions. It highlights the potential for multicenter collaborations on prospective trials integrating supportive care therapies with radiotherapy.

Deformation behavior, microstructure evolution and phase transformation of dual-phase Mg-Li-Zn-Sr-Ca alloy under isothermal compression

The deformation behavior, phase transformation and microstructure evolution of dual-phase Mg-Li-Zn-Sr-Ca alloy under different deformation parameters were investigated through isothermal compression experiments. Serrated flow behavior was observed in the flow curves, indicating a strain aging behavior. R=0.9971 and AARE=3.88 % demonstrate the reliable predictive capability of established constitutive model. Hot processing maps indicate that instability region is only at T=423–490 K, ε̇ =0.007 s–1-1 s–1. As the temperature exceeds 523 K, needle-shaped phases precipitated from the β-Li phase, which was confirmed to be α-Mg phase. With increasing temperature and reducing strain rate, the quantity and size of them increased. Furthermore, its precipitation may be due to the high lattice diffusion coefficient of the β-Li phase. The degree of dynamic recrystallization (DRX) increased, the proportion of low-angle grain boundaries (LAGBs) and kernel average misorientation (KAM) decreased, these phenomena primarily associated with the dynamic recovery (DRV) and DRX processes. In addition, under the same processing parameters, the degree of DRX in the α-Mg phase is higher than that of the β-Li phase, the density of geometrically necessary dislocations (GND) of the α-Mg phase is higher than that of the β-Li phase. The β-Li phase can be activated more slip system and it can reduce the accumulation of dislocations. Meanwhile, the high density of GND of the α-Mg phase also predicts a higher strain energy and a greater drive force for recrystallisation. As the temperature rises, the intensity of the (0002) basal texture of the α-Mg phase increased, which is attributed to the selective growth of DRXed grains.

Stronger together: Implementing patient-reported symptom tool in routine cancer care in diverse Asia—A multi-national pilot feasibility study (PROMiSE-Pilot).

TPS180 Background: Patients diagnosed with cancer often experience disease or treatment-related symptoms, which can be under-elicited and under-appreciated by clinicians during time-poor consultations. This is particularly challenging in Asia where structural disparities in healthcare access mean oncology services are often under-resourced. Five oncologists from Thailand, India, Singapore, Philippines and Australia formed a working group as part of ASCO Asia-Pacific Leadership Development Program (LDP-AP). Systematic symptom monitoring using patient-reported outcomes measures (PROM) was identified as a potential solution to improve care in diverse Asian settings. PROM has demonstrated improved outcomes in Western settings but its utility in resource limited Asian contexts is less well established. A study was developed to evaluate the feasibility of implementing PROM in routine outpatient care across diverse cultural contexts in Asia. Methods: PROMiSE-Pilot is a prospective, multi-centre, feasibility study of integrating PROM in routine outpatient care across Asia. The Edmonton Symptom Assessment Scale questionnaire (ESAS-r) was selected as the PROM tool. Clinicians in 4 hospitals in Singapore, Manila, Bangkok and Hyderabad will be invited to participate, and their patients will be invited to complete the ESAS-r on paper before each visit. The primary aim is to evaluate if proportion of patients who complete ≥5 of 10 items on ESAS-r is ≥85% (Clopper Pearson). Secondary aims include assessing proportion who complete ≥8 and all 10 items and perceived utility of ESAS-r evaluated through surveys adapted to measure patient and clinician satisfaction. Site-specific patient, clinician, administrative barriers and facilitators will be studied. A pragmatic approach to context-specific implementation was adopted with each site developing its own process map for delivering the pilot and adapting to local patient demographics (e.g. low literacy), cultural contexts and resources. Translated versions of ESAS-r were acquired where necessary. Recruitment commenced in March 2024 following ethics approval at 2 sites. 87 patient encounters have been captured from 5 participating clinicians in Singapore. 5 clinicians have agreed to participate in Bangkok. Target recruitment is 200 encounters per site. Multi-centre data will be presented at the Breakthrough congress. Clinicians from ASCO LDP-AP identified PROM as a low-cost but potentially high-value approach to improving quality of care in resource limited settings in Asia. Understanding the feasibility of such a tool is vital prior to consideration of wider scale adoption by stakeholders. This co-developed multi-national pilot additionally demonstrates the value of collaboration, our strength in diversity and a pragmatic model for investigator-initiated studies in Asia.

2191 Physiotherapists’ perspectives of barriers and facilitators to effective community provision after hip fracture

Abstract Introduction to investigate physiotherapists’ perspectives of effective community provision following hip fracture. Methods qualitative semi-structured interviews were conducted with 17 community physiotherapists across England. Thematic analysis drawing on the Theoretical Domains Framework identified barriers and facilitators to implementation of effective provision. Interviews were complemented by process mapping community provision in one London borough, to identify points of care where suggested interventions are in place and/or could be implemented. Results four themes were identified: ineffective coordination of care systems, ineffective patient stratification, insufficient staff recruitment and retention approaches and inhibitory fear avoidance behaviours. To enhance care coordination, participants suggested improving access to social services and occupational therapists, maximising multidisciplinary communication through online notation, extended physiotherapy roles, orthopaedic-specific roles and seven-day working. Participants advised the importance of stratifying patients on receipt of referrals, at assessment and into appropriately matched interventions. To mitigate insufficient staff recruitment and retention, participants proposed return-to-practice streams, apprenticeship schemes, university engagement, combined acute-community rotations and improving job description advertisements. To reduce effects of fear avoidance behaviour on rehabilitation, participants proposed the use of patient-specific goals, patient and carer education, staff education in psychological strategies or community psychologist access. Process mapping of one London borough identified points of care where suggested interventions to overcome barriers were in place and/or could be implemented. Conclusion physiotherapists propose that effective provision of community physiotherapy following hip fracture could be improved by refining care coordination, utilising stratification techniques, employing enhanced recruitment and retainment strategies and addressing fear avoidance behaviours.

2269 Preventing frailty crises: improving the care of frail patients in an acute hospital Ward setting

Abstract Introduction Frailty is common in hospitalised older patients and hospitalisation can lead to negative outcomes. Our study aimed to provide insights into current decision-making processes on treatment, care and discharge by clinical teams. Methods We conducted a prospective cohort study in frail older patients ≥65 years old admitted to acute medical and surgical wards. Clinical Frailty Scale ≥5 was used to identify frail patients and process mapping was undertaken to identify common themes, trajectories and potentially modifiable factors. We followed patient journeys from admission to discharge and examined factors contributing to longer hospitalisation. We documented existing processes, environmental, system and clinical factors influencing patient care. Comprehensive geriatric assessments identified underlying geriatric syndromes and where gaps in management were identified, we recommended frailty interventions. Results Fifteen patients provided informed consent, of whom 73% were female and average age 80 years, ranging 69–95 years. 67% were frail (CFS 5–6) and 33% were severely frail (CFS 7–9). Most patients were sarcopenic with a SARC-F score of ≥4 and had functional and gait impairment. 60% were underweight (BMI <22). Process mapping revealed gaps in frailty-focused care and included delayed transfer to acute wards, delayed investigations, and multiple unidentified geriatric syndromes which were prevalent in this cohort. Patients fell into three broad groups, short (1–6 days), intermediate (7–14 days), or long (>14 days) length of stay and delays in discharge-planning were common, mean of 4.17 days, as were delays in identification of a caregiver. Recommendations for community support services were provided to >50% patients. Conclusion Our study shows that mapping the frail patient’s journey can identify gaps in existing processes and opportunities for improvement and collaboration. Integrating geriatric care into general wards could improve patient outcomes. We aim to use this work to guide frailty-attuned care for hospitalised older patients.

2278 Adding value to the patient experience through a clinically optimised pathway approach

Abstract Introduction High numbers of clinically optimised patients in a DGH were having daily clinical input. RAAC clinical incident resulted in movement of clinically optimised patients from the district general hospital to a community hospital increasing the community bedbase from 32 to 72. This gave the opportunity to review how these patients were managed. Method In the first PDSA cycle, it was recognised that daily medical ward rounds for clinically optimised patients were neither necessary nor optimal and potentially perpetuated the impression that patients required in hospital care. These observations were sought using process mapping and fish bone diagram. In the second cycle, all clinically optimised were planned to be seen once a week on ward round. All patients were discussed on the daily multidisciplinary board round and if needed were changed on the board to not clinically optimised which prompted review. Nurses could also ask for review outside of the board round. Results During a four-week period one third, (24/72) of patients needed review outside of the weekly planned review. Of these 79.2% required only one review. Consequentially junior doctors reported to save an estimated cumulative of 16–48 hrs per week. Balancing measures of falls, mortality, pressure sores and complaints showed no change in the four months after implementation of the change. Patient, family and staff qualitative feedback was gathered. The next two cycles involved polypharmacy review and offered clinically optimised patients a ‘What Matters to Me’; meeting with their family utilising the time saved to improve communication, medication review and future care planning. Conclusion Data suggested no adverse impact of change in practice. Staff were redeployed to the front door frailty team rather than community hospital to improve access to Comprehensive Geriatric Assessment, and a new pathway was designed to create uniformity in flow for admissions to frailty.

The mapping of processes in a campus of the Federal Institute of Education, Science and Technology in Brazil: a case study

This research analyzes the process mapping developed by the Business Process Mapping Commission (CMPN) in a Campus of the Federal Institute of Education, Science and Technology, a Brazilian Public Institution of Higher Education (IPES). From a documentary analysis, the history of management initiatives by processes of the rectory and the Campus object of study was presented. In the form of a case study, it was possible to identify, through a semi-structured interview with the members of the CMPN, the motivations, expectations, methodology and the main challenges faced in the implementation of the mapping of the processes that until the end of this work was in progress. Through the application of a questionnaire with closed questions, it was possible to assess that, in the perception of teaching, research and extension managers, the mapping of processes has a positive impact on the quality of teaching. Process management is an approach that can generate greater efficiency in the organization, however, it is perceived that the particularities of the Brazilian public sector create barriers for IPES initiatives to achieve the critical success factors found in the literature, requiring their own models.

Analysis of Land Use and Land Cover Changes and Trends in Fantalle Range Land, East Shewa Zone, Oromia Regional State, Ethiopia

This study was conducted in Fantalle Range lands in East Shewa zone of, Oromia Region, Ethiopia, to assess land use land cover changes, trends, drivers and their socioeconomics. Household surveys were conducted through simple random sampling to collect qualitative data. Qualitative data are used to investigate the causes and effects of land use and land cover changes. SPSS software (version 20) was used for data analysis, and descriptive research methods were adopted. Additionally, map processing was done using ERDAS Imagine (version 9.1) and ArcGIS (version 10.1). The land use land cover classification activity was started by obtaining Landsat images of 1972, 1990, 2000 and 2020 at different intervals from the Earth Explorer (USGS) from the Landsat 4, Landsat 5, Landsat 7 and Landsat 8, respectively. Land use land cover change (LULCC) maps are generated based on year classification. Range land, agricultural land, woody vegetation, bare land and settlement are the five main LULCC categories generated from satellite data. The findings show that in the presence of LULCC, agricultural land, settlements and bare land expand significantly, while range land and woodland show a decreasing trend. The classification results of the 1972 image show that rangeland/grazing land accounts for the largest proportion of the land in this area, accounting for 31.6%. In addition, due to various factors, the number of livestock owned in pastoral areas is also decreasing. The main cause of changes in livestock types is drought, which can cause different impacts, such as feed and water shortages and health problems. Therefore, intervention in land use manipulation is needed to maintain ecosystems and natural resources. Furthermore, rangeland policies should be developed to maintain pastoral and pastoral systems.

Creative-aesthetic product design and tools

Providing a product with characteristics of beauty and creative innovation is one of the aims of any contemporary industry to meet the needs of customers and satisfy their aesthetic and functional requirements. To study the production process and the realisation of creative products with aesthetically pleasing attributes, we created an environment that allows the construction of simple textured polygons (triangles, squares, rhombuses and pentagons) through a software application. To overcome traditional ways of assessing creative products, a Birkhoff aesthetic measure, Euclidean distance and entropy measure have been developed and applied to a sample of smart products, manufactured in the implemented environment, to analyse their aesthetic, creative and order–complexity–chaos features, respectively. The results provided us with measurable quantities of the required qualities for the sample and for each distinct product, combining the metrics to visualise the creative products in 2D and 3D spaces. Further mathematical methods, such as the point process and density probability map applied on the same sample, allowed us to move from a statistical space to probabilistic landscapes, with enhanced forecasting capability on creative features for all future products. Industrial applications are expected in the production and evaluation of products from a creative point of view.

One hundred lava flows of Mt. Etna, Italy: July 2019–December 2023 update

ABSTRACT Integration of multi-sensor, multi-platform remotely sensed data is an effective methodology for monitoring active volcanoes as it ensures a constant data flow, which is needed for repeated eruptive events in brief intervals. It allows broad observation of the eruptive scenario and quantification of the erupted products. We integrated remote sensing data, through GIS software, to map the lava flows of Etna, one of the most active volcanoes in the world. Between July 2019 and December 2023, Etna gave rise to seventy-five eruptive events, mainly from the summit craters, emplacing one hundred lava flows. We updated Etna's 1999-2019 map, with the most recent eruptive products, mapping ninety-three lava flows out of the one hundred-five. For cartographic simplicity, summit flows are grouped by year or eruptive cycle, while flank flows are distinguished by date. To better display the products and highlight the mapping process, we added twenty-one detailed maps to the main map.

Hot Forgeability of Titanium Alloy Ti–6Al–2.2Mo–1.4Cr–0.4Fe–0.3Si Alloy: An Approach Using Processing Map

Hot Forgeability of Titanium Alloy Ti–6Al–2.2Mo–1.4Cr–0.4Fe–0.3Si Alloy: An Approach Using Processing Map

Evaluation of Printing Parameters on 3D Extrusion Printing of Pluronic Hydrogels and Machine Learning Guided Parameter Recommendation.

Bioprinting is an emerging technology for the construction of complex three-dimensional (3D) constructs used in various biomedical applications. One of the challenges in this field is the delicate manipulation of material properties and various disparate printing parameters to create structures with high fidelity. Understanding the effects of certain parameters and identifying optimal parameters for creating highly accurate structures are therefore a worthwhile subject to investigate. The objective of this study is to investigate high-impact print parameters on the printing printability and develop a preliminary machine learning model to optimize printing parameters. The results of this study will lead to an exploration of machine learning applications in bioprinting and to an improved understanding between 3D printing parameters and structural printability. Reported results include the effects of rheological property, nozzle gauge, nozzle temperature, path height, and ink composition on the printability of Pluronic F127. The developed Support Vector Machine model generated a process map to assist the selection of optimal printing parameters to yield high quality prints with high probability (>75%). Future work with more generalized machine learning models in bioprinting is also discussed in this article. The finding of this study provides a simple tool to improve printability of extrusion-based bioprinting with minimum experimentations.

Cost Comparison of Prostatic Artery Embolization Between In-Hospital and Outpatient-Based Lab Settings.

Purpose This study aimed to determine the costs associated with prostatic artery embolization (PAE) performed in hospital and outpatient-based lab (OBL) settings. Methods Procedures were performed in similarly equipped procedure suites located within a tertiary hospital or OBL. Time-driven activity-based costing (TDABC) was utilized to calculate procedural costs incurred by the institution. Process maps were created describing personnel, space, equipment, and materials. The time duration of each procedural step was recorded independently by a nurse caring for the patient at the time of the procedure, and mean values were included in our model. Using institutional and publicly available financial data, costs, and capacity cost rates were determined. Results Thirty-seven PAE procedures met inclusion criteria with a mean patient age of 70.4 (+/- 6.7) years and a mean prostate gland size of 129.7 (+/-56.4) cc. Twenty-six procedures were performed within the hospital setting, and 11 procedures were performed within the OBL. Reduction in International Prostate Symptom Score (IPSS) was not significantly different following hospital and OBL procedures (57.2% vs. 82.4%, P = 0.0796). Mean procedural time was not significantly different between the hospital and OBL settings (136.6 vs. 147.3 minutes, P = 0.1893). However, the duration between admission and discharge was significantly longer for procedures performed in a hospital (468.8 vs. 325.4 minutes, P <0.0001). Total costs for hospital-based procedures were marginally higher ($3,858.28 vs. $3,642.67). Conclusion Total PAE cost was similar between the hospital and OBL settings. However, longer periprocedural times for hospital-based procedures and differences in reimbursement may favor the performance of PAE in an OBL setting.

Hot deformation and constitutive modeling of a Ti-Al-Sn-Zr-Mo-Cr-Nb alloy

Titanium alloys are the ideal structural materials for automotive and aerospace industries, and hot deformation is widely used to modify the microstructure of the alloy. In this work, a Ti-Al-Sn-Zr-Mo-Cr-Nb alloy was hot deformed at various strain rates and temperatures. The deformation behavior, microstructure, processing maps, and constitutive modeling are investigated. The results show that the hot deformation behavior of the studied alloy is sensitive to the processing parameters, the revised Johnson-Cook model with an average relative error of 1.463 %, and a correlation coefficient of 0.991 can accurately describe the hot deformation behavior of the alloy. Based on the established processing maps, the safe processing areas are 1133–1213 K, 0.004–0.1 s−1 and 1093–1213 K, 0.001–0.004 s−1. With the increased deformation temperature, both the fraction and size of the equiaxed α and lamellar α phases are gradually decreased, and the spheroidization degree of the lamellar α phase gradually decreases too. The strain rates have different influences on the evolution of α and β phases. With the increased strain rates, the fraction of recrystallized and deformed β phase is remarkably decreased, the fraction of sub-structured microstructures of β phase is obviously increased, while the fraction of deformed structures of the α phase is less affected.

Research on the construction and mapping model of knowledge organization system driven by standards

With the rapid development of artificial intelligence and enterprise digital transformation, the standardization organization, storage and management of semantic knowledge in computers have become the current research focus. As the core theory of knowledge system construction, knowledge organization (KO) provides theoretical support for the study of semantic knowledge organization and representation, among which knowledge organization system (KOS) is the important tool of semantic organization. At present, many scholars have carried out research from different perspectives of KOS based on theory, which provides the direction for the sustainable development of KOS. However, most of these studies focus on some aspects of KOS, which are in a "scattered" state, lacking systematic analysis of the basic principles of KOS construction and semantic organization based on theories and international standards. Therefore, this paper firstly constructs KOS theoretical models in the conceptual world and computer world respectively through a comprehensive study of multi-disciplinary basic theories such as semantics, logic, system theory, and international standards such as ISO 1087:2019, ISO 25964:2013, and ISO 11179:2023, and traces the iterative construction, organization and mapping process from "concept" in the conceptual world to "metadata" knowledge and semantics in the computer world. The semantic organization based on metadata is realized in computer. Secondly, on this basis, in order to realize ontology representation of domain knowledge, the ontology construction method based on MDR metadata is proposed. Finally, taking the semantic organization and ontology construction of Epicentre model in petroleum field as an example, the feasibility of the ideas and methods proposed in this paper is verified. The model and method proposed in this paper is independent of the specific type of KOS, so it is innovative and universal. The methodology is also applicable to other fields of conceptual system modeling, metadata standard construction, and data model modeling.

FRAP 2.0: a community engagement method applied to cervical cancer disparities among Hispanic women

focused Rapid Assessment Process (fRAP) 2.0 is a community engagement approach combining geospatial mapping with rapid qualitative assessment in cyclical fashion within communities to capture multifactorial and multilevel features impacting...

Aerodynamic instability evolution of a multi-stage combined compressor

Unstable operating conditions such as surge could cause damage to both aerodynamic performance and structural integrity of a compression system. This paper addresses the critical issue of aerodynamic instability in compressor design, particularly focusing on an axial-centrifugal combined compressor, a widely used yet underexplored configuration. An experimental investigation was conducted on a three-stage axial and one-stage centrifugal compressor (3A1C), using two pipe systems and employing fast-responding transducers to capture the dynamic instability process from choke condition to deep surge. Results reveal that at the design speed, 3A1C enters deep surge directly, whereas at off-design speeds, it experiences rotating stall and mild surge across a wide mass flow range. Some special instability features in the combined compressor can be found in the steady state map and dynamic process. The characteristic curve of the first axial stage keeps a positive slope during the whole mass flow range at an off-design speed. The first stage could work stably on the stall characteristic curve because the centrifugal stage has stronger pressurization and plays a dominant role in global aerodynamic instability. Besides, rotating instability occurs at the first rotor tip and disappears as the back pressure increases, which is also rarely seen in a single-axial compressor. This is also related to the strong pressurization of the centrifugal stage. The findings of this paper will contribute to the understanding of aerodynamic instabilities in combined compressors.

Reduced Time to Admit Emergency Department Patients to Inpatient Beds Using Outflow Barrier Analysis and Process Improvement.

Because admitted emergency department (ED) patients waiting for an inpatient bed contribute to dangerous ED crowding, we conducted a patient flow investigation to discover and solve outflow delays. After solution implementation, we measured whether the time admitted ED patients waited to leave the ED was reduced. In June 2022, a team using Lean Healthcare methodologies identified flow delays and underlying barriers in a Midwest, mid-sized hospital. We calculated barriers' magnitudes of burden by the frequency of involvement in delays. During October-December 2022, solutions targeting barriers were implemented. In October 2023, we tested whether waiting time, defined as daily median time in minutes from admission disposition to departure (ADtoD), declined by conducting independent sample, single-tailed t-test comparing pre- to post-intervention time periods, January 1-September 30, 2022 (273 days) to January 1-September 30, 2023 (273 days). Additionally, we regressed ADtoD onto pre-/post period while controlling for ED volume (total daily admissions and ED daily encounters) and hospital occupancy. A run chart analysis of monthly median ADtoD assessed improvement sustainability. Process mapping revealed that three departments (ED, environmental services [EVS], and transport services) co-produced the outflow of admitted ED patients wherein 18 delays were identified. The EVS-clinical care collaboration failures explained 61% (11/18) of delays. Technology contributed to 78% (14/18) of delays primarily because staff's technology did not display needed information, a condition we coined "digital blindness." Comparing pre- and post-intervention days (3,144 patients admitted pre-intervention and 3,256 patients post), the median minutes a patient waited (ADtoD) significantly decreased (96.4 to 87.1 minutes, P = 0.04), even while daily ED encounter volume significantly increased (110.7 to 117.3 encounters per day, P < 0.001). After controlling in regression for other factors associated with waiting, the intervention reduced ADtoD by 12.7 minutes per patient (standard error 5.10, P = 0.01; 95% confidence interval -22.7, -2.7). We estimate that the intervention translated to ED staff avoiding 689 hours of admitted patient boarding over nine months (ADtoD coefficient [-12.7 minutes] multiplied by post-intervention ED admissions [3,256] and divided by 60). Run chart analysis substantiated the intervention's sustainability over nine months. After systemwide patient flow investigation, solutions resolving digital blindness and environmental services-clinical care collaboration failures significantly reduced ED admitted patient boarding.

Effect of Y2O3 on high temperature thermal compression performance of Cu–10W composites and microstructure analysis

In this study, Cu–10W and 2 wt%Y2O3/Cu–10W composites were successfully prepared via mechanical ball milling and spark plasma sintering. Hot compression experiments on the two materials were carried out in the temperature range of 300°C-600 °C and in the strain rate range of 0.01 s−1–10 s−1. The hot deformation activation energy of the two materials was calculated and a constitutive equation was established. The optimum hot deformation process parameters were obtained according to a hot processing map. The effects of Y2O3 on the thermal deformation behavior of the Cu–10W composites and their microstructures were investigated, and the results showed that Y2O3 could enhance the stability of Cu–10W at high temperatures. The activation energies of thermal deformation of Cu–10W and 2 wt%Y2O3/Cu–10W were 159.56 kJ/mol and 129.85 kJ/mol, respectively. Moreover, Y2O3 improved the interfacial bonding strength of Cu and W in the Cu–10W material, effectively preventing the generation of microcracks and pores during the high-temperature compression process; Y2O3 provides more nucleation sites in the recrystallization process, which is favorable for the excitation of recrystallization. A low strain rate at high temperatures favors the occurrence of recrystallization, and the 2 wt%Y2O3/Cu–10W composites tend to exhibit discontinuous dynamic recrystallization (DDRX) under high-Z-value conditions and continuous dynamic recrystallization (CDRX) under low-Z-value conditions.