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The number of patients seeking treatment in emergency departments is rising, although many governments are seeking to reduce expenditure on health. Emergency departments must achieve more with the same resources or perform the same functions with fewer resources. Patients demand higher emergency clinical care quality, with low waiting times viewed as a key quality criterion by many patients. The objective of this study was to create an improved working system in emergency departments that cuts patient waiting times for first specialty physician contact. Techniques from industrial flow management were applied to the working process of an emergency department and the concept was named 'First View.' A total of 3269 patient contacts using the First View Concept during a treatment month showed statistical significance. Before introduction, a total 3230 patients in a comparative treatment month had a median waiting time before the first doctor contact of 47.6 min, a first quartile waiting time of 36.1 min, and a third quartile waiting time of 62.7 min. After introduction, 3269 patients had a median waiting time before first specialty physician contact of 11.2 min, a first quartile waiting time of 9.1 min, and a third quartile waiting time of 15.2 min. Industrial flow concepts can achieve significant improvements in emergency department workflows in countries in which sufficient numbers of specialty physicians are available. More attention to the organization of emergency department working processes is needed, especially involving lean management.
Aldehyde oxidases (AOXs) are homodimeric proteins belonging to the xanthine oxidase family of molybdenum-containing enzymes. Each 150-kDa monomer contains a FAD redox cofactor, two spectroscopically distinct [2Fe-2S] clusters, and a molybdenum cofactor located within the protein active site. AOXs are characterized by broad range substrate specificity, oxidizing different aldehydes and aromatic N-heterocycles. Despite increasing recognition of its role in the metabolism of drugs and xenobiotics, the physiological function of the protein is still largely unknown. We have crystallized and solved the crystal structure of mouse liver aldehyde oxidase 3 to 2.9 angstrom. This is the first mammalian AOX whose structure has been solved. The structure provides important insights into the protein active center and further evidence on the catalytic differences characterizing AOX and xanthine oxidoreductase. The mouse liver aldehyde oxidase 3 three-dimensional structure combined with kinetic, mutagenesis data, molecular docking, and molecular dynamics studies make a decisive contribution to understand the molecular basis of its rather broad substrate specificity.
Today, diverse communities of zooxanthellate corals thrive, but do not build reef, under a wide range of environmental conditions. In these settings they inhabit natural bottom communities, sometimes forming patch-reefs, coral carpets and knobs. Episodes in the fossil record, characterized by limited coral-reef development but widespread occurrence of coral-bearing carbonates, may represent the fossil analogs of these non-reef building, zooxanthellate coral communities. If so, the study of these corals could have valuable implications for paleoenvironmental reconstructions. Here we focus on the evolution of early Paleogene corals as a fossil example of coral communities mainly composed by zooxanthellate corals (or likely zooxanthellate), commonly occurring within carbonate biofacies and with relatively high diversity but with a limited bioconstructional potential as testified by the reduced record of coral reefs. We correlate changes of bioconstructional potential and community compositions of these fossil corals with the main ecological/environmental conditions at that time. The early Paleogene greenhouse climate was characterized by relatively short pulses of warming with the most prominent occurring at the Paleocene-Eocene boundary (PETM event), associated with high weathering rates, nutrient fluxes, and pCO(2) levels. A synthesis of coral occurrences integrated with our data from the Adriatic Carbonate Platform (SW Slovenia) and the Minervois region (SW France), provides evidence for temporal changes in the reef-building capacity of corals associated with a shift in community composition toward forms adapted to tolerate deteriorating sea-water conditions. During the middle Paleocene coral-algal patch reefs and barrier reefs occurred from shallow-water settings, locally with reef-crest structures. A first shift can be traced from middle Paleocene to late Paleocene, with small coral-algal patch reefs and coral-bearing mounds development in shallow to intermediate water depths. In these mounds corals were highly subordinated as bioconstructors to other groups tolerant to higher levels of trophic resources (calcareous red algae, encrusting foraminifera, microbes, and sponges). A second shift occurred at the onset of the early Eocene with a further reduction of coral framework-building capacity. These coral communities mainly formed knobs in shallow-water, turbid settings associated with abundant foraminiferal deposits. We suggest that environmental conditions other than high temperature determined a combination of interrelated stressors that limited the coral-reef construction. A continuous enhancement of sediment load/nutrients combined with geochemical changes of ocean waters likely displaced corals as the main bioconstructors during the late Paleocene-early Eocene times. Nonetheless, these conditions did not affect the capacity of some corals to colonize the substrate, maintain biodiversity, and act as locally important carbonate-sediment producers, suggesting broad environmental tolerance limits of various species of corals. The implications of this study include clues as to how both ancient and modern zooxanthellate corals could respond to changing climate.
This thesis investigates the gradient flow of Dirac-harmonic maps. Dirac-harmonic maps are critical points of an energy functional that is motivated from supersymmetric field theories. The critical points of this energy functional couple the equation for harmonic maps with spinor fields. At present, many analytical properties of Dirac-harmonic maps are known, but a general existence result is still missing. In this thesis the existence question is studied using the evolution equations for a regularized version of Dirac-harmonic maps. Since the energy functional for Dirac-harmonic maps is unbounded from below the method of the gradient flow cannot be applied directly. Thus, we first of all consider a regularization prescription for Dirac-harmonic maps and then study the gradient flow. Chapter 1 gives some background material on harmonic maps/harmonic spinors and summarizes the current known results about Dirac-harmonic maps. Chapter 2 introduces the notion of Dirac-harmonic maps in detail and presents a regularization prescription for Dirac-harmonic maps. In Chapter 3 the evolution equations for regularized Dirac-harmonic maps are introduced. In addition, the evolution of certain energies is discussed. Moreover, the existence of a short-time solution to the evolution equations is established. Chapter 4 analyzes the evolution equations in the case that the domain manifold is a closed curve. Here, the existence of a smooth long-time solution is proven. Moreover, for the regularization being large enough, it is shown that the evolution equations converge to a regularized Dirac-harmonic map. Finally, it is discussed in which sense the regularization can be removed. In Chapter 5 the evolution equations are studied when the domain manifold is a closed Riemmannian spin surface. For the regularization being large enough, the existence of a global weak solution, which is smooth away from finitely many singularities is proven. It is shown that the evolution equations converge weakly to a regularized Dirac-harmonic map. In addition, it is discussed if the regularization can be removed in this case.
The EVE curriculum framework
(2012)
The Eu Timescape
(2012)
This article deals with Spanish modal adverbs and verbs of cognitive attitude (Capelli 2007) and their epistemic and/or evidential use. The article is based upon the hypothesis that the study of the use of these linguistic devices has to be highly context-sensitive, as it is not always (only) the sentence level that has to be looked at if one wants to find out whether a certain adverb or verb of cognitive attitude is used evidentially or epistemically. In this article, therefore, the context is used to determine which meaning aspects of an element are encoded and which are contributed by the context. The data were retrieved from the daily newspaper El Pais. Nevertheless, the present study is not a quantitative one, but rather a qualitative study. My corpus analysis indicates that it is not possible to differentiate between the linguistic categories of evidentiality and epistemic modality in every case, although it indeed is possible in the vast majority of cases. In verbs of cognitive attitude, evidentiality and epistemic modality seem to be two interwoven categories, while concerning modal adverbs it is usually possible to separate the categories and to distinguish between the different subtypes of evidentiality such as visual evidence, hearsay and inference.
This article deals with Spanish modal adverbs and verbs of cognitive attitude (Capelli 2007) and their epistemic and/or evidential use. The article is based upon the hypothesis that the study of the use of these linguistic devices has to be highly context-sensitive, as it is not always (only) the sentence level that has to be looked at if one wants to find out whether a certain adverb or verb of cognitive attitude is used evidentially or epistemically. In this article, therefore, the context is used to determine which meaning aspects of an element are encoded and which are contributed by the context. The data were retrieved from the daily newspaper El País. Nevertheless, the present study is not a quantitative one, but rather a qualitative study. My corpus analysis indicates that it is not possible to differentiate between the linguistic categories of evidentiality and epistemic modality in every case, although it indeed is possible in the vast majority of cases. In verbs of cognitive attitude, evidentiality and epistemic modality seem to be two interwoven categories, while concerning modal adverbs it is usually possible to separate the categories and to distinguish between the different subtypes of evidentiality such as visual evidence, hearsay and inference.