A cell volume sensing instrument has been built which employs the principle used in the Coulter counter in which a cell changes the impedance of a narrow orifice as it passes through the orifice. An improved transducer utilizes a coaxial flow of the cell suspension inside a sheath of cell-free solution through the orifice, thereby avoiding some drawbacks of earlier systems. The instrument is described, and the procedure necessary to achieve acceptable operation is discussed. The output for normal human red blood cells is nearly symmetrical with a narrow peak. Abnormal blood samples show various departures from symmetry and narrowness of peak. The output of this instrument is compared with that from a commercially available instrument, and our data show a more accurate representation of the actual distribution of blood volumes. The resolution of this instrument is such that it could be of significant value in a clinical laboratory.
ObjectiveEarly and accurate prediction of hospital surgical-unit occupancy is critical for improving scheduling, staffing and resource planning. Previous studies on occupancy prediction have focused primarily on adult healthcare settings, we sought to develop occupancy prediction models specifically tailored to the needs and characteristics of paediatric surgical settings.Materials and methodsWe conducted a single-centre retrospective cohort study at a surgical unit in a tertiary-care paediatric hospital in Boston, Massachusetts, USA. We developed a hierarchical modelling framework for predicting next-day census using multiple types of data—from bottom-up patient-specific orders and procedures to top-down temporal variables and departmental admission statistics.ResultsThe model predicted upcoming admissions and discharges with a median error of 17%–21% (2–3 patients per day), and next-day census with a median error of 7% (n=3). The primary factors driving these predictions included day of week and scheduled surgeries, as well as procedure duration, procedure type and days since admission. We found that paediatric surgical procedure duration was highly predictive of postoperative length of stay.DiscussionOur hierarchical modelling framework provides an overview of the factors driving capacity issues in the paediatric surgical unit, highlighting the importance of both top-down temporal features (eg, day of week) as well as bottom-up electronic health records (EHR)derived features (eg, orders for patient) for predicting next-day census. In the practice, this framework can be implemented stepwise, from top to bottom, making it easier to adopt.ConclusionModelling frameworks combining top-down and bottom-up features can provide accurate predictions of next-day census in a paediatric surgical setting.
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