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- D’Aeth, Josh C., et al.
(author)
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Optimal hospital care scheduling during the SARS-CoV-2 pandemic
- 2023
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In: Management science. - : Institute for Operations Research and the Management Sciences (INFORMS). - 0025-1909 .- 1526-5501. ; 69:10, s. 5695-6415
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Journal article (peer-reviewed)abstract
- The COVID-19 pandemic has seen dramatic demand surges for hospital care that have placed a severe strain on health systems worldwide. As a result, policy makers are faced with the challenge of managing scarce hospital capacity to reduce the backlog of non-COVID patients while maintaining the ability to respond to any potential future increases in demand for COVID care. In this paper, we propose a nationwide prioritization scheme that models each individual patient as a dynamic program whose states encode the patient’s health and treatment condition, whose actions describe the available treatment options, whose transition probabilities characterize the stochastic evolution of the patient’s health, and whose rewards encode the contribution to the overall objectives of the health system. The individual patients’ dynamic programs are coupled through constraints on the available resources, such as hospital beds, doctors, and nurses. We show that the overall problem can be modeled as a grouped weakly coupled dynamic program for which we determine near-optimal solutions through a fluid approximation. Our case study for the National Health Service in England shows how years of life can be gained by prioritizing specific disease types over COVID patients, such as injury and poisoning, diseases of the respiratory system, diseases of the circulatory system, diseases of the digestive system, and cancer.
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- D’Aeth, Josh C., et al.
(author)
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Optimal national prioritization policies for hospital care during the SARS-CoV-2 pandemic
- 2021
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In: Nature Computational Science. - : Springer Nature. - 2662-8457. ; 1:8, s. 521-531
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Journal article (peer-reviewed)abstract
- In response to unprecedented surges in the demand for hospital care during the SARS-CoV-2 pandemic, health systems have prioritized patients with COVID-19 to life-saving hospital care to the detriment of other patients. In contrast to these ad hoc policies, we develop a linear programming framework to optimally schedule elective procedures and allocate hospital beds among all planned and emergency patients to minimize years of life lost. Leveraging a large dataset of administrative patient medical records, we apply our framework to the National Health Service in England and show that an extra 50,750–5,891,608 years of life can be gained compared with prioritization policies that reflect those implemented during the pandemic. Notable health gains are observed for neoplasms, diseases of the digestive system, and injuries and poisoning. Our open-source framework provides a computationally efficient approximation of a large-scale discrete optimization problem that can be applied globally to support national-level care prioritization policies.
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- Bennecke, E, et al.
(author)
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Early Genital Surgery in Disorders/Differences of Sex Development: Patients' Perspectives
- 2021
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In: Archives of sexual behavior. - : Springer Science and Business Media LLC. - 1573-2800 .- 0004-0002. ; 50:3, s. 913-923
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Journal article (peer-reviewed)abstract
- Controversy continues over a proposed moratorium on elective genital surgery in childhood for disorders/differences of sex development (DSD). Empirical evidence on patient preference is needed to inform decision-making. We conducted a multicentre survey by cross-sectional questionnaire in 14 specialized clinics in six European countries. The sample comprised 459 individuals (≥ 16 years) with a DSD diagnosis, including individuals with congenital adrenal hyperplasia (CAH) (n = 192), XY DSD with prenatal androgen effect (A) (n = 150), and without (nA) (n = 117). Main outcome measures were level of agreement with given statements regarding genital surgery, including clitoris reduction, vaginoplasty, and hypospadias repair. A total of 66% of individuals with CAH and 60% of those with XY DSD-A thought that infancy or childhood were the appropriate age for genital surgery. Females with XY DSD were divided on this issue and tended to prefer vaginoplasty at a later age (XY DSD-A 39%, XY DSD-nA 32%). A total of 47% of males preferred early hypospadias surgery. Only 12% (CAH), 11% (XY DSD-A), and 21% (XY DSD-nA) thought they would have been better off without any surgery in childhood or adolescence. Individuals who had early genital surgery were more likely to approve of it. Outcome data failed to support a general moratorium on early elective genital surgery. Participant perspectives varied considerably by diagnostic category, gender, history of surgery, and contact with support groups. Case-by-case decision-making is better suited to grasping the ethical complexity of the issues at stake.Trial registration: German Clinical Trials Register DRKS00006072.
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- Legall, H., et al.
(author)
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A compact laboratory transmission X-ray microscope for the water window
- 2013
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In: Journal of Physics, Conference Series. - : IOP Publishing. - 1742-6588 .- 1742-6596. ; 463:1, s. 012013-
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Journal article (peer-reviewed)abstract
- In the water window (2.2-4.4 nm) the attenuation of radiation in water is significantly smaller than in organic material. Therefore, intact biological specimen (e.g. cells) can be investigated in their natural environment. In order to make this technique accessible to users in a laboratory environment a Full-Field Laboratory Transmission X-ray Microscope (L-TXM) has been developed. The L-TXM is operated with a nitrogen laser plasma source employing an InnoSlab high power laser system for plasma generation. For microscopy the Ly α emission of highly ionized nitrogen at 2.48 nm is used. A laser plasma brightness of 5 × 1011 photons/(s × sr × μm2 in line at 2.48 nm) at a laser power of 70 W is demonstrated. In combination with a state-of-the-art Cr/V multilayer condenser mirror the sample is illuminated with 106 photons/(μm2 × s). Using objective zone plates 35-40 nm lines can be resolved with exposure times < 60 s. The exposure time can be further reduced to 20 s by the use of new multilayer condenser optics and operating the laser at its full power of 130 W. These exposure times enable cryo tomography in a laboratory environment.
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- Legall, H., et al.
(author)
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Compact X-ray microscope for the water window based on a high brightness laser plasma source
- 2012
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In: Optics Express. - 1094-4087. ; 20:16, s. 18362-18369
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Journal article (peer-reviewed)abstract
- We present a laser plasma based x-ray microscope for the water window employing a high-average power laser system for plasma generation. At 90 W laser power a brightness of 7.4 x 10(11) photons/(s x sr x mu m(2)) was measured for the nitrogen Ly alpha line emission at 2.478 nm. Using a multilayer condenser mirror with 0.3 % reflectivity 10(6) photons/(mu m(2) x s) were obtained in the object plane. Microscopy performed at a laser power of 60 W resolves 40 nm lines with an exposure time of 60 s. The exposure time can be further reduced to 20 s by the use of new multilayer condenser optics and operating the laser at its full power of 130 W.
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