Discrete event simulation of patient admissions to a neurovascular unit.

Evidence exists that clinical outcomes improve for stroke patients admitted to specialized Stroke Units. The Toronto Western Hospital created a Neurovascular Unit (NVU) using beds from general internal medicine, Neurology and Neurosurgery to care for patients with stroke and acute neurovascular conditions. Using patient-level data for NVU-eligible patients, a discrete event simulation was created to study changes in patient flow and length of stay pre- and post-NVU implementation. Varying patient volumes and resources were tested to determine the ideal number of beds under various conditions. In the first year of operation, the NVU admitted 507 patients, over 66% of NVU-eligible patient volumes. With the introduction of the NVU, length of stay decreased by around 8%. Scenario testing showed that the current level of 20 beds is sufficient for accommodating the current demand and would continue to be sufficient with an increase in demand of up to 20%.

(K4Li4)Al8Ge8O32.8H2O: an Li+-exchanged potassium aluminogermanate with the zeolite gismondine (GIS) topology.

The title compound, lithium potassium dialuminium digermanium octaoxide dihydrate, (K,Li)-(Al,Ge)-GIS (GIS is gismondine), is the result of a 50% Li(+) exchange into the K-(Al,Ge)-GIS structure. The (K,Li)-(Al,Ge)-GIS structure was determined from a 4 x 4 x 2 micro m octahedral single crystal at the ESRF synchrotron X-ray source. The ion exchange results in a symmetry transformation from I2/a for K-(Al,Ge)-GIS to C2/c for (K,Li)-(Al,Ge)-GIS. The structural change is due to disordering of K(+) ions with Li(+) ions along the [001] channel and ordering of water molecules in the [101] channels. The distance between sites partially occupied by K(+) ions increases from 2.19 (3) A in K-(Al,Ge)-GIS to 2.94 (3) A in (K,Li)-(Al,Ge)-GIS. The Li(+) ions occupy positions along the twofold axis at the intersection of the eight-membered-ring channels in a twofold coordination with water molecules. For the four closest framework O(2-) anions, the Li.O distances are 3.87 (4) A.

Low back pain.

Low back pain is a very common and significant problem in our society, and there are both mechanical and psychosocial aspects to its etiology. This paper presents a systematic approach to the treatment of common types of low back pain. Treatment, beginning with conservative care, is outlined in this paper in the form of an algorithm. Current research directed at both the diagnostic and treatment aspects of low back pain is addressed.