Association between school learning models and psychological and social health visits to the emergency room.

Objectives: We aimed to assess the impact of in-person and distance school learning models on children's visits to the emergency department (ED) for psychological or social ("psychosocial") complaints. Methods: We analyzed presentations to one emergency department in a mid-sized Midwestern city. We used the public school system schedule to determine in-person and distance learning periods by the grade level. We calculated the incidence of visits to the emergency department during academic years 2018-2019, 2019-2020, and 2020-2021, with particular attention to the time after March 13, 2020, which was the pandemic period. We compared the incidence of visits during in-person versus distance learning school models. Results: A total of 7181 visits occurred during the academic years studied, 17.1% due to psychosocial complaints. The incidence of psychosocial visits to the ED was lower during distance learning than during the pandemic in-person learning period (given per 1000 student years: 20.5 vs. 24.1, p = 0.14). This difference was statistically significant among middle schoolers (23.3 vs. 46.6, p < 0.001). While not statistically significant, the difference among high schoolers was pragmatically relevant (38.2 vs. 49.3, p = 0.086). Conclusions: Distance learning was associated with a decrease in the incidence of psychosocial visits to the emergency department relative to in-person learning. Future investigation is required to verify results and better understand any causative relationships.

Performance evaluation and chemical oxygen demand removal of tannery wastewater through the aerobic-anaerobic route.

With characterized for complex and maximum substance (suspended solids, broke up oil, a mixture of inorganic and chromium sulfides), tannery wastewater was subjected to a treatment process on removal of chemical oxygen demand (COD) via upstream anaerobic sludge blanket reactor where we found reduced departure efficiencies and that process limits were affected by the assortments in regular stacking rates, closeness of chromium, and sulfides. Hence, a combination of the aerobic-anaerobic hybrid reactor was set up for sequential treatment to determine possible COD reduction. This study investigated the biological degradation of tannery wastewater in a laboratory-scale sequential up-flow aerobic-anaerobic reactor. The aerobic zone at the top was packed with spherical ball-shaped polyhedral polypropylene, and the anaerobic zone at the bottom was packed medium with granular media. The aeration flow rate varied by 2 L/min, 4 L/min, and 6 L/min in the aerobic zone, and the reactor maintained an organic loading rate (OLR) of 5 kg COD/m3/d. Parameters like COD and gas yield assess the performance of the reactor. The maximum COD of 86% is removed in the anaerobic zone with an aeration rate of 6 L/min, and the 1800-mL methane gas yield is measured by the 29th day.

Charge Puddles Driven Complex Crossover of Magnetoresistance in Non-Topological Sulfur Doped Antimony Selenide Nanowires.

A race to achieve a crossover from positive to negative magnetoresistance is intense in the field of nanostructured materials to reduce the size of memory devices. Here, the unusual complex magnetoresistance in nonmagnetic sulfur-doped Sb2 Se3  nanowires is demonstrated. Intentionally, sulfur is doped in such a way to nearly achieve the charge neutrality point that is evident from switching of carrier type from p-type to n-type at 13 K as inferred from the low-temperature thermoelectric power measurements. A change from 3D variable range hopping (VRH) to power law transport with α = 0.18  in resistivity measurement signifies a Luttinger liquid transport with weak links through the nanowires. Interestingly, high magnetic field induced negative magnetoresistance (NMR) occurring in hole dominated temperature regimes can only be explained by invoking the concept of charge puddles. Spot energy dispersive spectroscopy (EDS), magnetic force microscopy (MFM) measurements, Tmott  and Regel plot indicate an enhanced disorder in these sulfurized nanowires that are found to be the precursor for the formation of these charge puddles. Tunability of conducting states in these nanowires is investigated in the light of interplay of carrier type, magnetic field, temperature, and intricate intra-inter wire transport that makes this nanowires potential for large scale spintronic devices.

The association between specific narrative elements and patient perspectives on acute pain treatment.

BACKGROUND: Narratives are effective tools for communicating with patients about opioid prescribing for acute pain and improving patient satisfaction with pain management. It remains unclear, however, whether specific narrative elements may be particularly effective at influencing patient perspectives. METHODS: This study was a secondary analysis of data collected for Life STORRIED, a multicenter RCT. Participants included 433 patients between 18 and 70 years-old presenting to the emergency department (ED) with renal colic or musculoskeletal back pain. Participants were instructed to view one or more narrative videos during their ED visit in which a patient storyteller discussed their experiences with opioids. We examined associations between exposure to individual narrative features and patients' 1) preference for opioids, 2) recall of opioid-related risks and 3) perspectives about the care they received. RESULTS: Participants were more likely to watch videos featuring storytellers who shared their race or gender. We found that participants who watched videos that contained specific narrative elements, for example mention of prescribed opioids, were more likely to recall having received information about pain treatment options on the day after discharge (86.3% versus 72.9%, p = 0.02). Participants who watched a video that discussed family history of addiction reported more participation in their treatment decision than those who did not (7.6 versus 6.8 on a ten-point scale, p = 0.04). CONCLUSIONS: Participants preferentially view narratives featuring storytellers who share their race or gender. Narrative elements were not meaningfully associated with patient-centered outcomes. These findings have implications for the design of narrative communication tools.

Influence of heat input on the mechanical characteristics, corrosion and microstructure of ASTM A36 steel welded by GTAW technique.

The Gas Tungsten Arc Welding process weld for the 4 mm thickness of the ASTM A36 steel plate with varied heat input parameters of 0.608 kJ/mm, 0.900 kJ/mm and 1.466 kJ/mm, respectively. The effect of different heat inputs on microstructure, corrosion, and mechanical characteristics of developed weld joints are examined by three zones: heat-affected zone, welded zone, and base metal zone. The optical microscopic results of weld joints illustrate that fine grain structure leads to enhance welding strength. It is revealed that the increased heat input parameter on the weld joint shows a decreased tensile strength and hardness of the weld joint. The corrosion resistance of the weld joint is evaluated by Potentio-dynamic polarization. It facilitates that the corrosion rate of the weld joint is decreased with increasing heat input, which results indicate the best and worst corrosion micrograph of the polygonal ferrite and ferrite plus polygonal ferrite. However, the weld joint prepared with 0.900 kJ/mm heat input found maximum corrosion resistance.

Optimization and prediction of CBN tool life sustainability during AA1100 CNC turning by response surface methodology.

The aluminium alloy (AA1100) was familiar with automotive flexible shaft coupling applications due to its high strength, good machinability, and superior thermal and resistance to corrosion characteristics. Machining tool life drives the prominent role for deciding the product quality (machining) act aims to productivity target with zero interruptions. The novelty of this present investigation is the focus on increasing tool life during the complexity of CNC turning operation for AA1100 alloy by using CBN coated insert tool with varied input parameters of spindle speed (SS), feed rate (f), and depth of cut (DOC). Design of experiment (L16), analysis of variance (ANOVA) statistical system adopted with response surface methodology (RSM) is implemented for experimental analysis. The turning input parameters of SS, f and DOC are considered as factors and its SS (900, 1100, 1300, and 1500 rpm), f (0.1, 0.15, 0.2, and 0.25), and DOC (0.1, 0.2, 0.3, and 0.4 mm) values are treated as levels. The investigational analysis was made with the ANOVA technique and the desirability of high tool life with input turning parameters was optimized by RSM, and sample no 11/16 was predicted as high tool life and performed with extended working hours compared to other samples. The RSM optimized best turning parameter combinations are 0.1 mm DOC, 0.2mm/rev to 0.25mm/rev f, and 1300 rpm-1500 rpm SS, facilitating a higher tool life of more than 20min.

Association of limited English proficiency with emergency department irregular departures and return visits: A cross-sectional cohort study in the Upper Midwest between January 2018 and December 2021.

OBJECTIVES: Patients with limited English proficiency (LEP) have been shown to experience disparities in emergency department (ED) care. The objectives of this study were to examine the associations between LEP and irregular ED departures and return ED visits. METHODS: We conducted a multicenter cross-sectional analysis of 18 EDs within an integrated health system in the upper Midwest from January 1, 2018, to December 31, 2021. ED visits of pediatric and adult patients who were discharged on the index visit were included for analysis. We analyzed the association of LEP with irregular departures, 72-h and 7-day return visits, and ED disposition at the time of that return visit. Multivariable model associations were calculated using generalized estimating equations and reported as odds ratios (OR) with 95% confidence intervals (CIs). RESULTS: A total of 745,464 total ED visits were analyzed, including 27,906 (3.7%) visits among patients with LEP. The most common preferred languages among patients with LEP were Spanish (12,759; 45.7%), Somali (4978; 17.8%), and Arabic (3185; 11.4%). After multivariable adjustment there were no differences in proportions of irregular departures (OR 1.09, 95% CI 0.99-1.21), 72-h returns (OR 0.99, 95% CI 0.92-1.06), or 7-day returns (OR 0.99, 95% CI 0.93-1.05) between patients with LEP or English proficiency. Patients with LEP returning within 72 h (OR 1.19, 95% CI 1.01-1.40) and 7 days (OR 1.15, 95% CI 1.01-1.33) were more likely to be admitted to the hospital. CONCLUSIONS: After multivariable adjustment, we did not find an increased frequency of irregular ED departures or 72-h or 7-day returns among patients with LEP compared with people proficient in English. However, we did find that higher proportions of patients with LEP were admitted to the hospital at the time of the return ED visit.

Incremental innovations in operation theaters.

Background: The field of ophthalmology has been built upon continuous innovations. COVID-19 pandemic has been an important driving force behind many innovations in ophthalmology and other branches of medicine. Innovations in ophthalmology has been a key to surgical progress. The process of promoting innovation in surgery is imperative in the evolving practice of ophthalmology. Purpose: In this video we demonstrate some incremental innovations in operation theaters which help in increasing the efficiency and improving the performance of a surgeon. These innovations also provide a more comfortable environment for the patient undergoing the surgery. Synopsis: A few incremental innovations that are described in our video also help in preventing the spread of COVID infection during surgery. This video also showcases a few wet lab innovations that help train residents in their surgical skills. Highlights: Use and reuse of simple materials make it cost effective and ecofriendly. These incremental innovations help in the smooth running of operation theaters. Thus, they are small improvements in the existing setup and help in creating a smooth and error free OT flow. Video Link: https://youtu.be/thFLvC-XykE.

Water-Induced Separation of Polymers from High Nanoparticle-Content Nanocomposite Films.

Polymer nanocomposites with high loadings of nanoparticles (NPs) exhibit exceptional mechanical and transport properties. Separation of polymers and NPs from such nanocomposites is a critical step in enabling the recycling of these components and reducing the potential environmental hazards that can be caused by the accumulation of nanocomposite wastes in landfills. However, the separation typically requires the use of organic solvents or energy-intensive processes. Using polydimethylsiloxane (PDMS)-infiltrated SiO2 NP films, we demonstrate that the polymers can be separated from the SiO2 NP packings when these nanocomposites are exposed to high humidity and water. The findings indicate that the charge state of the NPs plays a significant role in the propensity of water to undergo capillary condensation within the PDMS-filled interstitial pores. We also show that the size of NPs has a crucial impact on the kinetics and extent of PDMS expulsion, illustrating the importance of capillary forces in inducing PDMS expulsion. We demonstrate that the separated polymer can be collected and reused to produce a new nanocomposite film. The work provides insightful guidelines on how to design and fabricate end-of-life recyclable high-performance nanocomposites.

Effect of fiber layer formation on mechanical and wear properties of natural fiber filled epoxy hybrid composites.

Natural fiber-reinforced polymer matrix composites are gathering significance in future trend applications such as automotive, aerospace, sport, and other engineering applications due to their superior enhanced mechanical, wear, and thermal properties. Compared to synthetic fiber, natural fiber is low adhesive and flexural strength properties. The research aims to synthesize the epoxy hybrid composites by utilizing the silane (pH = 4) treated Kenaf (KF) and sisal fiber (SF) as layering by uni, bi, and multi-unidirectional via hand layup techniques. Thirteen composite samples have been prepared by three-layer formation adopted with different weight ratios of E/KF/SF such as 100E/0KF/0SF, 70E/30KF/0SF, 70E/0KF/30SF, 70E/20KF/10SF, and 70E/10KF/20SF respectively. The effect of layer formation on the tensile, flexural, and impact strength of composites is studied by ASTM D638, D790, and D256 standards. The unidirectional fiber layer formed (sample 5) 70E/10KF/20SF composite is found maximum tensile and flexural strength of 57.9 ± 1.2 MPa and 78.65 ± 1.8 MPa. This composite is subjected to wear studies by pin-on-disc wear apparatus configured with a hardened grey cast-iron plate under an applied load of 10, 20, 30, and 40 N at different sliding velocities of 0.1, 0.3, 0.5, and 0.7 m/s. The wear rate of the sample progressively increases with increasing load and sliding speed of the composite. The minimum wear rate of 0.012 mg/min (sample 4) is found on 7.6 N frictional force at 0.1 m/s sliding speed. Moreover, sample 4 at a high velocity of 0.7 m/s with a low load (10 N) shows a wear rate of 0.034 mg/min. The wear-worn surface is examined and found adhesive and abrasive wear on a high frictional force of 18.54 N at 0.7 m/s. The enhanced mechanical and wear behavior of sample 5 is recommended for automotive seat frame applications.

Mechanical alloying of Mg0.8-XTi0.2 and study the effect of adding (x = 0.2 wt%) transition metal like Sc, Zr, or Nb on their phase transitions, activation energy, and hydrogen storage properties.

Till now Mg-based alloys have attracted much attention due to the high storage capacity of hydrogen. An effort was made to evaluate the apparent activation energy and electrochemical behavior of transition metals such as scandium (Sc), zirconium (Zr), and niobium (Nb) alloyed with Mg-Ti. Mg0.8Ti0.2, Mg0.6Ti0.2Sc0.2, Mg0.6Ti0.2Zr0.2, and Mg0.6Ti0.2Nb0.2 alloy powders were synthesized using high-energy ball milling. Ballmilled powders were subjected to structural and morphological characterization using X-ray diffraction and scanning electron microscopy respectively. A strong shift in the inter-planar spacing value of milled powders confirmed supersaturated solid solution of Ti and transition metals in Mg. The inter-planar spacing values before and after milling are found to be 0.24 and 0.21 nm, respectively. Mg0.8Ti0.2, Mg0.6Ti0.2Sc0.2, and Mg0.6Ti0.2Zr0.2 alloy powders result in the FCC phase while Mg0.6Ti0.2Nb0.2 powders result in BCC phase, however, the entire powders have an amorphous background. SEM-EDS analysis of the milled powders confirmed the presence of Mg, Ti, Sc, Zr, and Nb elements with a small amount of oxygen. Selected area electron diffraction (SAED) pattern of Mg0.8Ti0.2 alloy powders exhibits a nanocrystalline nature owing to their polycrystalline ring pattern. Exothermic peak broadening increases after the substitution of Nb and Zr in Mg0.8Ti0.2 alloy powder, which exhibits a lower activation energy (188 kJ mol-1) than others. In cyclic voltammetry, a drenched cathodic peak is observed for Mg0.8Ti0.2 at a potential around -0.83 V. In electrochemical impedance spectroscopy, the charge transfer resistance of Mg0.6Ti0.2Sc0.2 is lower than that of Mg0.6Ti0.2Zr0.2 and Mg0.6Ti0.2Nb0.2 alloy but higher than Mg0.8Ti0.2 electrode materials, and charge-discharge studies were done on the developed electrode materials. It shows that Mg0.8Ti0.2 electrode material delivers a maximum discharge capacity of 535 mA h g-1.

Personalized risk communication and opioid prescribing in association with nonprescribed opioid use: A secondary analysis of a randomized controlled trial.

BACKGROUND: To determine the impact of personalized risk communication and opioid prescribing on nonprescribed opioid use, we conducted a secondary analysis of randomized controlled trial participants followed prospectively for 90 days after an emergency department (ED) visit for acute back or kidney stone pain. METHODS: A total of 1301 individuals were randomized during an encounter at four academic EDs into a probabilistic risk tool (PRT) arm, a narrative-enhanced PRT arm, or a general risk information arm (control). In this secondary analysis, both risk tool arms were combined and compared with the control arm. We used logistic regressions to determine associations between receiving personalized risk information, receiving an opioid prescription in the ED, and nonprescribed opioid use in general and by race. RESULTS: Complete follow-up data were available for 851 participants; 23.3% (n = 198) were prescribed opioids (34.2% of White vs. 11.6% of Black participants, p < 0.001). Fifty-six (6.6%) participants used nonprescribed opioids. Participants in the personalized risk communication arms had lower nonprescribed opioid use odds (adjusted odds ratio [aOR] 0.58, 95% confidence interval [CI] 0.4-0.83). Black versus White participants had greater nonprescribed opioid use odds (aOR 3.47, 95% CI 2.05-5.87, p < 0.001). Black participants who were prescribed opioids had a lower marginal probability of using nonprescribed opioids versus those who were not (0.06, 95% CI 0.04-0.08, p < 0.001 vs. 0.10, 95% CI 0.08-0.11, p < 0.001). The absolute risk difference in nonprescribed opioid use for Black and White participants, respectively, in the risk communication versus the control arm, was 9.7% and 0.1% (relative risk ratio 0.43 vs. 0.95). CONCLUSIONS: Among Black but not White participants, personalized opioid risk communication and opioid prescribing were associated with lower odds of nonprescribed opioid use. Our findings suggest that racial disparities in opioid prescribing-which have been previously described within the context of this trial-may paradoxically increase nonprescribed opioid use. Personalized risk communication may effectively reduce nonprescribed opioid use, and future research should be designed specifically to explore this possibility in a larger cohort.

Comparison of emergency department throughput and process times between male and female patients: A retrospective cohort investigation by the Reducing Disparities Increasing Equity in Emergency Medicine Study Group.

Introduction: Health equity for all patients is an important characteristic of an effective healthcare system. Bias has the potential to create inequities. In this study, we examine emergency department (ED) throughput and care measures for sex-based differences, including metrics such as door-to-room (DTR) and door-to-healthcare practitioner (DTP) times to look for potential signs of systemic bias. Methods: We conducted an observational cohort study of all adult patients presenting to the ED between July 2015 and June 2017. We collected ED operational, throughput, clinical, and demographic data. Differences in the findings for male and female patients were assessed using Poisson regression and generalized estimating equations (GEEs). A priori, a clinically significant time difference was defined as 10 min. Results: A total of 106,011 adult visits to the ED were investigated. Female patients had 8-min longer median length-of-stay (LOS) than males (P < 0.01). Females had longer DTR (2-min median difference, P < 0.01), and longer DTP (5-min median difference, P < 0.01). Females had longer median door-to-over-the-counter analgesia time (84 vs. 80, P = 0.58), door-to-advanced analgesia (95 vs. 84, P < 0.01), door-to-PO (by mouth) ondansetron (70 vs. 62, P = 0.02), and door-to-intramuscular/intravenous antiemetic (76 vs. 69, P = 0.02) times compared with males. Conclusion: Numerous statistically significant differences were identified in throughput and care measures-mostly these differences favored male patients. Few of these comparisons met our criteria for clinical significance.

Prevalence and Categorization of Drug-Related Problems in the Emergency Department.

BACKGROUND: Drug-related problems (DRPs) are common among patients seen in the emergency department (ED), but the true incidence is not clear. OBJECTIVES: The primary objective of this study was to determine the prevalence of DRPs among patients seen in a U.S. ED. The secondary objective was to categorize these DRPs by problem type and by medication class. METHODS: This was a prospective observational cohort study of a random sample of ED patients between December 2011 and March 2013. ED pharmacists screened randomly selected patients for the presence of a DRP contributing to the ED visit. Four independent auditors evaluated the results to achieve consensus for the presence or absence of DRPs and categorization of the DRPs. RESULTS: Among 1039 patients screened for DRPs, 308 (29.6%) were found to have at least 1 DRP contributing to the ED visit. Among a total of 443 DRPs, the most commonly identified categories were adverse drug reaction (n = 193 [43.6%]), ineffective medication (n = 69 [15.6%]), and subtherapeutic dosage (n = 68 [15.3%]). The most commonly implicated drug classes were cardiovascular medications (n = 113 [26.5%]), anti-infective medications (n = 52 [12.2%]), and analgesic medications (n = 58 [13.6%]). CONCLUSIONS: A substantial proportion of ED visits are associated in part or in total with DRPs. Adverse drug reactions and cardiovascular medications are the most common category and medication class implicated, respectively.

Heart disease diagnosis using optimized features of hybridized ALCSOGA algorithm and LSTM classifier.

Cardiac disease is the predominant cause of global death mainly due to its hidden symptoms and late diagnosis. Hence, early detection is important to improve quality of life. Though traditional researches attempted to predict heart disease, most of them lacked with respect to accuracy. To solve this, the present study proposes a hybridized Ant Lion Crow Search Optimization Genetic Algorithm (ALCSOGA) to perform effective feature selection. This hybrid optimization encompasses Ant Lion, Crow Search and Genetic Algorithm. Ant lion algorithm determines the elite position. While, the Crow Search Algorithm utilizes the phenomenon of position and memory of each crow for evaluating the objective function. Both these algorithms are fed into Genetic Algorithm to improve the performance of feature selection process. Then, Stochastic Learning rate optimized Long Short Term Memory (LSTM) is proposed to classify the extracted optimized features. Finally, comparative analysis is performed in terms of accuracy, recall, F1-score, and precision. Moreover, statistical analysis is performed with respect to Sum of Squares (SS), degree of freedom (df), F Critical (F crit), F Statistics (F), p, and Mean Square (MS) value. Analytical results revealed the efficiency of proposed system over conventional methods and thereby confirming its efficiency for predicting heart disease.

Two-Dimensional Weak Antilocalization Signatures Due to Quantum Coherent Transport in Nanocrystalline SnTe.

Nanostructured topological crystalline insulators (TCIs) in the presence of exotic surface states with spin momentum locking reported in individual nanostructures are predicted to hold a great promise for spintronics and quantum computing applications. However, practical application demands a strategy with large-scale production and integration for device applications. In this work, we demonstrate through prominent signatures of weak antilocalization (WAL), arising predominantly from destructive quantum interference on robust surface states, that a correlated TCI phase is possible in the nanobulk assembly of carefully nanostructured quasi-two-dimensional SnTe (edge-to-edge length ∼ 382 nm) synthesized by a simple, rapid, and scalable microwave-assisted solvothermal method. Hikami-Larkin-Nagaoka analysis (T-0.71), as well as the temperature dependence of resistivity, illustrates an interplay of both conductions from 2D channels and 3D EEI effects as the precursor for the observed WAL at low temperatures (2-6 K). Interestingly, the enhanced thermoelectric power of the sample of ∼45 µV/K, with a p-type carrier concentration of ∼1018/cm3 at 300 K, makes this SnTe nanocrystalline assembly more attractive as a multifunctional material for large-scale technological applications.

A Multicentered Randomized Controlled Trial Comparing the Effectiveness of Pain Treatment Communication Tools in Emergency Department Patients With Back or Kidney Stone Pain.

Objectives. To compare the effectiveness of 3 approaches for communicating opioid risk during an emergency department visit for a common painful condition. Methods. This parallel, multicenter randomized controlled trial was conducted at 6 geographically disparate emergency department sites in the United States. Participants included adult patients between 18 and 70 years of age presenting with kidney stone or musculoskeletal back pain. Participants were randomly assigned to 1 of 3 risk communication strategies: (1) a personalized probabilistic risk visual aid, (2) a visual aid and a video narrative, or 3) general risk information. The primary outcomes were accuracy of risk recall, reported opioid use, and treatment preference at time of discharge. Results. A total of 1301 participants were enrolled between June 2017 and August 2019. There was no difference in risk recall at 14 days between the narrative and probabilistic groups (43.7% vs 38.8%; absolute risk reduction = 4.9%; 95% confidence interval [CI] = -2.98, 12.75). The narrative group had lower rates of preference for opioids at discharge than the general risk information group (25.9% vs 33.0%; difference = 7.1%; 95% CI = 0.64, 0.97). There were no differences in reported opioid use at 14 days between the narrative, probabilistic, and general risk groups (10.5%, 10.3%, and 13.3%, respectively; P = .44). Conclusions. An emergency medicine communication tool incorporating probabilistic risk and patient narratives was more effective than general information in mitigating preferences for opioids in the treatment of pain but was not more effective with respect to opioid use or risk recall. Trial Registration. Clinical Trials.gov identifier: NCT03134092. (Am J Public Health. 2022;112(S1):S45-S55. https://doi.org/10.2105/AJPH.2021.306511).

Service design in the healthcare space with a special focus on non-clinical service departments: A synthesis and future directions.

Although there has been a tremendous change in the way diseases are diagnosed and treated, the ways in which health care delivery has been managed has seen very little change.Several academic studies have arisen in the area of service design, but an amalgamation of this research, especially in the area of healthcare services is not available. The aim of this systematic review is to evaluate the published research on service design in healthcare and accordingly identify the gaps and scope of future research. After analyzing the articles and reviewing the Service design in healthcare literature, the following are our main contributions: (i) clarification of the service design concept and the developments that appears in the literature review of service design in the healthcare sector; (ii) classification of the service design tools and techniques that are most commonly used in the healthcare sector; (iii) demonstration of the service design as the preponderant construct that is used as a tool and technique to improve quality and efficiency in the healthcare service.The resultant systematic review reveals a change in the type of research carried out, the service design tools used and a shift towards service design from using the co-design tool to other methods. The paper highlights the gaps in the very limited amount of empirical work in the non-clinical healthcare space and accordingly a model is recommended.

Three Cases of Emergency Department Medical Malpractice Involving "Consultations": How Is Liability Legally Determined?

This article presents three successfully litigated medical malpractice cases involving emergency physicians and consultants. We discuss the respective case medical diagnoses, as well as established legal principles that determine in a court proceeding which provider will be liable. Specifically, we explain the legal principles of "patient physician relationship" and "affirmative act."