Influence of prolonged hospitalization on overall bed occupancy: a five-year single-centre study

Background: Effective bed use is crucial to an efficient NHS. Current targets suggest a decrease in mean occupancy as the most appropriate method of improving overall efficiency. The elderly and those suffering from complex medical problems are thought to account for a high proportion of overall bed occupancy.

Aim: To assess the effect of prolonged hospital stay (>100 days) on overall bed occupancy in a modern teaching hospital.

Design: Retrospective analysis.

Methods: Analysis of all admission episodes (n = 117 178) over a five-year period in a large teaching hospital in a single UK region, serving a population of approximately 200 000. A logistic regression multi-factorial model was used to assess the effect of demographic and diagnostic variables on duration of stay.

Results: A prolonged stay (>100 days) was seen in 648 admission episodes (0.6%). These accounted for 11% of the overall bed occupancy over the 5-year period. Excluding all prolonged admission episodes from our analysis made no difference to the overall median length of stay.

Discussion: Prolonged hospitalizations have a significant impact on bed occupancy. Targeting these very long (>100 days) hospital stays may better improve overall efficiency, compared to targeting mean or median length of stay.

Post-Occupancy Evaluation: Purpose, Benefits and Barriers

This paper explores the historical development of POE in order to provide a contextual backdrop to current discussions. This review provides a much needed discussion on the benefits and barriers facing POE which should enable designers, facility managers and building users to appreciate the value and purpose of this important building evaluation process. The paper will encourage architects and building owners to conduct POEs to benefit all stakeholders and future designs. This is an international peer reviewed journal.

The Impact of Admissions for the Management of End-stage renal disease on hospital bed occupancy

BACKGROUND:

End-stage renal disease (ESRD) is increasingly prevalent but the inpatient costs associated with this condition are poorly defined due to limitations with data extraction and failure to differentiate between hospitalisation for renal and non-renal disease reasons. The impact of admissions primarily for the management of ESRD on hospital bed utilisation was assessed over a 5-year period in a large teaching hospital.

METHODS:

All admission episodes were reviewed and the ESRD group was identified by a primary International Classification of Diseases code for ESRD or a non-specific primary renal failure code with a secondary code for ESRD. The frequency and duration of hospitalisation and contribution to bed day occupancy of this group with ESRD was determined.

RESULTS:

There were 70,808 patients responsible for a total of 116,915 admissions and 919,212 bed days over the study period. Of these, 988 (1.4%) patients were admitted for the management of ESRD, accounting for 2,387 (2.0%) of admissions and utilisation of 23,011 (2.5%) bed days. After adjustment for age and gender, those admitted for ESRD management were significantly more likely to have a prolonged admission exceeding 30 days (odds ratio 1.46, 95% confidence interval 1.23-1.72, p < 0.001). When the admission was an emergency rather than an elective event, the patient was 4.6 times more likely to be hospitalised for over 30 days.

CONCLUSIONS:

Persons admitted for ESRD management are hospitalised more frequently and for longer than the overall inpatient population, occupying a substantial number of bed days.

An HMM-based spectrum occupancy predictor for energy efficient cognitive radio

Spectrum sensing is the cornerstone of cognitive radio technology and refers to the process of obtaining awareness of the radio spectrum usage in order to detect the presence of other users. Spectrum sensing algorithms consume considerable energy and time. Prediction methods for inferring the channel occupancy of future time instants have been proposed as a means of improving performance in terms of energy and time consumption. This paper studies the performance of a hidden Markov model (HMM) spectrum occupancy predictor as well as the improvement in sensing energy and time consumption based on real occupancy data obtained in the 2.4GHz ISM band. Experimental results show that the HMM-based occupancy predictor outperforms a kth order Markov and a 1-nearest neighbour (1NN) predictor. Our study also suggests that by employing such a predictive scheme in spectrum sensing, an improvement of up to 66% can be achieved in the required sensing energy and time.

General trends in the barriers of catalytic reactions on transition metal surfaces

A catalyst preparation by design is one of the ultimate goals in chemistry. The first step towards this goal is to understand the origin of reaction barriers. In this study, we have investigated several catalytic reactions on some transition metal surfaces, using density functional theory. All the reaction barriers have been determined. By detailed analyses we obtain some insight into the reaction barrier. Each barrier is related to (i) the potential energy surface of reactants on the surface, (ii) the total chemisorption energy of reactants, and (iii) the metal d orbital occupancy and the reactant valency. (C) 2001 American Institute of Physics.

“Building performance evaluation: The case of McClay Library”

The government of the UK has set an ambitious target that all newly built homes be carbon neutral by 2016 and to achieving an overall 80% carbon emission by 2050. Carbon Trust in 2009 published a research revealing that non-domestic buildings accounted for 18% of the emissions in the UK. They argued that to achieve the targets of low carbon emission there is need for better building stock that are better used. The evaluation of the performance of buildings is therefore critical if the understanding of how they are used is to be known. This paper is a brief building performance evaluation of the newly build library at Queens University Belfast carried out during the summer of 2010. It employed the Post-Occupancy Evaluation (POE) methodology to assess its performance. The results reveal that despite the intelligent technologies in the building there was a mismatch between the measured data and the perception of users of its performance. The study suggests the need for further study for reasons of dichotomy of the data. Keywords: building performance evaluation, carbon reduction strategies, passive environmental design techniques, active renewable energy technologies, Northern Ireland

Patterns of hospitalisation before and following initiation of haemodialysis: a 5 year single centre study

Background: The utilisation of healthcare resources by prevalent haemodialysis patients has been robustly evaluated with regard to the provision of outpatient haemodialysis; however, the impact of hospitalisation among such patients is poorly defined. Minimal information is available in the UK to estimate the health and economic burden associated with the inpatient management of prevalent haemodialysis patients. The aim of this study was to assess the pattern of hospitalisation among a cohort of haemodialysis patients, before and following their initiation of haemodialysis. In addition the study sought to assess the impact of their admissions on bed occupancy in a large tertiary referral hospital in a single region in the UK.

Methods: All admission episodes were reviewed and those receiving dialysis with the Belfast City Hospital Programme were identified over a 5 year period from January 2001 to December 2005. This tertiary referral centre provides dialysis services for a population of approximately 700?000 and additional specialist renal services for the remainder of Northern Ireland. The frequency and duration of hospitalisation, and contribution to bed day occupancy of haemodialysis patients, was determined and compared to other common conditions which are known to be associated with high bed occupancy. In addition, the pattern and timing of admissions in dialysis patients in relation to their dialysis initiation date was assessed.

Results: Over the 5 year study period, 798 haemodialysis patients were admitted a total of 2882 times. These accounted for 2.5% of all admissions episodes; the median number of admissions for these patients was 3 (2–5) which compared with 1 (1–2) for non-dialysis patients. The majority of first hospitalisations (54%) were within 100 days before or after commencement of maintenance dialysis therapy. In all clinical specialties the median length of stay for haemodialysis patients was significantly longer than for patients not on haemodialysis (p=0.004). In multivariate analysis with adjustment for age, gender, and other clinically relevant diagnostic codes, maintenance haemodialysis patients stayed on average 3.75 times longer than other patient groups (ratio of geometric means 3.75, IQR 3.46–4.06).

Conclusions: Maintenance haemodialysis therapy is an important risk factor for prolonged hospitalisation regardless of the primary reason for admission. Such patients require admission more frequently than the general hospital population, particularly within 100 days before and after initiation of their first dialysis treatment.

RFID based Efficient Lighting Control

The Kyoto Protocol and the European Energy Performance of Buildings Directive put an onus on governments
and organisations to lower carbon footprint in order to contribute towards reducing global warming. A key
parameter to be considered in buildings towards energy and cost savings is its indoor lighting that has a major
impact on overall energy usage and Carbon Dioxide emissions. Lighting control in buildings using Passive
Infrared sensors is a reliable and well established approach; however, the use of only Passive Infrared does not
offer much savings towards reducing carbon, energy, and cost. Accurate occupancy monitoring information can
greatly affect a building’s lighting control strategy towards a greener usage. This paper presents an approach for
data fusion of Passive Infrared sensors and passive Radio Frequency Identification (RFID) based occupancy
monitoring. The idea is to have efficient, need-based, and reliable control of lighting towards a green indoor
environment, all while considering visual comfort of occupants. The proposed approach provides an estimated
13% electrical energy savings in one open-plan office of a University building in one working day. Practical
implementation of RFID gateways provide real-world occupancy profiling data to be fused with Passive
Infrared sensing towards analysis and improvement of building lighting usage and control.

Doonloughan: a seasonal settlement site on the Connemara coast

A series of shell middens and miscellaneous habitation sites, located in a dune
system in west County Galway, have been exposed and are slowly disappearing
through wind, wave and surface erosion. In 1992 a project was initiated to
record, sample and date some of these sites and the radiocarbon results
demonstrated that activity in the area spanned the Early Bronze Age through to
the Iron Age and into the early and post medieval periods. This preliminary
fieldwork was succeeded by the excavation of three of the better-preserved sites; a Bronze Age midden in 1994 and two early medieval sites (the subject of this paper), in 1997. The medieval sites dated to the late-seventh to ninth century adand were represented by a sub-circular stone hut with a hearth and the charred remains of a more ephemeral wooden tent-like structure. The discovery of a bronze penannular brooch of ninth/tenth century date at the latter site wouldsuggest that the settlements are not the remains of transient, impoverishedpeoples of the lower classes of society, eking out a living along the coast. The calcareous sands ensured good preservation of organic remains*fish and mammal bones, charred cereal grains, seeds and seaweed, and marine molluscs. Analyses of these indicated exploitation of marine resources but, otherwise, were comparable with the diet and economy represented by assemblages from established contemporary site types of the period. Unlike raths, cranno´gs and monastic settlements, however, the volume of material represented at the Galway sites was slight, despite the excellent preservation conditions. A range of seasonal indicators also suggested temporary habitation: probable latespring/summer occupation of the stone hut site and autumnal occupancy of the second, less substantial site. It is suggested that the machair plain, beside which the dunes are located, was most probably the attraction for settlers to the area and was exploited as an alternative pasture for the seasonal grazing of livestock.
*

Employer occupation of regulatory space of the Employee Information and Consultation (I&C) Directive in liberal market economies

This article shows how both employers and the state have influenced macro-level processes and structures concerning the content and transposition of the European Union (EU) Employee Information and Consultation (I&C) Directive. It argues that the processes of regulation occupied by employers reinforce a voluntarism which marginalizes rather than shares decision-making power with workers. The contribution advances the conceptual lens of ‘regulatory space’ by building on Lukes’ multiple faces of power to better understand how employment regulation is determined across transnational, national and enterprise levels. The research proposes an integrated analytical framework on which ‘occupancy’ of regulatory space can be evaluated in comparative national contexts.

Magnetic short-range order in the new ternary phase Mn8Pd15Si7

A new compound, Mn8Pd15Si7, is reported to crystallize in a face centered cubic unit cell of dimension a = 12.0141(2) angstrom, space groupFm (3) over barm, and can thus be classified as a G-phase. The crystal structure was studied by single crystal X-ray diffraction, X-ray and neutron powder diffraction and electron diffraction. A filled Mg6Cu16Si7 type structure was found, corresponding to the Sc11Ir4 type structure. The magnetic properties were investigated by magnetization measurements and Reverse Monte Carlo modeling of low temperature magnetic short-range order (SRO). Dominating near neighbor antiferromagnetic correlations were found between the Mn atoms and geometric frustration in combination with random magnetic interactions via metal sites with partial Mn occupancy were suggested to hinder formation of long-range magnetic order.