Length of Stay-Based Patient Flow Models: Recent Developments and Future Directions

Modelling patient flow in health care systems is vital in understanding the system activity and may therefore prove to be useful in improving their functionality. An extensively used measure is the average length of stay which, although easy to calculate and quantify, is not considered appropriate when the distribution is very long-tailed. In fact, simple deterministic models are generally considered inadequate because of the necessity for models to reflect the complex, variable, dynamic and multidimensional nature of the systems. This paper focuses on modelling length of stay and flow of patients. An overview of such modelling techniques is provided, with particular attention to their impact and suitability in managing a hospital service.

Spatially Resolved Measurements of Laser Filamentation in Long Scale Length Underdense Plasmas with and without Beam Smoothing

The onset of filamentation, following the interaction of a relatively long (tau(L) similar or equal to 1 ns) and intense (I-L similar or equal to 5 x 10(14) W/cm(2)) laser pulse with a neopentane filled gas bag target, has been experimentally studied via the proton radiography technique, in conditions of direct relevance to the indirect drive inertial confinement fusion scheme. The density gradients associated with filamentation onset have been spatially resolved yielding direct and unambiguous evidence of filament formation and quantitative information about the filamentation mechanism in agreement with previous theoretical modelings. Experimental data confirm that, once spatially smoothed laser beams are used, filamentation is not a relevant phenomenon during the heating laser beams propagation through typical hohlraum gas fills.

Does pre-operative estimation of oesophageal tumour metabolic length using F-18-fluorodeoxyglucose PET/CT images compare with surgical pathology length?

PURPOSE:
The aim of the study was to compare the pre-operative metabolic tumour length on FDG PET/CT with the resected pathological specimen in patients with oesophageal cancer.

METHODS:
All patients diagnosed with oesophageal carcinoma who had undergone staging PET/CT imaging between the period of June 2002 and May 2008 who were then suitable for curative surgery, either with or without neo-adjuvant chemotherapy, were included in this study. Metabolic tumour length was assessed using both visual analysis and a maximum standardised uptake value (SUV(max)) cutoff of 2.5.

RESULTS:
Thirty-nine patients proceeded directly to curative surgical resection, whereas 48 patients received neo-adjuvant chemotherapy, followed by curative surgery. The 95% limits of agreement in the surgical arm were more accurate when the metabolic tumour length was visually assessed with a mean difference of -0.05 cm (SD 2.16 cm) compared to a mean difference of +2.42 cm (SD 3.46 cm) when assessed with an SUV(max) cutoff of 2.5. In the neo-adjuvant group, the 95% limits of agreement were once again more accurate when assessed visually with a mean difference of -0.6 cm (SD 1.84 cm) compared to a mean difference of +1.58 cm (SD 3.1 cm) when assessed with an SUV(max) cutoff of 2.5.

CONCLUSION:
This study confirms the high accuracy of PET/CT in measuring gross target volume (GTV) length. A visual method for GTV length measurement was demonstrated to be superior and more accurate than when using an SUV(max) cutoff of 2.5. This has the potential of reducing the planning target volume with dose escalation to the tumour with a corresponding reduction in normal tissue complication probability.

Performance analysis of a metro WDM ring networks with variable-length packets under symmetric and asymmetric traffic

In this paper, we discuss and evaluate two proposed metro wavelength division multiplexing (WDM) ring network architectures for variable-length packet traffic in storage area networks (SANs) settings. The paper begins with a brief review of the relevant architectures and protocols in the literature. Subsequently, the network architectures along with their medium access control (MAC) protocols are described. Performance of the two network architectures is studied by means of computer simulation in terms of their queuing delay, node throughput and proportion of packets dropped. The network performance is evaluated under symmetric and asymmetric traffic scenarios with Poisson and self-similar traffic. (C) 2011 Elsevier Inc. All rights reserved.

The association between macular pigment optical density and CFH, ARMS2, C2/BF, and C3 genotype.

Age-related macular degeneration (AMD) is the most common cause of blindness in older people in developed countries, and risk for this condition may be classified as genetic or environmental, with an interaction between such factors predisposing to this disease. This study investigated the relationship between AMD risk genes, macular pigment optical density (MPOD), which may protect against AMD, and serum concentrations of the macular carotenoids, lutein (L) and zeaxanthin (Z). This was a cross-sectional study of 302 healthy adult subjects. Dietary intake of L and Z was assessed by food frequency questionnaire, and MPOD was measured by customized heterochromatic flicker photometry. We also calculated MPOD Area as the area of MP under the spatial profile curve, to reflect MP across the macula. Serum L and Z were measured by HPLC. Genotyping of tag SNPs in the genes CFH, ARMS2, C3, C2 and BF was undertaken with multiplex polymerase chain reaction (PCR) and primer extension methodology (ABI Snapshot, ABI Warrington UK) on DNA extracted from peripheral blood. The mean ± SD (range) age of the subjects in this study was 48 ± 11 (21-66) years. There was a statistically significant association between CFH genotype and family history of AMD, with subjects having two non-risk CFH haplotypes (n =35), or one non-risk and one protective CFH haplotype (n = 33), being significantly more likely to have a negative family history of AMD (Pearson Chi square: p = 0.001). There was no significant association between the AMD risk genes investigated and either MPOD (One way ANOVA: p > 0.05) or serum concentrations of L or Z (One way ANOVA: p > 0.05, for both). Subjects who were homozygous for risk alleles of both CFH and ARMS2 (n = 4) had significantly lower MPOD at 0.5_ and 1_ retinal eccentricity (Independent samples t test: p

Determination of the Tolman length in the improved Derjaguin-Broekhoff-de Boer theory for capillary condensation of ethanol in mesoporous thin films by ellipsometric porosimetry

Ethanol adsorption-desorption isotherms on well-organized mesoporous silica and titania films with hexagonal pores structure were studied by ellipsometric porosimetry. The mesopore volume Was calculated from the change of the effective refractive index at the end points of the isotherm. An improved Derjaguin-Broekhoff-de Boer (IDBdB) model for cylindrical pores is proposed for the determination of the pore size. In this model, the disjoining pressure isotherms were obtained by measuring the thickness of the ethanol film on a non-porous film with the same chemical composition. This approach eliminates uncertainties related to the application of the statistical film thickness determined via t-plots in previous versions of the DBdB model. The deviation in the surface tension of ethanol in the mesopores from that of a flat interface was described by the Tolman parameter in the Gibbs-Tolman-Koening-Buff equation. A positive value of the Tolman parameter of 0.2 nm was found from the fitting of the desorption branch of the isotherms to the experimental data obtained by Low Angle X-ray Diffraction (LA-XRD) and Transmission Electron Microscopy (TEM) measurements in the range of pore diameters between 2.1 and 8.3 nm. (C) 2009 Elsevier Inc. All rights reserved.