Modelling Patient Duration of Stay to Facilitate Resource Management of Geriatric Hospitals

A fundamental aspect of health care management is the effective allocation of resources. This is of particular importance in geriatric hospitals where elderly patients tend to have more complex needs. Hospital managers would benefit immensely if they had advance knowledge of patient duration of stay in hospital. Managers could assess the costs of patient care and make allowances for these in their budget. In this paper, we tackle this important problem via a model which predicts the duration of stay distribution of patients in hospital. The approach uses phase-type distributions conditioned on a Bayesian belief network.

Assessing length of stay and associated characteristics of geriatric patients in Northern Ireland

The effective provision of care for the elderly is becoming increasingly more difficult. This is due to the rising proportion of elderly in the population, increasing demands placed on the health services and the financial strain placed on an already stretched economy. The research presented in this paper uses three different models to represent the length of stay distribution of geriatric patients admitted to one of the six key acute hospitals in Northern Ireland and various patient characteristics associated with their respective length of stay. The accurate modelling of bed usage within wards would enable hospital managers to prepare patient discharge packages and rehabilitation services in advance. The models presented within the paper include a Cox proportional hazards model, a Bayesian network with a discrete variable to represent length of stay and a special conditional phase-type model (C-Ph) with a connecting outcome node. This research demonstrates the new efficient fitting algorithm employed for Coxian phase-type distributions while updating C-Ph models for recent elderly patient data.

Addressing Bed Costs for the Elderly: A New Methodology for Modelling Patient Outcomes and Length of Stay

The proportion of elderly in the population has dramatically increased and will continue to do so for at least the next 50 years. Medical resources throughout the world are feeling the added strain of the increasing proportion of elderly in the population. The effective care of elderly patients in hospitals may be enhanced by accurately modelling the length of stay of the patients in hospital and the associated costs involved. This paper examines previously developed models for patient length of stay in hospital and describes the recently developed conditional phase-type distribution (C-Ph) to model patient duration of stay in relation to explanatory patient variables. The Clinics data set was used to demonstrate the C-Ph methodology. The resulting model highlighted a strong relationship between Barthel grade, patient outcome and length of stay showing various groups of patient behaviour. The patients who stay in hospital for a very long time are usually those that consume the largest amount of hospital resources. These have been identified as the patients whose resulting outcome is transfer. Overall, the majority of transfer patients spend a considerably longer period of time in hospital compared to patients who die or are discharged home. The C-Ph model has the potential for considering costs where different costs are attached to the various phases or subgroups of patients and the anticipated cost of care estimated in advance. It is hoped that such a method will lead to the successful identification of the most cost effective case-mix management of the hospital ward.

Rheological, mechanical and membrane penetration properties of novel dual drug systems for percutaneous delivery

In this study it has been demonstrated that mixtures of two solid drugs, ibuprofen and methyl nicotinate, with different but complementary pharmacological activities and which exist as a single liquid phase over a wide composition range at skin temperature, can be formulated as o/w emulsions without the use of an additional hydrophobic carrier. These novel dual drug systems provided significantly enhanced in vitro penetration rates through a model lipophilic barrier membrane compared to conventional individual formulations of each active. Thus, for ibuprofen, drug penetration flux enhancements of three- and 10-fold were observed when compared to an aqueous ibuprofen suspension and a commercial alcohol-based ibuprofen formulation, respectively. Methyl nicotinate penetration rates were shown to be similar for aqueous gels and emulsified systems. Mechanisms explaining these observations are proposed. Novel dual drug formulations of ibuprofen and methyl nicotinate, formulated within the liquid range at skin temperature, were investigated by oscillatory rheology and texture profile analysis. demonstrating the effects of drug and viscosity enhancer concentrations, and disperse phase type upon the rheological, mechanical and drug penetration properties of these systems. (C) 2000 Elsevier Science B.V. All rights reserved.

Using the hidden Markov model to capture quality of care in Lombardy geriatric wards

Quality of care is an important aspect of healthcare monitoring, which is used to ensure that the healthcare system is delivering care of the highest standard. With populations growing older there is an increased urgency in making sure that the healthcare delivered is of the highest standard. Healthcare providers are under increased pressure to ensure that this is the case with public and government demand expecting a healthcare system of the highest quality. Modelling quality of care is difficult to measure due to the many ways of defining it. This paper introduces a potential model which could be used to take quality of care into account when modelling length of stay. The Coxian phase-type distribution is used to model length of stay and the associated quality of care incorporated into the Coxian using a Hidden Markov model. Covariates are also introduced to determine their impact on the hidden level to find out what potentially can affect quality of care. This model is applied to geriatic patient data from the Lombardy region of Italy. The results obtained highlighted that bed numbers and the type of hospital (public or private) can have an effect on the quality of care delivered.

Electron acoustic soliton energy of the Kadomtsev-Petviashvili equation in the Earth’s magnetotail region at critical ion density

The nonlinear properties of small amplitude electron-acoustic solitary waves (EAWs) in a homogeneous system of unmagnetized collisionless plasma consisted of a cold electron fluid and isothermal ions with two different temperatures obeying Boltzmann type distributions have been investigated. A reductive perturbation method was employed to obtain the Kadomstev-Petviashvili (KP) equation. At the critical ion density, the KP equation is not appropriate for describing the system. Hence, a new set of stretched coordinates
is considered to derive the modified KP equation. Moreover, the solitary solution, soliton energy and the associated electric field at the critical ion density were computed. The present investigation can be of relevance to the electrostatic solitary structures observed in various space plasma environments, such as Earth’s magnetotail region.

A search for circumstellar material around B-type stars in the Galactic halo

19 B-type stars, selected from the Palomar-Green Survey, have been observed at infrared wavelengths to search for possible infrared excesses, as part of an ongoing programme to investigate the nature of early-type stars at high Galactic latitudes. The resulting infrared fluxes, along with Stromgren photometry, are compared with theoretical flux profiles to determine whether any of the targets show evidence of circumstellar material, which may be indicative of post-main- sequence evolution. Eighteen of the targets have flux distributions in good agreement with theoretical predictions. However, one star, PG 2120 + 062, shows a small near-infrared excess, which may be due either to a cool companion of spectral type F5-F7, or to circumstellar material, indicating that it may be an evolved object such as a post-asymptotic giant branch star, in the transition region between the asymptotic giant branch and planetary nebula phase, with the infrared excess due to recent mass loss during giant branch evolution.

Human Papillomavirus Type 16 E6 and E7 Cause Polyploidy in Human Keratinocytes and Up-Regulation of G2-M-phase Proteins

Human papillomavirus type 16 proteins E6 and E7 have been shown to cause centrosome amplification and lagging chromosomes during mitosis. These abnormalities during mitosis can result in missegregation of the chromosomes, leading to chromosomal instability. Genomic instability is thought to be an essential part of the conversion of a normal cell to a cancer cell. We now show that E6 and E7 together cause polyploidy in primary human keratinocytes soon after these genes are introduced into the cells. Polyploidy seems to result from a spindle checkpoint failure arising from abrogation of the normal functions of p53 and retinoblastoma family members by E6 and E7, respectively. In addition, E6 and E7 cause deregulation of cellular genes such as Plk1, Aurora-A, cdk1, and Nek2, which are known to control the G2-M-phase transition and the ordered progression through mitosis.

The VLT-FLAMES survey of massive stars: atmospheric parameters and rotational velocity distributions for B-type stars in the Magellanic Clouds

Aims.We aim to provide the atmospheric parameters and rotational velocities for a large sample of O- and early B-type stars, analysed in a homogeneous and consistent manner, for use in constraining theoretical models. Methods: Atmospheric parameters, stellar masses, and rotational velocities have been estimated for approximately 250 early B-type stars in the Large (LMC) and Small (SMC) Magellanic Clouds from high-resolution VLT-FLAMES data using the non-LTE TLUSTY model atmosphere code. This data set has been supplemented with our previous analyses of some 50 O-type stars (Mokiem et al. 2006, 2007) and 100 narrow-lined early B-type stars (Hunter et al. 2006; Trundle et al. 2007) from the same survey, providing a sample of ~400 early-type objects. Results: Comparison of the rotational velocities with evolutionary tracks suggests that the end of core hydrogen burning occurs later than currently predicted and we argue for an extension of the evolutionary tracks. We also show that the large number of the luminous blue supergiants observed in the fields are unlikely to have directly evolved from main-sequence massive O-type stars as neither their low rotational velocities nor their position on the H-R diagram are predicted. We suggest that blue loops or mass-transfer binary systems may populate the blue supergiant regime. By comparing the rotational velocity distributions of the Magellanic Cloud stars to a similar Galactic sample, we find that (at 3s confidence level) massive stars (above 8 M?) in the SMC rotate faster than those in the solar neighbourhood. However there appears to be no significant difference between the rotational velocity distributions in the Galaxy and the LMC. We find that the v sin i distributions in the SMC and LMC can modelled with an intrinsic rotational velocity distribution that is a Gaussian peaking at 175 km s-1 (SMC) and 100 km s-1 (LMC) with a 1/e half width of 150 km s-1. We find that in NGC 346 in the SMC, the 10-25 M? main-sequence stars appear to rotate faster than their higher mass counterparts. It is not expected that O-type stars spin down significantly through angular momentum loss via stellar winds at SMC metallicity, hence this could be a reflection of mass dependent birth spin rates. Recently Yoon et al. (2006) have determined rates of GRBs by modelling rapidly rotating massive star progenitors. Our measured rotational velocity distribution for the 10-25 M? stars is peaked at slightly higher velocities than they assume, supporting the idea that GRBs could come from rapid rotators with initial masses as low as 14 M? at low metallicities.

The VLT-FLAMES survey of massive stars: atmospheric parameters and rotational velocity distributions for B-type stars in the Magellanic Clouds (vol 457, pg 265, 2006)

We correct the estimates of the dispersions in the rotational velocities for early-type stars in our Galaxy (Dufton et al. 2006, A&A, 457, 265) and the Magellanic Clouds (Hunter et al. 2008, A&A, 479, 541). The corrected values are pi(1/4) (i.e. approximately 33%) larger than those published in the original papers.

Coexistence of Weak Ferromagnetism and Ferroelectricity in the High Pressure LiNbO_{3}-Type Phase of FeTiO_{3}

We report the magnetic and electrical characteristics of polycrystalline FeTiO3 synthesized at high pressure that is isostructural with acentric LiNbO3 (LBO). Piezoresponse force microscopy, optical second harmonic generation, and magnetometry demonstrate ferroelectricity at and below room temperature and weak ferromagnetism below ~120??K. These results validate symmetry-based criteria and first-principles calculations of the coexistence of ferroelectricity and weak ferromagnetism in a series of transition metal titanates crystallizing in the LBO structure.