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.

Use of a rotating disc reactor to investigate the heterogeneously catalysed oxidation of cinnamyl alcohol in toluene and ionic liquids

To evaluate the effect of mass transfer limitations in the three-phase oxidation of cinnamyl alcohol carried out in toluene and an ionic liquid (1-butyl-3-methyl-imidazolium bis(trifluoromethylsulphonyl)imide), studies have been performed in a rotating disc reactor and compared with those carried out in a stirred tank reactor where mass transfer effects are considered negligible. High catalyst efficiencies are found in the stirred tank reactor with the use of both ionic liquid and toluene, although there is a decrease in rate for the ionic liquid reactions. In contrast, internal pore diffusion limits the reaction in both solvents in the rotating disc reactor. This mass transfer resistance reduces the problem of overoxidation of the metal surface when the reaction is carried out in toluene, leading to significantly higher rates of reaction than expected, although at the cost of decreased selectivity.

Thin-zone TAP reactor as a basis of �state-by-state transient screening

Thin-zone TAP reactor is presented as a basis of the new state-by-state transient screening approach which has been proposed by the authors for non-steady-state kinetic characterization of industrial catalysts. The general thin-zone TAP reactor model is described, and its mathematical status is justified analytically. It is shown that this model provides high enough accuracy to be applicable in the wide conversion interval (up to 90%), which is an important advantage of this approach compared with the traditional differential reactor.

Co-melt fluidised bed granulation of pharmaceutical powders: Improvements in drug bioavailability

This study investigates the use of co-melt fluidised bed granulation for the agglomeration of model pharmaceutical powders, namely, lactose mono-hydrate, PEG 10000, poly-vinyl pyrolidone and ibuprofen as a model drug. Granulation within the co-melt system was found to follow a nucleationâ??steady growthâ??coating regime profile. Using high molecular weight PEG binder, the granulation mechanism and thus the extent of granulation was found to be significantly influenced by binder viscosity. The compression properties of the granulate within the hot fluidised bed were correlated using a novel high temperature experimental procedure. It was found that the fracture stress and fractural modulus of the materials under hot processing conditions were orders of magnitude lower than those measured under ambient conditions. A range of particle velocities within the granulator were considered based on theoretical models. After an initial period of nucleation, the Stokes deformation number analysis indicated that only velocities within the high shear region of the fluidised bed were sufficient to promote significant granule deformation and therefore, coalescence. The data also indicated that larger granules de-fluidised preventing agglomeration by coalescence. Furthermore, experimental data indicated that dissipation of the viscous molten binder to the surface was the most important factor in the latter stages of the granulation process. From a pharmaceutical perspective the inclusion of the model drug, ibuprofen, combined with PVP in the co-melt process proved to be highly significant. It was found that using DSC analysis on the formulations that the decrease in the heat of fusion associated with the melting of ibuprofen within the FHMG systems may be attributed to interaction between PVP and ibuprofen through inter-molecular hydrogen bonding. This interaction decreases the crystallinity of ibuprofen and facilitates solubilisation and bioavailability within the solid matrix.

Characterization of a dielectric barrier discharge operating in an open reactor with flowing helium

A dielectric barrier discharge (DBD) generated by flowing helium between the parallel-plate electrodes of an open air reactor has been characterized using time resolved optical and electrical measurements. A sinusoidal voltage of up to 5 kV (peak to peak) of frequencies from 3 to 50 kHz has been applied to the discharge electrodes. The helium flow rate is varied up to 10 litre min(-1). The adjustment of flow rate allows the creation of uniform DBDs with optimized input power equal to 120 +/- 10 mW cm(-3). At flow rates from 4 to 6 litre min(-1) a uniform DBD is obtained. The maxima in the line intensities of N-2(+) and helium at 391.4 nm and 706.5 nm, respectively, 2 under those conditions indicate the importance of helium metastables and He-2(+) in sustaining such a discharge. The power efficiency and discharge 2 current show maxima when the DBD In He/air is uniform. The gas temperature during the discharge has been measured as 360 +/- 20 K.

Time dependence of rotational state populations of excited hydrogen molecules in an RF excited plasma reactor

We report on time-dependent population distributions of excited rotational states of hydrogen in a capacitively coupled RF discharge. The common model to obtain the gas temperature from the rotational distribution is not applicable at all times during the discharge cycle due to the time dependence of the EEDF. The apparent temperature within a cycle assumes values between 350 K and 450 K for the discharge parameters of this experiment. We discuss the optimum time window within the discharge cycle that yields the best approximation to the actual temperature. Erroneous results can be obtained, in principle, with time-integrated measurements; we find, however, that in the present case the systematic error amounts to only approximately 20 K. This is due to the fact that the dominant contribution to the average intensity arises during that time window for which the assumptions underlying the analysis are best fulfilled. A similar analysis can be performed for N+2 rotational bands with a small amount of nitrogen added to the discharge gas. These populations do not exhibit the time variations found in the case of H2.