Investigating the efficiency of fitting Coxian phase-type distributions to health care data

Coxian phase-type distributions are becoming a popular means of representing survival times within a health care environment. They are favoured as they show a distribution as a system of phases and can allow for an easy visual representation of the rate of flow of patients through a system. Difficulties arise, however, in determining the parameter estimates of the Coxian phase-type distribution. This paper examines ways of making the fitting of the Coxian phase-type distribution less cumbersome by outlining different software packages and algorithms available to perform the fit and assessing their capabilities through a number of performance measures. The performance measures rate each of the methods and help in identifying the more efficient. Conclusions drawn from these performance measures suggest SAS to be the most robust package. It has a high rate of convergence in each of the four example model fits considered, short computational times, detailed output, convergence criteria options, along with a succinct ability to switch between different algorithms.

Doping, sport and the law: time for repeal of prohibition?

This article concerns the legal issues that surround the prohibition of doping in sport. The current policy on the use of performance enhancing drugs (PEDs) in sport is underpinned by both a paternalistic desire to protect athletes’ health and the long-term integrity or ‘spirit’ of sport. The policy is put into administrative effect globally by the World Anti-Doping Agency (WADA), which provides the regulatory and legal framework through which the vast majority of international sports federations harmonise their anti-doping programmes. On outlining briefly both the broad administrative structures of international sport’s various anti-doping mechanisms, and specific legal issues that arise in disciplinary hearings involving athletes accused of doping, this article questions the sustainability of the current ‘zero tolerance’ approach, arguing, by way of analogy to the wider societal debate on the criminalisation of drugs, and as informed by Sunstein and Thaler’s theory of libertarian paternalism, that current policy on anti-doping has failed. Moreover, rather than the extant moral and punitive panic regarding doping in sport, this article, drawing respectively on Seddon’s and Simon’s work on the history of drugs and crime control mentality, contends that, as an alternative, harm reductionist measures should be promoted, including consideration of the medically supervised use of certain PEDs.

The prediction of intake potential and organic matter digestibility of grass silages by near infrared spectroscopy analysis of undried samples

A study was undertaken to examine a range of sample preparation and near infrared reflectance spectroscopy (NIPS) methodologies, using undried samples, for predicting organic matter digestibility (OMD g kg(-1)) and ad libitum intake (g kg(-1) W-0.75) of grass silages. A total of eight sample preparation/NIRS scanning methods were examined involving three extents of silage comminution, two liquid extracts and scanning via either external probe (1100-2200 nm) or internal cell (1100-2500 nm). The spectral data (log 1/R) for each of the eight methods were examined by three regression techniques each with a range of data transformations. The 136 silages used in the study were obtained from farms across Northern Ireland, over a two year period, and had in vivo OMD (sheep) and ad libitum intake (cattle) determined under uniform conditions. In the comparisons of the eight sample preparation/scanning methods, and the differing mathematical treatments of the spectral data, the sample population was divided into calibration (n = 91) and validation (n = 45) sets. The standard error of performance (SEP) on the validation set was used in comparisons of prediction accuracy. Across all 8 sample preparation/scanning methods, the modified partial least squares (MPLS) technique, generally minimized SEP's for both OMD and intake. The accuracy of prediction also increased with degree of comminution of the forage and with scanning by internal cell rather than external probe. The system providing the lowest SEP used the MPLS regression technique on spectra from the finely milled material scanned through the internal cell. This resulted in SEP and R-2 (variance accounted for in validation set) values of 24 (g/kg OM) and 0.88 (OMD) and 5.37 (g/kg W-0.75) and 0.77 (intake) respectively. These data indicate that with appropriate techniques NIRS scanning of undried samples of grass silage can produce predictions of intake and digestibility with accuracies similar to those achieved previously using NIRS with dried samples. (C) 1998 Elsevier Science B.V.

Preliminary clinical assessment of polyvinyl alcohol-tetrahydroxyborate hydrogels as potential topical formulations for local anesthesia of lacerations

The aim of this study was to assess a novel semisolid material as a potential topical drug delivery system for acute laceration. The objectives were to correlate physical characterization data using rheologic studies and to compare with clinical assessment of performance in an emergency department (ED).

Optimization of image quality and dose for Varian aS500 electronic portal imaging devices (EPIDs)

This study was carried out to investigate whether the electronic portal imaging (EPI) acquisition process could be optimized, and as a result tolerance and action levels be set for the PIPSPro QC-3V phantom image quality assessment. The aim of the optimization process was to reduce the dose delivered to the patient while maintaining a clinically acceptable image quality. This is of interest when images are acquired in addition to the planned patient treatment, rather than images being acquired using the treatment field during a patient's treatment. A series of phantoms were used to assess image quality for different acquisition settings relative to the baseline values obtained following acceptance testing. Eight Varian aS500 EPID systems on four matched Varian 600C/D linacs and four matched Varian 2100C/D linacs were compared for consistency of performance and images were acquired at the four main orthogonal gantry angles. Images were acquired using a 6 MV beam operating at 100 MU min(-1) and the low-dose acquisition mode. Doses used in the comparison were measured using a Farmer ionization chamber placed at d(max) in solid water. The results demonstrated that the number of reset frames did not have any influence on the image contrast, but the number of frame averages did. The expected increase in noise with corresponding decrease in contrast was also observed when reducing the number of frame averages. The optimal settings for the low-dose acquisition mode with respect to image quality and dose were found to be one reset frame and three frame averages. All patients at the Northern Ireland Cancer Centre are now imaged using one reset frame and three frame averages in the 6 MV 100 MU min(-1) low-dose acquisition mode. Routine EPID QC contrast tolerance (+/-10) and action (+/-20) levels using the PIPSPro phantom based around expected values of 190 (Varian 600C/D) and 225 (Varian 2100C/D) have been introduced. The dose at dmax from electronic portal imaging has been reduced by approximately 28%, and while the image quality has been reduced, the images produced are still clinically acceptable.

The Paradox of Performative Immediacy: Law, Music, Improvisation

In a 1999 essay, J.M. Balkin and Sanford Levinson called for law to be considered as a performing art. Against or perhaps going further than Balkin and Levinson, this commentary claims that while engagement with performance practices in the arts, such as music, is of the utmost value to law and legal theory, we must not take for granted what it means to ‘‘perform’’. Uniting Jacques Derrida’s la Villette performance (with jazz legend, Ornette Coleman) with his writings on performativity in law, this commentary looks to the musical practice of improvisation to trouble the notion of performance as immediate and singular and to question taken for granted distinctions between text and performance, writing and music, composition and improvisation. The consequence of this refined understanding of the performative on legal theory and the actual practice of law is a reconceptualization of law as improvisation, that is, both singular and general, pre-existent and immediate, and a refocusing on the creativity that lies at the heart of law’s conservativism.

Review of constitutive models for describing the time dependent behaviour of soft clays

Different classes of constitutive models have been proposed to capture the time-dependent behaviour of soft soil (creep, stress relaxation, rate dependency). This paper critically reviews many of the models developed based on understanding of the time dependent stress-strain-stress rate-strain rate behaviour of soils and viscoplasticity in terms of their strengths and weaknesses. Some discussion is also made on the numerical implementation aspects of these models. Typical findings from numerical analyses of geotechnical structures constructed on soft soils are also discussed. The general elastic viscoplastic (EVP) models can roughly be divided into two categories: models based on the concept of overstress and models based on non-stationary flow surface theory. Although general in structure, both categories have their own strengths and shortcomings. This review indicates that EVP analysis is yet to be vastly used by the geotechnical engineers, apparently due to the mathematical complication involved in the formulation of the constitutive models, unconvincing benefit in terms of the accuracy of performance prediction, requirement of additional soil parameter(s), difficulties in determining them, and the necessity of excessive computing resources and time. © 2013 Taylor & Francis.

Performance management systems and Public Value Strategy: a case study

Purpose
This article aims to analyze the role of performance management systems (PMS) in supporting public value strategies.

Design/methodology/approach
This article draws on the public value dynamic model by Horner and Hutton (2010). It presents the results of a case study of implementation of a PMS model, the ‘Value Pyramid’ (VP).

Findings
The results stress the need for an improved conceptualization of PMS within public value strategy. Through experimentation using the VP, the case site was able to measure and visualize what it considered public value and reflect on the internal/external causes of both creation and destruction of public value.

Research limitations/implication
This article is limited to just one case study, although in-depth and longitudinal.

Originality/value
This article is one of the first attempting to understand the role of PMS within the public value strategy framework, answering the call of Benington and Moore (2010) to consider public value from an accounting perspective.

Integrating elements of undergraduate curriculum learning

Integrating elements of undergraduate curriculum learning Rapidly advancing practice and recognition of nursing, midwifery and medicine as a vital interrelated workforce, implies a need for a variety of curricula opportunities. This project addresses the challenge for healthcare educators to widen student engagement and participation through inter-professional education by creating learning environments whereby student interactions foster the desire to develop situational awareness, independent learning and contribution to patient advocacy. Overall aim of this ‘Feeding and Nutrition in Infants and Children’ project is to provide opportunities for integrated learning to enable students to advance their knowledge and understanding of current best practice. This Inter-professional (IPE) student-lead workshop was initially implemented in 2006-07 in collaboration with the Centre for Excellence in IPE, within the curricula of medical and nursing programmes¹. Supported by the development of a student resource pack, this project is now being offered to Learning Disability nursing and Midwifery students since September 2014. Methods: Fourth year medical students, undertaking a ‘Child Healthcare module’, alongside nursing and /or midwifery students are divided into groups with three or four students from each profession. Each group focuses on a specific feeding problem that is scenario-based on a common real-life issue prior to the workshop and then present their findings / possible solutions to feeding problem. They are observed by both facilitators and peers, who provide constructive feedback on aspects of performance including patient safety, cultural awareness, communication, decision making skills, teamwork and an appreciation of the role of various professionals in managing feeding problems in infants and children. Results: Participants complete a Likert-scale questionnaire to ascertain their reactions to this integrated learning experience. Ongoing findings suggest that students evaluate this learning activity very positively and have stated that they value the opportunity to exercise their clinical judgement and decision making skills. Most recent comments: ‘appreciate working alongside other student’s / multidisciplinary team approach’ As a group students engage in this team problem-solving exercise, drawing upon their strengths and abilities to learn from each other. This project provides a crucial opportunity for learning and knowledge exchange for all those medical, midwifery and nursing students involved. Reference: 1. Purdy, J. & Stewart, M (2009) ‘Feeding and Nutrition in Infants and Children: An Interprofessional Approach’. The Clinical Teacher, vol 6, no.3. Authors: Dr. Angela Bell, Centre for Medical Education, Queen’s University Belfast. Doris Corkin, Senior Lecturer (education), Children’s Nursing, School of Nursing & Midwifery, Queen’s University Belfast. Carolyn Moorhead, Midwifery Lecturer, School of Nursing & Midwifery, Queen’s University Belfast. Ann Devlin, Lecturer (education), Learning Disability Nursing, School of Nursing & Midwifery, Queen’s University Belfast.

Surrogate-based analysis and optimization for the design of heat sinks with jet impingement

Heat sinks are widely used for cooling electronic devices and systems. Their thermal performance is usually determined by the material, shape, and size of the heat sink. With the assistance of computational fluid dynamics (CFD) and surrogate-based optimization, heat sinks can be designed and optimized to achieve a high level of performance. In this paper, the design and optimization of a plate-fin-type heat sink cooled by impingement jet is presented. The flow and thermal fields are simulated using the CFD simulation; the thermal resistance of the heat sink is then estimated. A Kriging surrogate model is developed to approximate the objective function (thermal resistance) as a function of design variables. Surrogate-based optimization is implemented by adaptively adding infill points based on an integrated strategy of the minimum value, the maximum mean square error approach, and the expected improvement approaches. The results show the influence of design variables on the thermal resistance and give the optimal heat sink with lowest thermal resistance for given jet impingement conditions. 

Developing management capability within a horizontal supply chain in performance measurement deployment and evolution: A Dynamic Capabilities and Goal Theory perspective

Complex collaboration in rapidly changing business environments create challenges for management capability in Utility Horizontal Supply Chains (UHSCs) involving the deploying and evolving of performance measures. The aim of the study is twofold. First, there is a need to explore how management capability can be developed and used to deploy and evolve Performance Measurement (PM), both across a UHSC and within its constituent organisations, drawing upon a theoretical nexus of Dynamic Capability (DC) theory and complementary Goal Theory. Second, to make a contribution to knowledge by empirically building theory using these constructs to show the management motivations and behaviours within PM-based DCs. The methodology uses an interpretive theory building, multiple case based approach (n=3) as part of a USHC. The data collection methods include, interviews (n=54), focus groups (n=10), document analysis and participant observation (reflective learning logs) over a five-year period giving longitudinal data. The empirical findings lead to the development of a conceptual framework showing that management capabilities in driving PM deployment and evolution can be represented as multilevel renewal and incremental Dynamic Capabilities, which can be further understood in terms of motivation and behaviour by Goal-Theoretic constructs. In addition three interrelated cross cutting themes of management capabilities in consensus building, goal setting and resource change were identified. These management capabilities require carefully planned development and nurturing within the UHSC. 

Children's use of interventions to learn causal structure

Children aged between 5 and 8 years freely intervened on a three-variable causal system, with their task being to discover whether it was a common-cause structure or one of two causal chains. From 6-7 years, children were able to use information from their interventions to correctly disambiguate the structure of a causal chain. We used a Bayesian model to examine children’s interventions on the system; this showed that with development children became more efficient in producing the interventions needed to disambiguate the causal structure and that the quality of interventions, as measured by their informativeness, improved developmentally. The latter measure was a significant predictor of children’s correct inferences about the causal structure. A second experiment showed that levels of performance were not reduced in a task in which children did not select and carry out interventions themselves, indicating no advantage for self-directed learning. However, children’s performance was not related to intervention quality in these circumstances, suggesting that children learn in a different way when they carry out interventions themselves.

Effect of nanosilica addition on the fresh properties and shrinkage of mortars with fly ash and superplasticizer

The ongoing use of various mineral additions along with chemical admixtures such as superplasticizers justifies the need for further research. Understanding and quantifying their effects and possible synergies on the fresh and hardened properties of cement-based materials is necessary, especially if some of these components are known to have a pozzolanic effect. This paper describes and models the fresh and hardened properties of cement mortars including nanosilica and fly ash, and relates their properties to the proportioning of these materials and the superplasticizer dosage. Mini-slump, Marsh cone and Lombardi cone tests were used to examine the properties of the fresh mortars, and to assess density, plastic shrinkage, and drying shrinkage up to 20 days. The equations presented in this paper make it possible to optimize mortar proportionings to the required levels of performance in both fresh and hardened states.

A Numerical and Experimental Assessment of the Use of a Turbine Utilizing Splitter Blades for an Automotive Variable Geometry Turbocharger

Automotive manufacturers require improved part load engine performance to further improve fuel economy. For a swing vane VGS (Variable Geometry Stator) turbine this means a more closed stator vane, to deal with the low MFRs (Mass Flow Rates), high PRs (Pressure Ratios) and low rotor rotational speeds. During these conditions the turbine is operating at low velocity ratios. As more energy is available at high pressure ratios and during lower turbocharger rotational speeds, a turbine which is efficient at these conditions is desirable. Another key aspect for automotive manufacturers is engine responsiveness. High inertia designs result in “turbo lag” which means an increased time before the target boost pressure is reached. Therefore, designs with improved performance at low velocity ratios, reduced inertia or an increased swallowing capacity are the current targets for turbocharger manufacturers.

To try to meet these design targets a CFD (Computational Fluid Dynamics) study was performed on a turbine wheel using splitter blades. A number of parameters were investigated. These included splitter blade merdional length, blade number and blade angle distribution.

The numerical study was performed on a scaled automotive VGS. Three different stator vane positions have been analysed. A single passage CFD model was developed and used to provide information on the flow features affecting performance in both the stator vanes and turbine.

Following the CFD investigation the design with the best compromise in terms of performance, inertia and increased MFP (Mass Flow Parameter) was selected for manufacture and testing. Tests were performed on a scaled, low temperature turbine test rig. The aerodynamic flow path of the gas stand was the same as that investigated during the CFD. The test results revealed a design which had similar performance at the closed stator vane positions when compared to the baseline wheel. At the maximum MFR stator vane condition a drop of −0.6% pts in efficiency was seen. However, 5.5% increase in MFP was obtained with the additional benefit of a drop in rotor inertia of 3.7%, compared to the baseline wheel.

Chloride ingress into marine exposed concrete: A comparison of empirical- and physically- based models

In establishing the reliability of performance-related design methods for concrete – which are relevant for resistance against chloride-induced corrosion - long-term experience of local materials and practices and detailed knowledge of the ambient and local micro-climate are critical. Furthermore, in the development of analytical models for performance-based design, calibration against test data representative of actual conditions in practice is required. To this end, the current study presents results from full-scale, concrete pier-stems under long-term exposure to a marine environment with work focussing on XS2 (below mid-tide level) in which the concrete is regarded as fully saturated and XS3 (tidal, splash and spray) in which the concrete is in an unsaturated condition. These exposures represent zones where concrete structures are most susceptible to ionic ingress and deterioration. Chloride profiles and chloride transport behaviour are studied using both an empirical model (erfc function) and a physical model (ClinConc). The time dependency of surface chloride concentration (Cs) and apparent diffusivity (Da) were established for the empirical model whereas, in the ClinConc model (originally based on saturated concrete), two new environmental factors were introduced for the XS3 environmental exposure zone. Although the XS3 is considered as one environmental exposure zone according to BS EN 206-1:2013, the work has highlighted that even within this zone, significant changes in chloride ingress are evident. This study aims to update the parameters of both models for predicting the long term transport behaviour of concrete subjected to environmental exposure classes XS2 and XS3.