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.

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.

Climate Adaptation: The future of extra-care housing for the elderly in the United Kingdom.

This paper describes the result of a project to develop climate adaptation design strategies funded by the UK’s Technology Strategy Board. The aim of the project was to look at the effects of climate change in the distant future (2080) on a vulnerable group such as older people with special needs and see how architectural design strategies and technologies may be used today to help mitigate problems ahead caused by climate change.
Older people are the most vulnerable sector of society and are particularly at risk in extreme weather, either excess cold in winter or continual high temperatures in summer. In the UK it is predicted that average temperatures may rise by as much as 8 degrees in Summer by 2080 and there will be a 20% greater chance of extreme weather events. This will place extreme stress on the building stock which is designed for today’s mild maritime climate.
The project took a current proposal for an extra-care home for the elderly designed to 2010 regulations and developed a road map to 2080 using climate models developed by the UK Meteorological Office. This allowed the current design to be assessed using future climatic data, proposals for improvement of the scheme to be made within existing constraints and also a new scheme to be developed from first principals using this data, and projections of new technologies that will be available. By comparing these schemes, the approach allowed a reassessment of the initial scheme, and allowed a new design to be developed that offered a more flexible solution incorporating future retrofit which allows new renewable technologies for heating, cooling and water storage to be added at a later date.

An in situ spatially resolved method to probe gas phase reactions through a fixed bed catalyst

A new method to spatially probe heterogeneous catalysed reactions within a packed bed of catalyst has been developed. The spatial resolution is achieved using a stationary perforated capillary coupled to a mass spectrometer while the catalyst bed is moved. The oxidation of CO promoted by H-2 over a Pd catalyst has been used to demonstrate the technique.

Fixed Bed Study of Ammonia Removal from Aqueous Solutions Using Natural Zeolite

Purpose
– The purpose of this paper is to investigate the performance of natural Jordanian zeolite tuff to remove ammonia from aqueous solutions using a laboratory batch method and fixed-bed column apparatus. Equilibrium data were fitted to Langmuir and Freundlich models.

Design/methodology/approach
– Column experiments were conducted in packed bed column. The used apparatus consisted of a bench-mounted glass column of 2.5 cm inside diameter and 100 cm height (column volume = 490 cm3). The column was packed with a certain amount of zeolite to give the desired bed height. The feeding solution was supplied from a 30 liter plastic container at the beginning of each experiment and fed to the column down-flow through a glass flow meter having a working range of 10-280ml/min.

Findings
– Ammonium ion exchange by natural Jordanian zeolite data were fitted by Langmuir and Freundlich isotherms. Continuous sorption of ammonium ions by natural Jordanian zeolite tuff has proven to be effective in decreasing concentrations ranging from 15-50 mg NH4-N/L down to levels below 1 mg/l. Breakthrough time increased by increasing the bed depth as well as decreasing zeolite particle size, solution flow-rate, initial NH4+ concentration and pH. Sorption of ammonium by the zeolite under the tested conditions gave the sorption capacity of 28 mg NH4-N/L at 20°C, and 32 mg NH4-N/L at 30°C.

Originality/value
– This research investigates the performance of natural Jordanian zeolite tuff to remove ammonia from aqueous solutions using a laboratory batch method and fixed-bed column apparatus. The equilibrium data of the sorption of Ammonia were plotted by using the Langmuir and Freundlich isotherms, then the experimental data were compared to the predictions of the above equilibrium isotherm models. It is clear that the NH4+ ion exchange data fitted better with Langmuir isotherm than with Freundlich model and gave an adequate correlation coefficient value.

Man-in-the-Middle Attack Test-bed Investigating Cyber-security Vulnerabilities in Smart Grid SCADA Systems

The increased complexity and interconnectivity of Supervisory Control and Data Acquisition (SCADA) systems in the Smart Grid has exposed them to a wide range of cyber-security issues, and there are a multitude of potential access points for cyber attackers. This paper presents a SCADA-specific cyber-security test-bed which contains SCADA software and communication infrastructure. This test-bed is used to investigate an Address Resolution Protocol (ARP) spoofing based man-in-the-middle attack. Finally, the paper proposes a future work plan which focuses on applying intrusion detection and prevention technology to address cyber-security issues in SCADA systems.

How using Technology Enhanced Learning could help modernise traditional large group teaching or Lecturing.

The efficiency of lecturing or large group teaching has been called into question for many years. An abundance of literature details the components of effective teaching which are not provided in the traditional lecture setting, with many alternative methods of teaching recommended. However, with continued constraints on resources large group teaching is here to stay and student’s expect and are familiar with this method.

Technology Enhanced Learning may be the way forward, to prevent educators from “throwing out the baby with the bath water”. TEL could help Educator’s especially in the area of life sciences which is often taught by lectures to engage and involve students in their learning, provide feedback and incorporate the “quality” of small group teaching, case studies and Enquiry Based Learning into the large group setting thus promoting effective and deep learning.

Simulation of Oil Shale Semi-Coke Particle Cold Transportation in a Spouted Bed Using CPFD Method

The spouted bed was widely used due to its good mixing of particles and effective phase transferability between the gas and solid phase. In this paper, the transportation process of particles in a 3D spouted bed was studied using the Computational Particle Fluid Dynamics (CPFD) numerical method. Experiments were conducted to verify the validity of the simulation results. Distributions of the pressure, velocities and particle concentration of transportation devices were investigated. The motion state and characteristics of multiphase flows in the transportation device were demonstrated under various operating conditions. The results showed that a good consistency was obtained between the simulated results and the experimental results. The motion characteristics of the gas-solid two-phase flow in the device was effectively predicted, which could assist the optimal operating condition estimation for the spouted transportation process.