Scheduling and Platforming Trains at Busy Complex Stations

We consider the problem of train planning or scheduling for large, busy, complex train stations, which are common in Europe and elsewhere, though not in North America. We develop the constraints and objectives for this problem, but these are too computationally complex to solve by standard combinatorial search or integer programming methods. Also, the problem is somewhat political in nature, that is, it does not have a clear objective function because it involves multiple train operators with conflicting interests. We therefore develop scheduling heuristics analogous to those successfully adopted by train planners using ''manual'' methods. We tested the model and algorithms by applying to a typical large station that exhibits most of the complexities found in practice. The results compare well with those found by traditional methods, and take account of cost and preference trade-offs not handled by those methods. With successive refinements, the algorithm eventually took only a few seconds to run, the time depending on the version of the algorithm and the scheduling problem. The scheduling models and algorithms developed and tested here can be used on their own, or as key components for a more general system for train scheduling for a rail line or network.Train scheduling for a busy station includes ensuring that there are no conflicts between several hundred trains per day going in and out of the station on intersecting paths from multiple in-lines and out-lines to multiple platforms, while ensuring that each train is allowed at least its minimum required headways, dwell time, turnaround time and trip time. This has to be done while minimizing (costs of) deviations from desired times, platforms or lines, allowing for conflicts due to through-platforms, dead-end platforms, multiple sub-platforms, and possible constraints due to infrastructure, safety or business policy.

Utility, Caller, and Patient Profile of a Novel Chemotherapy Telephone Helpline Service Within a Regional Cancer Centre in Northern Ireland

Background: The telephone is an accepted and useful means of communication for the management of patient care. The Chemotherapy Telephone Helpline (CTH) service, located in a large inner-city Trust within the United Kingdom, is a unique nurse-led service within Northern Ireland.

Objective: The objective of the study was to investigate the utility, caller, and patient profile of a novel CTH.

Methods: This was a retrospective study of telephone contacts during 2007 to the CTH. Calls were categorized by caller and patient characteristics, reason for call, and subsequent action.

Results: A total of 7498 calls were made to the CTH during 2007. Of these, 25.6% occurred outside 8AM-4PM. Callers included patients (45.8%), lay carers (31%), and health care professionals (20.5%); 35.2% of calls concerned patients with polysymptomatic problems; 36.8% of calls led directly to patients being medically assessed.

Conclusions: The utility of the CTH service confirms the need of this nurse-led service. This service facilitates access to specialist advice and support for patients, their families, and allied health care professionals.

Implications for Practice: The international significance of these findings for practice includes its demonstration of the multifaceted symptom experience of patients receiving chemotherapy and highlights the importance of rapid access to specialist cancer services for patients and their lay and professional carers. In addition, it demonstrates the capacity of helplines to identify gaps in professional skills and training.

Telephone survey evaluation of the educational impact of a distance learning course

The educational impact of a distance learning (DL) course entitled ''Health Screening for Health Promotion, was investigated using a telephone questionnaire survey. An introduction to the DL course was distributed to all community pharmacists in England (16,400); the main body of the course, on which pharmacists were examined, was distributed free of charge to all pharmacists who requested it (1,485). Pharmacists participating in the survey (868) were organized by random selection into groups and stratified according to age, sex and postcode. A matched control group was randomly drawn from those pharmacists who had not participated in the course. The DL course improved pharmacists' knowledge about health screening/health promotion issues (e.g., mean score of 66 percent achieved by a group who had completed the course; 51 percent achieved by the control group; P<0.001). Factors influencing score achieved included sex and year of registration. Males performed better than females (P<0.008) while performance decreased with number of years on the register (P<0.001).

Keeping it real! Enhancing realism in standardised patient OSCE stations

Background: Objective structured clinical examinations (OSCEs) are a
commonly used method of assessing clinical competency in healthcare education. They can providean opportunity to observe candidates interacting with patients.
There are many challenges in using real patients in OSCEs, and increasingly standardised patients are being used as a preference. However, by using standardised patients there is a risk of making the encounter arti?cial and removed from actual clinical practice.
Context: Efforts made in terms of cognitive, auditory, visual, tactile, psychological and emotional cues can minimise the differences between a simulated
and real clinical scenario. However, a number of factors, including feasibility, cost and usability, need to be considered if such techniques are to be practicable
within an OSCE framework.
Innovation: This article describes a series of techniques that have been used in our institution to enhance the realism of a standardised patient encounter in an
OSCE. Efforts in preparing standardised patient roles, and how they portray these roles, will be considered. A wide variety of equipment can also be used in
combination with a patient and the surrounding environment, which can further enhance the authenticity of the simulated scenario.
Implications: By enhancing the realism in simulated patient OSCE encounters, there is potential to trigger more authentic conscious responses from candidates and implicit reactions that the candidates themselves may be less
aware of. Furthermore, using such techniques may allow faculty members to select scenarios that were previously not thought possible in an OSCE

Responding to crisis: When the telephone fails

The world is changing. Advances in telecommunications have meant that the world is shrinking – data can be moved across continents in the time it takes to send an email or access the cloud. Although developments such as these highlight the extent of scientific and technological evolution, in terms of legal liability, questions must be asked as to the capacity of our legal structures to evolve accordingly.

This article looks at how emergency telephone provision and any shift to VoIP systems might fit with existing tort liability and associated duty implications. It does so by analysing the technology through the principles that signpost UK tort law. This article recognises that as an emerging area, the legal liability implications have not yet been discussed in any great detail. The aim of this article therefore is to introduce the area, encourage debate and consider the issues that may become increasingly relevant as these types of technologies become industrial standards.

Self-reported use of natural health products:A cross-sectional telephone survey in older Ontarians

Background: The self-reported use of natural health products (NHPs) (herbal products and vitamin and mineral supplements) has increased over the past decade in Canada. Because the elderly population might have comorbidities and concurrently administered medications, there is a need to explore the perceptions and behaviors associated with NHPs in this age group. Objective: The goal of this study was to assess the use of NHPs in a cohort of older Canadian residents and the characteristics, perceptions, and behaviors associated with NHP use. Methods: Survey participants aged =60 years were randomly selected from telephone listings in the area of greater Hamilton, Ontario, Canada. Data were collected using a standardized computer-assisted telephone interview system. Self-reported data covering 7 domains were collected: (1) demographics; (2) self-reported 12-month NHP use; (3) reasons for NHP use; (4) self-reported 12-month prescription medication use; (5) expenditures on NHPs; (6) patient-reported adverse events and drug-NHP interactions; and (7) perceptions of physicians' attitudes regarding NHPs. Descriptive statistics were used to compare the characteristics of NHP users with those of nonusers and to assess the characteristics of NHP users across these 7 domains. Multivariate regression analysis was conducted to determine the demographic variables that might be associated with NHP user status. Results: Of 2528 persons identified as age =60 years, 1206 (48%) completed the telephone interview. Six hundred sixteen of these respondents (51%) reported the use of =1 NHP during the previous 12 months. On the initial univariate analysis, younger age and higher income were significantly associated with reporting NHP use (mean age, users vs nonusers, 71.1 vs 72.7 years, respectively; 95% CI, 1.02-1.06; P <0.001; income more than Can $26,000 was 28% and 22% in users and nonusers, respectively; P = 0.028). One hundred seventy of 616 users (28%) used an NHP to treat the same condition for which they were concurrently receiving a prescription medication, and 43 (25%) had not informed their physicians about their NHP use. Patients' characteristics such as sex, education, smoking status, and self-reported health status did not differ significantly between users and nonusers. In individuals who regularly spent money to purchase NHPs (n = 394), the mean cost was $20.38/mo. NHP expenditure was not significantly associated with age, sex, or income. Conclusion: Based on these findings, a substantial proportion of those Ontarians aged =60 years reported NHP use, and there is a need for greater communication with physicians to avoid potential drug-NHP interactions. © 2009 Excerpta Medica Inc. All rights reserved.

Massive MIMO Systems with Hardware-Constrained Base Stations

Massive multiple-input multiple-output (MIMO) systems are cellular networks where the base stations (BSs) are equipped with unconventionally many antennas. Such large antenna arrays offer huge spatial degrees-of-freedom for transmission optimization; in particular, great signal gains, resilience to imperfect channel knowledge, and small inter-user interference are all achievable without extensive inter-cell coordination. The key to cost-efficient deployment of large arrays is the use of hardware-constrained base stations with low-cost antenna elements, as compared to today's expensive and power-hungry BSs. Low-cost transceivers are prone to hardware imperfections, but it has been conjectured that the excessive degrees-of-freedom of massive MIMO would bring robustness to such imperfections. We herein prove this claim for an uplink channel with multiplicative phase-drift, additive distortion noise, and noise amplification. Specifically, we derive a closed-form scaling law that shows how fast the imperfections increase with the number of antennas.