Economic consideration for reducing hospital presentations among patients with decompensated cirrhosis: not all presentations avoided can be considered equal

Individuals with decompensated cirrhosis and ascites requiring paracentesis utilize exceptionally high levels of hospital resources. Consequently, potential modifications to existing models of healthcare to assist patients in the management of their liver disease and reduce the need for hospital encounters have potential to improve patients’ health and reduce demand on acute hospital services. However, there is a paucity of data examining how much healthcare resources could be re-directed to interventions that prevent hospitalizations without net annual budgetary disadvantage (from the hospital’s perspective). The purpose of this study was to probabilistically examine how much healthcare resourcing could be saved per hospital presentation avoided among this clinical population.

Hospital in the Nursing Home program reduces emergency department presentations and hospital admissions from residential aged care facilities in Queensland, Australia: A quasi-experimental study

Background There has been considerable publicity regarding population ageing and hospital emergency department (ED) overcrowding. Our study aims to investigate impact of one intervention piloted in Queensland Australia, the Hospital in the Nursing Home (HiNH) program, on reducing ED and hospital attendances from residential aged care facilities (RACFs). Methods A quasi-experimental study was conducted at an intervention hospital undertaking the program and a control hospital with normal practice. Routine Queensland health information system data were extracted for analysis. Results Significant reductions in the number of ED presentations per 1000 RACF beds (rate ratio (95 % CI): 0.78 (0.67–0.92); p = 0.002), number of hospital admissions per 1000 RACF beds (0.62 (0.50–0.76); p < 0.0001), and number of hospital admissions per 100 ED presentations (0.61 (0.43–0.85); p = 0.004) were noticed in the experimental hospital after the intervention; while there were no significant differences between intervention and control hospitals before the intervention. Pre-test and post-test comparison in the intervention hospital also presented significant decreases in ED presentation rate (0.75 (0.65–0.86); p < 0.0001) and hospital admission rate per RACF bed (0.66 (0.54–0.79); p < 0.0001), and a non-significant reduction in hospital admission rate per ED presentation (0.82 (0.61–1.11); p = 0.196). Conclusions Hospital in the Nursing Home program could be effective in reducing ED presentations and hospital admissions from RACF residents. Implementation of the program across a variety of settings is preferred to fully assess the ongoing benefits for patients and any possible cost-savings.

Fate of pathogen indicators in a domestic blend of food waste and wastewater through a two-stage anaerobic digestion system

Anaerobic digestion is a viable on-site treatment technology for rich organic waste streams such as food waste and blackwater. In contrast to large-scale municipal wastewater treatment plants which are typically located away from the community, the effluent from any type of on-site system is a potential pathogenic hazard because of the intimacy of the system to the community. The native concentrations of the pathogen indicators Escherichia coli, Clostridium perfringens and somatic coliphage were tracked for 30 days under stable operation (organic loading rate (OLR) = 1.8 kgCOD m(-3) day(-1), methane yield = 52% on a chemical oxygen demand (COD) basis) of a two-stage laboratory-scale digester treating a mixture of food waste and blackwater. E. coli numbers were reduced by a factor of 10(6.4) in the thermophilic stage, from 10(7.5+/-0.3) to 10(1.1+/-0.1) cfu 100 mL(-1), but regenerated by a factor of 10(4) in the mesophilic stage. Neither the thermophilic nor mesophilic stages had any significant impact on C. perfringens concentrations. Coliphage concentrations were reduced by a factor of 10(1.4) across the two stages. The study shows that anaerobic digestion only reduces pathogen counts marginally but that counts in effluent samples could be readily reduced to below detection limits by filtration through a 0.22 microm membrane, to investigate membrane filtration as a possible sanitation technique.

(Re)presenting Masculinity: A theatre director's critical observations of, and theatrical experimentation with, (re)presentations of masculinity in selected works of contemporary Australian theatre

Health professionals, academics, social commentators and the media are increasingly sending the same message – Australian men are in crisis. This message has been supported by documented rises in alcoholism, violence, depression, suicide and crime amongst men in Australia. A major cause of this crisis, it can be argued, is an over-reliance on the out-dated and limited model of hegemonic masculinity that all men are encouraged to imitate in their own behaviour. This paper, as part of a larger study, explores representations of masculinity in selected works of contemporary Australian theatre in order to investigate the concept of hegemonic masculinity and any influence it may have on the perceived ‘crisis of masculinity’. Theatre is but one of the artistic modes that can be used to investigate masculinity and issues associated with identity. The Australia Council for the Arts recognises theatre, along with literature, dance, film, television, inter-arts, music and visual arts, as critical to the understanding and expression of Australian culture and identity. Theatre has been chosen in this instance because of the opportunities available to this study for direct access to specific theatre performances and creators and, also, because of the researcher’s experience, as a theatre director, with the dramatic arts. Through interviews with writers, directors and actors, combined with the analysis of scripts, academic writings, reviews, articles, programmes, play rehearsals and workshops, this research utilises theatre as a medium to explore masculinity in Australia.

Normalized Two Stage SVQ for Minimum Complexity Wide-band LSF Quantization

We develop a two stage split vector quantization method with optimum bit allocation, for achieving minimum computational complexity. This also results in much lower memory requirement than the recently proposed switched split vector quantization method. To improve the rate-distortion performance further, a region specific normalization is introduced, which results in 1 bit/vector improvement over the typical two stage split vector quantizer, for wide-band LSF quantization.

Two Stage Transform Vector Quantization of LSFs for Wideband Speech Coding

We investigate the use of a two stage transform vector quantizer (TSTVQ) for coding of line spectral frequency (LSF) parameters in wideband speech coding. The first stage quantizer of TSTVQ, provides better matching of source distribution and the second stage quantizer provides additional coding gain through using an individual cluster specific decorrelating transform and variance normalization. Further coding gain is shown to be achieved by exploiting the slow time-varying nature of speech spectra and thus using inter-frame cluster continuity (ICC) property in the first stage of TSTVQ method. The proposed method saves 3-4 bits and reduces the computational complexity by 58-66%, compared to the traditional split vector quantizer (SVQ), but at the expense of 1.5-2.5 times of memory.

An operational-level multi-stage mine production timetabling model for optimally synchronising drilling, blasting and excavating operations

This paper proposes a new multi-stage mine production timetabling (MMPT) model to optimise open-pit mine production operations including drilling, blasting and excavating under real-time mining constraints. The MMPT problem is formulated as a mixed integer programming model and can be optimally solved for small-size MMPT instances by IBM ILOG-CPLEX. Due to NP-hardness, an improved shifting-bottleneck-procedure algorithm based on the extended disjunctive graph is developed to solve large-size MMPT instances in an effective and efficient way. Extensive computational experiments are presented to validate the proposed algorithm that is able to efficiently obtain the near-optimal operational timetable of mining equipment units. The advantages are indicated by sensitivity analysis under various real-life scenarios. The proposed MMPT methodology is promising to be implemented as a tool for mining industry because it is straightforwardly modelled as a standard scheduling model, efficiently solved by the heuristic algorithm, and flexibly expanded by adopting additional industrial constraints.

Which patients with chronic kidney disease have the greatest symptom burden? A comparative study of advanced CKD stage and dialysis modality

Background Chronic kidney disease (CKD) leads to a range of symptoms, which are often under-recognised and little is known about the multidimensional symptom experience in advanced CKD. Objectives To examine (1) symptom burden at CKD stages 4 and 5, and dialysis modalities, and (2) demographic and renal history correlates of symptom burden. Methods Using a cross-sectional design, a convenience sample of 436 people with CKD was recruited from three hospitals. The CKD Symptom Burden Index (CKD-SBI) was used to measure the prevalence, severity, distress and frequency of 32 symptoms. Demographic and renal history data were also collected. Results Of the sample, 75.5 % were receiving dialysis (haemodialysis, n = 287; peritoneal dialysis, n = 42) and 24.5 % were not undergoing dialysis (stage 4, n = 69; stage 5, n = 38). Participants reported an average of 13.01 ± 7.67 symptoms. Fatigue and pain were common and burdensome across all symptom dimensions. While approximately one-third experienced sexual symptoms, when reported these symptoms were frequent, severe and distressing. Haemodialysis, older age and being female were independently associated with greater symptom burden. Conclusions In CKD, symptom burden is better understood when capturing the multidimensional aspects of a range of physical and psychological symptoms. Fatigue, pain and sexual dysfunction are key contributors to symptom burden, and these symptoms are often under-recognised and warrant routine assessment. The CKD-SBI offers a valuable tool for renal clinicians to assess symptom burden, leading to the commencement of timely and appropriate interventions.

Spatial variation of sequestered calcium in the multicellular stage of Dictyostelium discoideum as assayed by chlortetracycline fluorescence

Abstract. We have used chlortetracycline (CTC) as a fluorescent probe to detect the distribution of sequestered calcium in multicellular stages of Dictyostelium discoideum. Tips of late aggregates, slugs and early culminating masses fluoresce very strongly. Most of the fluorescence is intracellular in origin and emanates from a small number of intense punctate sources. The sources correspond in part to autophagic vacuoles viz. neutral-red staining, acidic digestive vesicles, and may also include intracellular organelles; cytoplasmic fluorescence is much weaker in comparison. The level of fluorescence drops in the middle portion of slugs and rises again in the posteriormost region, though not to as high a level as in the tip. This holds good irrespective of whether CTC is applied only in the neighbourhood of the aggregate centre, only in the aggregate periphery, or to the whole aggregate. We infer that there must be a good deal of mixing in the stages leading from aggregation to slug formation; thus the serial order in which cells enter an aggregate does not bear any relation to their ultimate fates. The other implication of our study is that calcium sequestration is much more extensive in prestalk and anterior-like cells than in prespore cells. These findings are discussed with regard to possible implications for pattern formation.

An adiabatic model for a two-stage double-inlet pulse tube refrigerator

A numerical modelling technique for predicting the detailed performance of a double-inlet type two-stage pulse tube refrigerator has been developed. The pressure variations in the compressor, pulse tube, and reservoir were derived, assuming the stroke volume variation of the compressor to be sinusoidal. The relationships of mass flowrates, volume flowrates, and temperature as a function of time and position were developed. The predicted refrigeration powers are calculated by considering the effect of void volumes and the phase shift between pressure and mass flowrate. These results are compared with the experimental results of a specific pulse tube refrigerator configuration and an existing theoretical model. The analysis shows that the theoretical predictions are in good agreement with each other.

The influence of lifetime sun exposure on breast cancer stage

This thesis was a retrospective cohort study that investigated the relationship between lifetime sun exposure and breast cancer stage, as a measure of prognosis, in women newly diagnosed with breast cancer. This project was the first of its kind and aimed to enhance the understanding of the effects of sun exposure, possibly mediated by vitamin D, on breast cancer stage and provide insight into ways in which the prognosis of breast cancer can be improved. The study found no significant relationship between lifetime sun exposure and breast cancer stage.

Experimental studies on a two stage pulse tube cryocooler reaching 2.5K

A two stage Pulse Tube Cryocooler (PTC) is designed and fabricated which reaches a no-load temperature of 2.5K in the second stage and similar to 60 K in the first stage respectively. The system provides a cooling power of similar to 250 mW at 5K in the second stage. Stainless steel meshes (size 200) and lead (Pb) granules are used as the first stage regenerator materials and combination of Pb with Er3Ni / HoCu2 are used as the second stage regenerator materials. The system operates at 1.6 Hz using a 6 kW water cooled helium compressor. Studies conducted by varying the dimensions of Pulse Tubes and regenerators show that the dimensions of the Pulse Tubes are more critical to the performance of the Cryocooler than those of the regenerators. Experimental studies show that the optimum volume ratios of Er3Ni to Pb and HoCu2 to Pb in the second stage regenerator should be 3:2 and 2:3 respectively for the best performance. Further, systems with HoCu2 performed better than those with Er3Ni. The theoretical analysis of the system has been carried out using a simple isothermal model. The experimentally measured cooling powers are in good agreement with the theoretical predictions.

2nd ESMO Consensus Conference in Lung Cancer: Locally advanced stage III non-small-cell lung cancer

To complement the existing treatment guidelines for all tumour types, ESMO organises consensus conferences to focus on specific issues in each type of tumour. The 2nd ESMO Consensus Conference on Lung Cancer was held on 11–12 May 2013 in Lugano. A total of 35 experts met to address several questions on non-small-cell lung cancer (NSCLC) in each of four areas: pathology and molecular biomarkers, first-line/second and further lines of treatment in advanced disease, early-stage disease and locally advanced disease. For each question, recommendations were made including reference to the grade of recommendation and level of evidence. This consensus paper focuses on locally advanced disease.

Development and transient performance results of a single stage activated carbon - HFC 134a closed cycle adsorption cooling system

A laboratory model of a thermally driven adsorption refrigeration system with activated carbon as the adsorbent and 1,1,1,2-tetrafluoroethane (HFC 134a) as the refrigerant was developed. The single stage compression system has an ensemble of four adsorbers packed with Maxsorb II specimen of activated carbon that provide a near continuous flow which caters to a cooling load of up to 5W in the 5-18 degrees C region. The objective was to utilise the low grade thermal energy to drive a refrigeration system that can be used to cool some critical electronic components. The laboratory model was tested for it performance at various cooling loads with the heat source temperature from 73 to 93 degrees C. The pressure transients during heating and cooling phases were traced. The cyclic steady state and transient performance data are presented. (C) 2010 Elsevier Ltd. All rights reserved.

Investigations of a two-stage pulse tube cryocooler operating down to 2.5K

A two-stage pulse tube cryocooler (PTC) which produces a no-load temperature of similar to 2.5 K in its second stage at an operating frequency of 1.6 Hz has been designed and fabricated. The second stage of the system provides a refrigeration power of similar to 250 mW at 5.0 K. The system uses stainless steel meshes (mesh size 200) along with lead (Pb) granules and combinations of Pb, Er3Ni, and HoCu2 as the first and second stage regenerator materials, respectively. Experimental studies have been carried out on different pulse tube configurations by varying the dimensions of the pulse tubes and regenerators to arrive at the best one, which leads to the lowest no-load second stage cold head temperature. Using this configuration, detailed experimental studies have been conducted by varying the volume percentage ratios of the second stage regenerator materials such as HoCu2, Er3Ni, and Pb (with an average grain size of similar to 250 mu m). This article presents the results of our experimental studies on cryocoolers with the regenerator material arranged in layered structures. Comparative studies have also been presented for specific cases where the regenerator materials are arranged as a homogeneous mixture in the second stage. The experimental results clearly indicate that the design of PTCs should use only layered structures of regenerator materials and not homogenous mixtures.