Using Discrete Event Simulation (DES) to manage theatre operations in healthcare: An audit-based case study

This paper discusses the application of Discrete Event Simulation (DES) in modelling the complex relationship between patient types, case-mix and operating theatre allocation in a large National Health Service (NHS) Trust in London. The simulation model that was constructed described the main features of nine theatres, focusing on operational processes and patient throughput times. The model was used to test three scenarios of case-mix and to demonstrate the potential of using simulation modelling as a cost effective method for understanding the issues of healthcare operations management and the role of simulation techniques in problem solving. The results indicated that removing all day cases will reduce patient throughput by 23.3% and the utilization of the orthopaedic theatre in particular by 6.5%. This represents a case example of how DES can be used by healthcare managers to inform decision making. © 2008 IEEE.

Continuous F0 in the source-excitation generation for HMM-based TTS: Do we need voiced/unvoiced classification?

Most HMM-based TTS systems use a hard voiced/unvoiced classification to produce a discontinuous F0 signal which is used for the generation of the source-excitation. When a mixed source excitation is used, this decision can be based on two different sources of information: the state-specific MSD-prior of the F0 models, and/or the frame-specific features generated by the aperiodicity model. This paper examines the meaning of these variables in the synthesis process, their interaction, and how they affect the perceived quality of the generated speech The results of several perceptual experiments show that when using mixed excitation, subjects consistently prefer samples with very few or no false unvoiced errors, whereas a reduction in the rate of false voiced errors does not produce any perceptual improvement. This suggests that rather than using any form of hard voiced/unvoiced classification, e.g., the MSD-prior, it is better for synthesis to use a continuous F0 signal and rely on the frame-level soft voiced/unvoiced decision of the aperiodicity model. © 2011 IEEE.

Improved transmission performance of adaptively modulated optical OFDM signals over directly modulated DFB laser-based IMDD links using adaptive cyclic prefix.

The impact of Adaptive Cyclic Prefix (ACP) on the transmission performance of Adaptively Modulated Optical OFDM (AMOOFDM) is explored thoroughly in directly modulated DFB laser-based, IMDD links involving Multimode Fibres (MMFs)/Single-Mode Fibres (SMFs). Three ACP mechanisms are identified, each of which can, depending upon the link properties, affect significantly the AMOOFDM transmission performance. In comparison with AMOOFDM having a fixed cyclic prefix duration of 25%, AMOOFDM with ACP can not only improve the transmission capacity by a factor of >2 (>1.3) for >1000 m MMFs (<80 km SMFs) with 1 dB link loss margin enhancement, but also relax considerably the requirement on the DFB bandwidth.

Computational modelling and characterisation of nanoparticle-based tuneable photonic crystal sensors

Photonic crystals are materials that are used to control or manipulate the propagation of light through a medium for a desired application. Common fabrication methods to prepare photonic crystals are both costly and intricate. However, through a cost-effective laser-induced photochemical patterning, one-dimensional responsive and tuneable photonic crystals can easily be fabricated. These structures act as optical transducers and respond to external stimuli. These photonic crystals are generally made of a responsive hydrogel that can host metallic nanoparticles in the form of arrays. The hydrogel-based photonic crystal has the capability to alter its periodicity in situ but also recover its initial geometrical dimensions, thereby rendering it fully reversible and reusable. Such responsive photonic crystals have applications in various responsive and tuneable optical devices. In this study, we fabricated a pH-sensitive photonic crystal sensor through photochemical patterning and demonstrated computational simulations of the sensor through a finite element modelling technique in order to analyse its optical properties on varying the pattern and characteristics of the nanoparticle arrays within the responsive hydrogel matrix. Both simulations and experimental results show the wavelength tuneability of the sensor with good agreement. Various factors, including nanoparticle size and distribution within the hydrogel-based responsive matrices that directly affect the performance of the sensors, are also studied computationally. © 2014 The Royal Society of Chemistry.

TN : TP ratio and planktivorous fish do not affect nutrient-chlorophyll relationships in shallow lakes

1. In previous work, phytoplankton regulation in freshwater lakes has been associated with many factors. Among these, the ratio of total nitrogen to total phosphorus (TN : TP) has been widely proposed as an index to identify whether phytoplankton are N- or P-limited. From another point of view, it has been suggested that planktivorous fish can be used to control phytoplankton. 2. Large-scale investigations of phytoplankton biomass [measured as chlorophyll a, (chl-a)] were carried out in 45 mid-lower Yangtze shallow lakes to test hypotheses concerning nutrient limitation (assessed with TN : TP ratios) and phytoplankton control by planktivorous fish. 3. Regression analyses indicated that TP was the primary regulating factor and TN the second regulating factor for both annual and summer phytoplankton chl-a. In separate nutrient-chl-a regression analyses for lakes of different TN : TP ratios, TP was also superior to TN in predicting chl-a at all particular TN : TP ranges and over the entire TN : TP spectrum. Further analyses found that chl-a : TP was not influenced by TN : TP, while chl-a : TN was positively and highly correlated to TP : TN. 4. Based on these results, and others in the literature, we argue that the TN : TP ratio is inappropriate as an index to identify limiting nutrients. It is almost impossible to specify a 'cut-off' TN : TP ratio to identify a limiting nutrient for a multi-species community because optimal N : P ratios vary greatly among phytoplankton species. 5. Lakes with yields of planktivorous fish (silver and bighead carp, the species native to China) > 100 kg ha(-1) had significantly higher chl-a and lower Secchi depth than those with yields < 100 kg ha(-1). TP-chl-a and TP-Secchi depth relationships are not significantly different between lakes with yields > 100 kg ha(-1) or < 100 kg ha(-1). These results indicate that the fish failed to decrease chl-a yield or enhance Z(SD). Therefore, silver carp and bighead carp are not recommended as a biotic agent for phytoplankton control in lake management if the goal is to control the entire phytoplankton and to enhance water quality.

Study of remote sensing based parameter uncertainty in Production Efficiency Models

The remote sensing based Production Efficiency Models (PEMs), springs from the concept of "Light Use Efficiency" and has been applied more and more in estimating terrestrial Net Primary Productivity (NPP) regionally and globally. However, global NPP estimates vary greatly among different models in different data sources and handling methods. Because direct observation or measurement of NPP is unavailable at global scale, the precision and reliability of the models cannot be guaranteed. Though, there are ways to improve the accuracy of the models from input parameters. In this study, five remote sensing based PEMs have been compared: CASA, GLO-PEM, TURC, SDBM and VPM. We divided input parameters into three categories, and analyzed the uncertainty of (1) vegetation distribution, (2) fraction of photosynthetically active radiation absorbed by the canopy (fPAR) and (3) light use efficiency (e). Ground measurements of Hulunbeier typical grassland and meteorology measurements were introduced for accuracy evaluation. Results show that a real-time, more accurate vegetation distribution could significantly affect the accuracy of the models, since it's applied directly or indirectly in all models and affects other parameters simultaneously. Higher spatial and spectral resolution remote sensing data may reduce uncertainty of fPAR up to 51.3%, which is essential to improve model accuracy.

Gold nanoparticle-based near-infrared fluorescent detection of biological thiols in human plasma

In this work, a new fluorescent method for sensitive detection of biological thiols in human plasma was developed using a near-infrared (NIR) fluorescent dye, FR 730. The sensing approach was based on the strong affinity of thiols to gold and highly efficient fluorescent quenching ability of gold nanoparticles (Au NPs). In the presence of thiols, the NIR fluorescence would enhance dramatically due to desorption of FR 730 from the surfaces of Au NPs, which allowed the analysis of thiol-containing amino acids in a very simple approach. The size of Au NPs was found to affect the fluorescent assay and the best response for cysteine detection was achieved when using Au NPs with the diameter of 24 nm, where a linear range of 2.5 x 10(-8) M to 4.0 x 10(-6) M and a detection limit of as low as 10 nM was obtained. This method also demonstrated a high selectivity to thiol-containing amino acids due to the strong affinity of thiols to gold.

Turn-on fluorescent detection of cyanide based on the inner filter effect of silver nanoparticles

A simple, sensitive fluorescent method for detecting cyanide has been developed based on the inner filter effect (IFE) of silver nanoparticles (Ag NPs). With a high extinction coefficient and tunable plasmon absorption feature, Ag NPs are expected to be a powerful absorber to tune the emission of the fluorophore in the IFE-based fluorescent assays. In the present work, we developed a turn-on fluorescent assay for cyanide based on the strong absorption of Ag NPs to both excitation and emission light of an isolated fluorescence indicator. In the presence of cyanide, the absorber Ag NPs will dissolve gradually, which then leads to recovery of the IFE-decreased emission of the fluorophore. The concentration of Ag NPs in the detection system was found to affect the fluorescence response toward cyanide greatly. Under the optimum conditions, the present IFE-based approach can detect cyanide ranging from 5.0 x 10 (7) to 6.0 x 10 (4) M with a detection limit of 2.5 x 10 (7) M, which is much lower than the corresponding absorbance-based approach and compares favorably with other reported fluorescent methods.

Ligand effect on the performance of organic light-emitting diodes based on europium complexes

A series of europium complexes were synthesized and their electroluminescent (EL) characteristics were studied. It was found by comparison that the different substituted groups, such as methyl, chlorine, and nitryl, on ligand 1,10-phenanthroline affect significantly the EL performance of devices based on these complexes. The more methyl-substituted groups on ligand 1,10-phenanthroline led to higher device efficiency. A chlorine-substituted group showed the approximate EL performance as two methyl-substituted groups, whereas a nitryl substituent reduced significantly the EL luminous efficiency. However, beta-diketonate ligand TTA and DBM exhibited similar EL performance. The improved EL luminous efficiency by proper substituted groups on the 1, 10-phenanthroline was attributed to the reduction of the energy loss caused by light hydrogen atom vibration, as well as concentration quenching caused by intermolecular interaction, and the match of energy level between the ligand and Eu3+.

Shape-memory and biocompatibility properties of segmented polyurethanes based on poly(L-lactide)

A series of segmented poly (L-lactide)-polyurethanes (PLA-PU) were synthesized by a two-step method, with oligo-poly(L-lactide) (PLA) as the soft segments and the reaction product of 2,4-toluene diisocyanate(TDI) and ethylene glycol(EG) as the hard segments. The shape memory properties of PLA-PUs were examined. The processed PLA-PUs could recover almost 100% to their original shape within 10 degrees C from the lowest recovery temperature. In the recovery process, the PLA-PUs showed a maximum contracting stress of shape change in the range of 1.5-4 MPa depending on the PLA segmental length and the hard-segmental content and higher than that of poly (e-caprolactone polyurethane) (PCL-PU). Besides, the influence of deforming and fixing temperatures on shape memory properties of PLA-PU was studied in detail. They could affect not only the recovery temperature but also the maximum contracting stress. The experiments of cell incubation were used to evaluate the biocompatibility of PLA-PU. The results show that the biocompatibility of PLA-PU is comparable to that of the pure PLA. This kind of polyurethane can be used as implanted medical devices with a shape memory property.

Electrochemical characteristic of LaNi-based hydrogen storage alloys

Effect of purity of alloy components on the electrode performance of LaNi2 alloys was investigated. The results showed the purity of components had less effect on discharge capacity and self-discharge of LaNi2 alloys. Partial substitution of Al or Mn for Ni greatly improved discharge properties of LaNi2-xAlx, or LaNi2-yMny alloys as negative electrodes in MFl-Ni battery, 0.15less than or equal toxless than or equal to0.25; 0.15less than or equal toyless than or equal to0.25. In addition, surface treatment of LaNi1.8Al0.2 alloy electrode was performed by polymerizing cis-butenedioate with Co-60- gamma -ray radiation, which. had better affect on self-discharge and cycle life of the alloy electrodes at low temperature(-28 C-degrees).

A simulation-based design method to transfer surface mount RF system to flip-chip die implementation

The flip-chip technology is a high chip density solution to meet the demand for very large scale integration design. For wireless sensor node or some similar RF applications, due to the growing requirements for the wearable and implantable implementations, flip-chip appears to be a leading technology to realize the integration and miniaturization. In this paper, flip-chip is considered as part of the whole system to affect the RF performance. A simulation based design is presented to transfer the surface mount PCB board to the flip-chip die package for the RF applications. Models are built by Q3D Extractor to extract the equivalent circuit based on the parasitic parameters of the interconnections, for both bare die and wire-bonding technologies. All the parameters and the PCB layout and stack-up are then modeled in the essential parts' design of the flip-chip RF circuit. By implementing simulation and optimization, a flip-chip package is re-designed by the parameters given by simulation sweep. Experimental results fit the simulation well for the comparison between pre-optimization and post-optimization of the bare die package's return loss performance. This design method could generally be used to transfer any surface mount PCB to flip-chip package for the RF systems or to predict the RF specifications of a RF system using the flip-chip technology.

Subterfuge-safe trust management for delegation of permissions in open environments

Open environments involve distributed entities interacting with each other in an open manner. Many distributed entities are unknown to each other but need to collaborate and share resources in a secure fashion. Usually resource owners alone decide who is trusted to access their resources. Since resource owners in open environments do not have a complete picture of all trusted entities, trust management frameworks are used to ensure that only authorized entities will access requested resources. Every trust management system has limitations, and the limitations can be exploited by malicious entities. One vulnerability is due to the lack of globally unique interpretation for permission specifications. This limitation means that a malicious entity which receives a permission in one domain may misuse the permission in another domain via some deceptive but apparently authorized route; this malicious behaviour is called subterfuge. This thesis develops a secure approach, Subterfuge Safe Trust Management (SSTM), that prevents subterfuge by malicious entities. SSTM employs the Subterfuge Safe Authorization Language (SSAL) which uses the idea of a local permission with a globally unique interpretation (localPermission) to resolve the misinterpretation of permissions. We model and implement SSAL with an ontology-based approach, SSALO, which provides a generic representation for knowledge related to the SSAL-based security policy. SSALO enables integration of heterogeneous security policies which is useful for secure cooperation among principals in open environments where each principal may have a different security policy with different implementation. The other advantage of an ontology-based approach is the Open World Assumption, whereby reasoning over an existing security policy is easily extended to include further security policies that might be discovered in an open distributed environment. We add two extra SSAL rules to support dynamic coalition formation and secure cooperation among coalitions. Secure federation of cloud computing platforms and secure federation of XMPP servers are presented as case studies of SSTM. The results show that SSTM provides robust accountability for the use of permissions in federation. It is also shown that SSAL is a suitable policy language to express the subterfuge-safe policy statements due to its well-defined semantics, ease of use, and integrability.

Identification of major factors influencing ELISpot-based monitoring of cellular responses to antigens from Mycobacterium tuberculosis.

A number of different interferon-gamma ELISpot protocols are in use in laboratories studying antigen-specific immune responses. It is therefore unclear how results from different assays compare, and what factors most significantly influence assay outcome. One such difference is that some laboratories use a short in vitro stimulation period of cells before they are transferred to the ELISpot plate; this is commonly done in the case of frozen cells, in order to enhance assay sensitivity. Other differences that may be significant include antibody coating of plates, the use of media with or without serum, the serum source and the number of cells added to the wells. The aim of this paper was to identify which components of the different ELISpot protocols influenced assay sensitivity and inter-laboratory variation. Four laboratories provided protocols for quantifying numbers of interferon-gamma spot forming cells in human peripheral blood mononuclear cells stimulated with Mycobacterium tuberculosis derived antigens. The differences in the protocols were compared directly. We found that several sources of variation in assay protocols can be eliminated, for example by avoiding serum supplementation and using AIM-V serum free medium. In addition, the number of cells added to ELISpot wells should also be standardised. Importantly, delays in peripheral blood mononuclear cell processing before stimulation had a marked effect on the number of detectable spot forming cells; processing delay thus should be minimised as well as standardised. Finally, a pre-stimulation culture period improved the sensitivity of the assay, however this effect may be both antigen and donor dependent. In conclusion, small differences in ELISpot protocols in routine use can affect the results obtained and care should be given to conditions selected for use in a given study. A pre-stimulation step may improve the sensitivity of the assay, particularly when cells have been previously frozen.

Trust and efficiency

Agency problems within the firm are a significant hindrance to efficiency. We propose trust between coworkers as a superior alternative to the standard tools used to mitigate agency problems: increased monitoring and incentive-based pay. We model trust as mutual, reciprocal altruism between pairs of coworkers and show how it induces employees to work harder, relative to those at firms that use the standard tools. In addition, we show that employees at trusting firms have higher job satisfaction, and that these firms enjoy lower labor cost and higher profits. We conclude by discussing how trust may also be easier to use within the firm than the standard agency-mitigation tools. © 2002 Elsevier Science B.V. All rights reserved.