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.

New dates for first millennium BC tephra isochrones in Ireland

Three distinct, first millennium BC tephras (BMR-190, OMH-185, GB4-150) have been recognized in Irish peat deposits, including a previously undated ash (BMR-190). We present the results of a programme of high-precision 14C wiggle-matching on a peat profile containing all three tephras from Glen West, County Fermanagh, Northern Ireland. The wiggle-match provides highly refined dates of 705-585cal. BC for BMR-190, 755-680cal. BC for OMH-185 and 800-758cal. BC for GB4-150. The tephras constitute valuable, widespread isochrones for palaeoecological research across the first millennium BC, when a prolonged 14C calibration plateau between 750 and 400 cal. BC presents a major problem to dating and correlating palaeoenvironmental events from multisite, multiproxy studies of the period.

Emotional speech: towards a new generation of databases

Research on speech and emotion is moving from a period of exploratory research into one where there is a prospect of substantial applications, notably in human-computer interaction. Progress in the area relies heavily on the development of appropriate databases. This paper addresses the issues that need to be considered in developing databases of emotional speech, and shows how the challenge of developing apropriate databases is being addressed in three major recent projects - the Belfast project, the Reading-Leeds project and the CREST-ESP project. From these and other studies the paper draws together the tools and methods that have been developed, addresses the problems that arise and indicates the future directions for the development of emotional speech databases.