Length of Stay-Based Patient Flow Models: Recent Developments and Future Directions

Modelling patient flow in health care systems is vital in understanding the system activity and may therefore prove to be useful in improving their functionality. An extensively used measure is the average length of stay which, although easy to calculate and quantify, is not considered appropriate when the distribution is very long-tailed. In fact, simple deterministic models are generally considered inadequate because of the necessity for models to reflect the complex, variable, dynamic and multidimensional nature of the systems. This paper focuses on modelling length of stay and flow of patients. An overview of such modelling techniques is provided, with particular attention to their impact and suitability in managing a hospital service.

Changes in solar activity and Holocene climatic shifts derived from C-14 wiggle-match dated peat deposits

Closely spaced sequences of accelerator mass spectrometer (AMS) C-14 dates of peat deposits display century-scale wiggles which can be fitted to the radiocarbon calibration curve. By wiggle-matching such sequences, high-precision calendar age chronologies can be generated which show that changes in mire surface wetness during the Bronze Age/Iron Age transition (c. 850 cal. BC) and the 'Little Ice Age' (Wolf, Sporer, Maunder and Dalton Minima) occurred during periods of suddenly increasing atmospheric concentration of C-14. Replicate evidence from peat-based proxy climate indicators in northwest Europe suggest these changes in climate may have been driven by temporary declines of solar activity. Carbon-accumulation rates of two raised peat bogs in the UK and Denmark record low values during the 'Little Ice Age' which reflects reduced primary productivity of the peat-forming vegetation during these periods of climatic deterioration.

Antimicrobial activity of short, synthetic cationic lipopeptides.

The increasing emergence of multidrug-resistant micro-organisms presents one of the greatest challenges in the clinical management of infectious diseases. Therefore, novel antimicrobial agents are urgently required to address this issue. In this report, we describe the solid phase synthesis, characterization, microbiological and toxicological evaluation of a library of ultrashort cationic antimicrobial lipopeptides based on the previously described tetrapeptide amide H-Orn-Orn-Trp-Trp-NH2 conjugated with saturated fatty acids which have inherent antimicrobial activity. The microbiological activity of these ultrashort cationic lipopeptides, which exhibit excellent, broad-spectrum antimicrobial activity against a number of clinically important pathogenic bacteria and fungi, including multidrug resistant micro-organisms in both planktonic and sessile (biofilm) cultures is reported.

Immunobiosensor detection of domoic acid as a screening test in bivalve molluscs: Comparison with liquid chromatography-based analysis

A rapid and sensitive immuno-based screening method was developed to detect domoic acid (DA) present in extracts of shellfish species using a surface plasmon resonance-based optical biosensor. A rabbit polyclonal antibody raised against DA was mixed with standard or sample extracts and allowed to interact with DA immobilized onto a sensor chip surface. The characterization of the antibody strongly suggested high cross-reactivity with DA and important isomers of the toxin. The binding of this antibody to the sensor chip surface was inhibited in the presence of DA in either standard solutions or sample extracts. The DA chip surface proved to be highly stable, achieving approximately 800 analyses per chip without any loss of surface activity. A single analytical cycle (sample injection, chip regeneration, and system wash) took 10 min to complete. Sample analysis (scallops, mussels, cockles, oysters) was achieved by simple extraction with methanol. These extracts were then filtered and diluted before analysis. Detection limits in the ng/g range were achieved by the assay; however, the assay parameters chosen allowed the test to be performed most accurately at the European Union's official action limit for DA of 20 mu g/g. At this concentration, intra- and interassay variations were measured for a range of shellfish species and ranged from 4.5 to 7.4% and 2.3 to 9.7%, respectively.

Rational Design of Acridine-Based Ligands with Selectivity for Human Telomeric Quadruplexes

Structure-based modeling methods have been used to design a series of disubstituted triazole-linked acridine compounds with selectivity for human telomeric quadruplex DNAs. A focused library of these compounds was prepared using click chemistry and the selectivity concept was validated against two promoter quadruplexes from the c-kit gene with known molecular structures, as well as with duplex DNA using a FRET-based melting method. Lead compounds were found to have reduced effects on the thermal stability of the c-kit quadruplexes and duplex DNA structures. These effects were further explored with a series of competition experiments, which confirmed that binding to duplex DNA is very low even at high duplex:telomeric quadruplex ratios. Selectivity to the c-kit quadruplexes is more complex, with some evidence of their stabilization at increasing excess over human telomeric quadruplex DNA. Selectivity is a result of the dimensions of the triazole-acridine compounds; and in particular the separation of the two alkyl-amino terminal groups. Both lead compounds also have selective inhibitory effects on the proliferation of cancer cell lines compared to a normal cell line, and one has been shown to inhibit the activity of the telomerase enzyme, which is selectively expressed in tumor cells, where it plays a role in maintaining telomere integrity and cellular immortalization.

An efficient feature selection method for mobile devices with application to activity recognition

This paper presents a feature selection method for data classification, which combines a model-based variable selection technique and a fast two-stage subset selection algorithm. The relationship between a specified (and complete) set of candidate features and the class label is modelled using a non-linear full regression model which is linear-in-the-parameters. The performance of a sub-model measured by the sum of the squared-errors (SSE) is used to score the informativeness of the subset of features involved in the sub-model. The two-stage subset selection algorithm approaches a solution sub-model with the SSE being locally minimized. The features involved in the solution sub-model are selected as inputs to support vector machines (SVMs) for classification. The memory requirement of this algorithm is independent of the number of training patterns. This property makes this method suitable for applications executed in mobile devices where physical RAM memory is very limited. An application was developed for activity recognition, which implements the proposed feature selection algorithm and an SVM training procedure. Experiments are carried out with the application running on a PDA for human activity recognition using accelerometer data. A comparison with an information gain based feature selection method demonstrates the effectiveness and efficiency of the proposed algorithm.

The back 2 activity trial: education and advice versus education and advice plus a structured walking programme for chronic low back pain.:education and advice versus education and advice plus a structured walking programme for chronic low back pain

BACKGROUND: Current evidence supports the use of exercise-based treatment for chronic low back pain that encourages the patient to assume an active role in their recovery. Walking has been shown it to be an acceptable type of exercise with a low risk of injury. However, it is not known whether structured physical activity programmes are any more effective than giving advice to remain active.

METHODS/DESIGN: The proposed study will test the feasibility of using a pedometer-driven walking programme, as an adjunct to a standard education and advice session in participants with chronic low back pain. Fifty adult participants will be recruited via a number of different sources. Baseline outcome measures including self reported function; objective physical activity levels; fear-avoidance beliefs and health-related quality of life will be recorded. Eligible participants will be randomly allocated under strict, double blind conditions to one of two treatments groups. Participants in group A will receive a single education and advice session with a physiotherapist based on the content of the 'Back Book'. Participants in group B will receive the same education and advice session. In addition, they will also receive a graded pedometer-driven walking programme prescribed by the physiotherapist. Follow up outcomes will be recorded by the same researcher, who will remain blinded to group allocation, at eight weeks and six months post randomisation. A qualitative exploration of participants' perception of walking will also be examined by use of focus groups at the end of the intervention. As a feasibility study, treatment effects will be represented by point estimates and confidence intervals. The assessment of participant satisfaction will be tabulated, as will adherence levels and any recorded difficulties or adverse events experienced by the participants or therapists. This information will be used to modify the planned interventions to be used in a larger randomised controlled trial.

DISCUSSION: This paper describes the rationale and design of a study which will test the feasibility of using a structured, pedometer-driven walking programme in participants with chronic low back pain.

TRIAL REGISTRATION: [ISRCTN67030896].

Catalytic hydrogenation of tertiary amides at low temperatures and pressures using bimetallic Pt/Re-based catalysts

Hydrogenation of tertiary amides, in particular, N-methylpyrrolidin-2-one, can be efficiently facilitated by a TiO(2)-supported bimetallic Pt/Re catalyst at low temperatures and pressures. Characterisation of the catalysts and kinetic tests have shown that the close interaction between the Re and Pt is crucial to the high activity observed. DFT calculations were used to examine a range of metal combinations and show that the role of the uncoordinated Re is to activate the C=O and that of the Pt is as a hydrogenation catalyst, removing intermediates from the catalyst surface. The rate enhancement observed on the TiO(2) support is thought to be due to the presence of oxygen vacancies allowing adsorption and weakening of the C=O bond. (C) 2011 Elsevier Inc. All rights reserved.

ZnO based nanowires grown by chemical vapour deposition for selective hydrogenation of acetylene alcohols

Vertically aligned ZnO nanowires (NWs) with a length of 1.5-10 mu m and a mean diameter of ca. 150 nm were grown by chemical vapour deposition onto a c-oriented ZnO seed layer which was deposited by atomic layer deposition on Si substrates. The substrates were then spin-coated with an ethanol solution containing Pd nanoparticles with an average size of 2.7 and 4.5 nm. A homogeneous distribution of the Pd nanoparticles on ZnO NWs has been obtained using both Pd particle series. The catalytic activity of the ZnO NWs and Pd/ZnO NWs catalysts was measured in the semihydrogenation of 2-methyl-3-butyn-2-ol at 303-343 K and a pressure of 2-10 bar. The effect of the solvent used on the catalytic performance of the Pd/ZnO NWs catalyst was studied. The Pd/ZnO catalysts showed alkene selectivity of up to 95% at an alkyne conversion of 99%. A kinetic model is proposed to explain the activity and selectivity of the ZnO support and Pd/ZnO catalysts.

New Cu-Based Catalysts Supported on TiO2 Films for Ullmann SNAr-Type C-O Coupling Reactions

New routes for the preparation of highly active TiO2-supported Cu and CuZn catalysts have been developed for C-O coupling reactions. Slurries of a titania precursor were dip-coated onto glass beads to obtain either structured mesoporous or non-porous titania thin films. The Cu and CuZn nanoparticles, synthesized using a reduction by solvent method, were deposited onto calcined films to obtain a Cu loading of 2 wt%. The catalysts were characterized by inductively coupled plasma (ICP) spectroscopy, temperature-programmed oxidation/reduction (TPO/TPR) techniques, Cu-63 nuclear magnetic resonance (NMR) spectroscopy, X-ray diffraction (XRD), scanning and transmission electron microscopy (S/TEM-EDX) and X-ray photo-electron spectroscopy (XPS). The activity and stability of the catalysts obtained have been studied in the C-O Ullmann coupling of 4-chloropyridine and potassium phenolate. The titania-supported nanoparticles retained catalyst activity for up to 12 h. However, catalyst deactivation was observed for longer operation times due to oxidation of the Cu nanoparticles. The oxidation rate could be significantly reduced over the CuZn/TiO2 catalytic films due to the presence of Zn. The 4-phenoxypyridine yield was 64% on the Cu/nonporous TiO2 at 120 degrees C. The highest product yield of 84% was obtained on the Cu/mesoporous TiO2 at 140 degrees C, corresponding to an initial reaction rate of 104 mmol g(cat)(-1) s(-1). The activation energy on the Cu/mesoporous TiO2 catalyst was found to be (144 +/- 5) kJ mol(-1), which is close to the value obtained for the reaction over unsupported CuZn nanoparticles (123 +/- 3 kJ mol(-1)) and almost twice the value observed over the catalysts deposited onto the non-porous TiO2 support (75 +/- 2 kJ mol(-1)).

The Kinetics of Semiconductor Photocatalysis in Activity-Indicator Films

The kinetics of dye reduction, in photocatalyst indicator ink films on self cleaning glass, is studied with respect to dye concentration. The water-based, photocatalyst indicator inks comprised a redox dye, D-ox, a sacrificial electron donor (glycerol) and a polymer, hydroxyethyl cellulose. The dyes used were: Resazurin (Rz), dichloroindo-phenol (DCIP) and methylene blue (MB), although the latter required acidification of the ink (0.01M HCl) to make it work effectively under ambient conditions. Under anaerobic conditions, the photoreduction of each of the dyes, in an otherwise identical ink formulation, on Activ (TM) self-cleaning glass is zero-order with respect to [D-ox]. Seven commercial samples of Rz, each in a typical ink formulation, were tested on the same piece of self-cleaning glass under aerobic conditions and produced a striking range (over 280%) of different apparent activities for the glass, when there should have been none. The underlying cause of this variation in assessed activity is shown to be due to the combination of a variation in the purity of the commercial samples and the zero-order nature of the kinetics of indicator dye reduction. The relevance of this work and the latter observation, in particular to future use of these films for the rapid assessment of the activities of new and established photocatalytic films, is briefly discussed.

A comparative study of three techniques for determining photocatalytic activity

Quantitative measurement of the activity of photoactive films is an area of importance. The establishment of tests for standardisation of performance is important for efficient research but also a major milestone in achieving technology acceptance. In this paper, we compare three different techniques across a range of film samples from various sources. Furthermore, we demonstrate the potential of the dye-based approach as a quick and simple test. A series of photoactive film samples are compared for measured activity against each test. The test is shown to be capable of reproducible and quantitative activity results. The test has potential for use

A web-based overview of semiconductor photochemistry-based current commercial applications

The major current commercial applications of semiconductor photochemistry promoted on the world wide web are reviewed. The basic principles behind the different applications are discussed, including the use of semiconductor photochemistry to: photo-mineralise organics, photo-sterilise and photo-demist. The range of companies, and their products, which utilise semiconductor photochemistry are examined and typical examples listed. An analysis of the geographical distribution of current commercial activity in this area is made. The results indicate that commercial activity in this area is growing world-wide, but is especially strong in Japan. The number and geographical distribution of patents in semiconductor photocatalysis are also commented on. The trends in the numbers of US and Japanese patents over the last 6 years are discussed. (C) 2002 Elsevier Science B.V. All rights reserved.

OXIDATION OF CHLORIDE TO CHLORINE BY CEIV IONS MEDIATED BY DIFFERENT RUIV AND IRIV OXIDE-BASED CATALYSTS

A number of different, characterised, supported and unsupported oxides of Ru(IV) and Ir(IV) have been tested for activity as a chlorine catalyst in the oxidation of brine by Ce(IV) ions. All the different materials tested gave yields of chlorine of > 90% and first-order kinetics for the reduction of the Ce(IV) ions. The samples prepared by the Adams method were the most active of the materials tested and are typified by high surface areas and appreciable activities per unit area. The kinetics of the catalysed reduction of Ce(IV) ions by brine were studied in detail using an Ru(IV) oxide prepared by the Adams method and supported on TiO2 and the results were rationalised in terms of an electrochemical model in which the rate-determining step is the diffusion-controlled reduction of Ce(IV) ions. In support of this model the measured activation energies for the oxidation of brine by Ce(IV) ions, catalysed by either a supported or unsupported Adams catalyst, were both close (18-21 kJ mol-1) to that expected for a diffusion-controlled reaction (ca. 15 kJ mol-1).

The effectiveness of physical activity interventions in socio-economically disadvantaged communities: A systematic review.

OBJECTIVE: Interventions to increase levels of physical activity (PA) in socio-economically disadvantaged communities are needed but little is known about their effectiveness. This review examines the effectiveness of interventions designed to increase PA in these communities and the theoretical frameworks and components used. METHODS: Five databases were searched for papers published in English between January 2000 and December 2010 that reported outcomes of PA interventions in socio-economically disadvantaged communities. Studies targeting individuals with pre-existing disease and not reporting a measure of free-living PA were excluded. Two reviewers independently extracted data and evaluated quality of evidence against pre-defined criteria. RESULTS: Of 478 publications identified, 27 were included. We found that group-based interventions were effective for adults but not for children; evidence for the effectiveness of interventions targeting individuals was insufficient; limited evidence suggested that community-wide interventions produced small changes in PA. Interventions underpinned by any theoretical framework, compared to none, were more likely to be effective. Several effective interventions included education, PA and social support components. CONCLUSION: Compared to other approaches, multi-component adult group-based interventions with theoretical frameworks are most effective in increasing PA in socio-economically disadvantaged communities. More robust evaluations of interventions targeting individuals in these 'hard-to-reach' communities are required. Copyright © 2012. Published by Elsevier Inc.