Influence of prolonged hospitalization on overall bed occupancy: a five-year single-centre study

Background: Effective bed use is crucial to an efficient NHS. Current targets suggest a decrease in mean occupancy as the most appropriate method of improving overall efficiency. The elderly and those suffering from complex medical problems are thought to account for a high proportion of overall bed occupancy.

Aim: To assess the effect of prolonged hospital stay (>100 days) on overall bed occupancy in a modern teaching hospital.

Design: Retrospective analysis.

Methods: Analysis of all admission episodes (n = 117 178) over a five-year period in a large teaching hospital in a single UK region, serving a population of approximately 200 000. A logistic regression multi-factorial model was used to assess the effect of demographic and diagnostic variables on duration of stay.

Results: A prolonged stay (>100 days) was seen in 648 admission episodes (0.6%). These accounted for 11% of the overall bed occupancy over the 5-year period. Excluding all prolonged admission episodes from our analysis made no difference to the overall median length of stay.

Discussion: Prolonged hospitalizations have a significant impact on bed occupancy. Targeting these very long (>100 days) hospital stays may better improve overall efficiency, compared to targeting mean or median length of stay.

On the evolutionary status of short-period cataclysmic variables

We present high-speed, three-colour photometry of seven short-period (Porb

Roche tomography of cataclysmic variables - IV. Star-spots and slingshot prominences on BV Cen

We present Roche tomograms of the G5-G8 IV/V secondary star in the long-period cataclysmic variable BV Cen reconstructed from Magellan Inamori Kyocera Echelle spectrograph echelle data taken on the Magellan Clay 6.5-m telescope. The tomograms show the presence of a number of large, cool star-spots on BV Cen for the first time. In particular, we find a large high-latitude spot which is deflected from the rotational axis in the same direction as seen on the K3-K5 IV/V secondary star in the cataclysmic variable AE Aqr. BV Cen also shows a similar relative paucity of spots at latitudes between 40° and 50° when compared with AE Aqr. Furthermore, we find evidence for an increased spot coverage around longitudes facing the white dwarf which supports models invoking star-spots at the L1 point to explain the low states observed in some cataclysmic variables. In total, we estimate that some 25 per cent of the Northern hemisphere of BV Cen is spotted. We also find evidence for a faint, narrow, transient emission line with characteristics reminiscent of the peculiar low-velocity emission features observed in some outbursting dwarf novae. We interpret this feature as a slingshot prominence from the secondary star and derive a maximum source size of 75000 km and a minimum altitude of 160000 km above the orbital plane for the prominence. The entropy landscape technique was applied to determine the system parameters of BV Cen. We find M1 = 1.18 +/-0.280.16Msolar and M2 = 1.05 +/-0.230.14Msolar and an orbital inclination of i = 53° +/- 4° at an optimal systemic velocity of ? = -22.3 km s-1. Finally, we also report on the previously unknown binarity of the G5IV star HD 220492.

Roche tomography of cataclysmic variables - III. Star-spots on AE Aqr

We present a Roche tomography reconstruction of the secondary star in the cataclysmic variable AE Aqr. The tomogram reveals several surface inhomogeneities that are due to the presence of large, cool star-spots. In addition to a number of lower latitude spots, the maps also show the presence of a large, high-latitude spot similar to that seen in Doppler images of rapidly rotating isolated stars, and a relative paucity of spots at a latitude of 40 degrees. In total, we estimate that some 18 per cent of the Northern hemisphere of AE Aqr is spotted.

ULTRACAM photometry of the eclipsing cataclysmic variables GY Cnc, IR Com and HT Cas

We present high-speed, three-colour photometry of the eclipsing cataclysmic variables GY Cnc, IR Com and HT Cas. We find that the sharp eclipses in GY Cnc and IR Com are due to eclipses of the white dwarf. There is some evidence for a bright-spot on the edge of the accretion disc in GY Cnc, but not in IR Com. Eclipse mapping of HT Cas is presented which shows changes in the structure of the quiescent accretion disc. Observations in 2002 show the accretion disc to be invisible except for the presence of a bright-spot at the disc edge. 2003 observations, however, clearly show a bright inner disc and the bright-spot to be much fainter than in 2002. Although no outburst was associated with either set of quiescent observations, the system was similar to 0.6 mJy brighter in 2003, mainly due to the enhanced emission from the inner disc. We propose that these changes are due to variations in the mass-transfer rate from the secondary star and through the disc. The disc colours indicate that it is optically thin in both its inner and outer regions. We estimate the white dwarf temperature of HT Cas to be 15 000 +/- 1000 K in 2002 and 14 000 +/- 1000 K in 2003.

The masses of the cataclysmic variables AC Cancri and V363 Aurigae

We present time-resolved spectroscopy and photometry of the double-lined eclipsing cataclysmic variables AC Cnc and V363 Aur (=Lanning 10). There is evidence of irradiation on the inner hemisphere of the secondary star in both systems, which we correct for using a model that reproduces the observations remarkably well. We find the radial velocity of the secondary star in AC Cnc to be K-R=176+/-3 km s(-1) and its rotational velocity to be v sin i=135+/-3 km s(-1). From these parameters we obtain masses of M-1=0.76+/-0.03 M-circle dot for the white-dwarf primary and M-2=0.77+/-0.05 M-circle dot for the K2+/-1 V secondary star, giving a mass ratio of q=1.02+/-0.04. We measure the radial and rotational velocities of the G7+/-2V secondary star in V363 Aur to be K-R=168+/-5 km s(-1) and v sin i=143+/-5 km s(-1), respectively. The component masses of V363 Aur are M-1=0.90+/-0.06M(circle dot) and M-2=1.06+/-0.11 M-circle dot giving a mass ratio of q=1.17+/-0.07. The mass ratios for AC Cnc and V363 Aur fall within the theoretical limits for dynamically and thermally stable mass transfer. Both systems are similar to the SW Sex stars, exhibiting single-peaked emission lines with transient absorption features, high-velocity S-wave components and phase-offsets in their radial-velocity curves. The Balmer lines in V363 Aur show a rapid increase in flux around phase 0 followed by a rapid decrease, which we attribute to the eclipse of an optically thick region at the centre of the disc. This model could also account for the behaviour of other SW Sex stars where the Balmer lines show only a shallow eclipse compared to the continuum.

Roche tomography of cataclysmic variables - II. Images of the secondary stars in AM Her, QQ Vul, IP Peg and HU Aqr

We present a set of Roche tomography reconstructions of the secondary stars in the cataclysmic variables AM Her, QQ Vul, IP Peg and HU Aqr. The image reconstructions show distinct asymmetries in the irradiation pattern for all four systems that can be attributed to shielding of the secondary star by the accretion stream/column in AM Her, QQ Vul and HU Aqr, and increased irradiation by the bright-spot in IP Peg. We use the entropy landscape technique to derive accurate system parameters (M-1, M-2, i and gamma) for the four binaries. In principle, this technique should provide the most reliable mass determinations available, since the intensity distribution across the secondary star is known. We also find that the intensity distribution can systematically affect the value of gamma derived from circular orbit fits to radial velocity variations.

Roche tomography of cataclysmic variables - I. Artefacts and techniques

Roche tomography is a technique used for imaging the Roche-lobe-filling secondary stars in cataclysmic variables (CVs). In order to interpret Roche tomograms correctly, one must determine whether features in the reconstruction are real, or the result of statistical or systematic errors. We explore the effects of systematic errors using reconstructions of simulated data sets, and show that systematic errors result in characteristic distortions of the final reconstructions that can be identified and corrected. In addition, we present a new method of estimating statistical errors on tomographic reconstructions using a Monte Carlo bootstrapping algorithm, and show this method to be much more reliable than Monte Carlo methods which 'jiggle' the data points in accordance with the size of their error bars.

The role played by a range of psychological variables in nurses’ handwashing behaviour

Background: Psychological models of behaviour change are used to predict patients’ health behaviours but have rarely been used to explore healthcare professionals’ health-related behaviour. Aim: To explore the association between self-reported handwashing and a range of psychological variables in a sample of nurses in a large acute hospital. Results and discussion: Nurses in this study were more likely to wash their hands if they perceived it to be important and if they thought their workplace helped them in doing so. The best predictor of perceived importance was how strongly a nurse believed that poor handwashing practice contributes to spreading infection. Conclusion: In this study, psychological variables such as perception of importance, perception of workplace support, occupational stress and perception of risk were important predictors of handwashing behaviour.