Looking in the wrong place for healthcare improvements: a system dynamics study of an accident and emergency department

Accident and Emergency (A&E) units provide a route for patients requiring urgent admission to acute hospitals. Public concern over long waiting times for admissions motivated this study, whose aim is to explore the factors which contribute to such delays. The paper discusses the formulation and calibration of a system dynamics model of the interaction of demand pattern, A&E resource deployment, other hospital processes and bed numbers; and the outputs of policy analysis runs of the model which vary a number of the key parameters. Two significant findings have policy implications. One is that while some delays to patients are unavoidable, reductions can be achieved by selective augmentation of resources within, and relating to, the A&E unit. The second is that reductions in bed numbers do not increase waiting times for emergency admissions, their effect instead being to increase sharply the number of cancellations of admissions for elective surgery. This suggests that basing A&E policy solely on any single criterion will merely succeed in transferring the effects of a resource deficit to a different patient group.

Parenting difficulties and postnatal depression: implications for primary healthcare assessment and intervention

Postnatal depression (PND) is associated with impairments in the mother–child relationship, and these impairments are themselves associated with adverse child outcomes. Thus, compared to the children of non-depressed mothers, children of mothers with PND are more likely to be insecurely attached, and to have externalising behaviour problems and poor cognitive development. Each of these three child outcomes is predicted by a particular pattern of difficulty in parenting: insecure attachment is related to maternal insensitivity, particularly in relation to infant distress and emotional vulnerability; externalising problems are particularly common in the context of hostile parenting; and poor cognitive development is related to parental difficulties in noticing infant signs of interest and supporting their engagement with the environment. This article sets out procedures for how parenting could be assessed in ways that are sensitive to the domain-specific associations between parenting and child outcome, while remaining sensitive to the child's developmental stage. This set of assessments requires field testing.

A cross layer protocol based on mac and routing protocols for healthcare applications using Wireless Sensor Networks

Using Wireless Sensor Networks (WSNs) in healthcare systems has had a lot of attention in recent years. In much of this research tasks like sensor data processing, health states decision making and emergency message sending are done by a remote server. Many patients with lots of sensor data consume a great deal of communication resources, bring a burden to the remote server and delay the decision time and notification time. A healthcare application for elderly people using WSN has been simulated in this paper. A WSN designed for the proposed healthcare application needs efficient MAC and routing protocols to provide a guarantee for the reliability of the data delivered from the patients to the medical centre. Based on these requirements, A cross layer based on the modified versions of APTEEN and GinMAC has been designed and implemented, with new features, such as a mobility module and routes discovery algorithms have been added. Simulation results show that the proposed cross layer based protocol can conserve energy for nodes and provide the required performance such as life time of the network, delay and reliability for the proposed healthcare application.

MAC protocols and mobility management module for healthcare applications using Wireless Sensor Networks

Using Wireless Sensor Networks (WSNs) in healthcare systems has had a lot of attention in recent years. In much of this research tasks like sensor data processing, health states decision making and emergency message sending are done by a remote server. Many patients with lots of sensor data consume a great deal of communication resources, bring a burden to the remote server and delay the decision time and notification time. A healthcare application for elderly people using WSN has been simulated in this paper. A WSN designed for the proposed healthcare application needs efficient Medium Access Control (MAC) and routing protocols to provide a guarantee for the reliability of the data delivered from the patients to the medical centre. Based on these requirements, the GinMAC protocol including a mobility module has been chosen, to provide the required performance such as reliability for data delivery and energy saving. Simulation results show that this modification to GinMAC can offer the required performance for the proposed healthcare application.

MAC protocols and mobility management module for healthcare applications using wireless sensor networks

Using Wireless Sensor Networks (WSNs) in healthcare systems has had a lot of attention in recent years. In much of this research tasks like sensor data processing, health states decision making and emergency message sending are done by a remote server. Many patients with lots of sensor data consume a great deal of communication resources, bring a burden to the remote server and delay the decision time and notification time. A healthcare application for elderly people using WSN has been simulated in this paper. A WSN designed for the proposed healthcare application needs efficient MAC and routing protocols to provide a guarantee for the reliability of the data delivered from the patients to the medical centre. Based on these requirements, the GinMAC protocol including a mobility module has been chosen, to provide the required performance such as reliability for data delivery and energy saving. Simulation results show that this modification to GinMAC can offer the required performance for the proposed healthcare application.

Patient and public involvement in healthcare quality improvement: how organizations can help patients and professionals to collaborate

Citizens across the world are increasingly called upon to participate in healthcare improvement. It is often unclear how this can be made to work in practice. This 4- year ethnography of a UK healthcare improvement initiative showed that patients used elements of organizational culture as resources to help them collaborate with healthcare professionals. The four elements were: (1) organizational emphasis on nonhierarchical, multidisciplinary collaboration; (2) organizational staff ability to model desired behaviours of recognition and respect; (3) commitment to rapid action, including quick translation of research into practice; and (4) the constant data collection and reflection process facilitated by improvement methods.

Big data architecture for pervasive healthcare: a literature review

Pervasive healthcare aims to deliver deinstitutionalised healthcare services to patients anytime and anywhere. Pervasive healthcare involves remote data collection through mobile devices and sensor network which the data is usually in large volume, varied formats and high frequency. The nature of big data such as volume, variety, velocity and veracity, together with its analytical capabilities com-plements the delivery of pervasive healthcare. However, there is limited research in intertwining these two domains. Most research focus mainly on the technical context of big data application in the healthcare sector. Little attention has been paid to a strategic role of big data which impacts the quality of healthcare services provision at the organisational level. Therefore, this paper delivers a conceptual view of big data architecture for pervasive healthcare via an intensive literature review to address the aforementioned research problems. This paper provides three major contributions: 1) identifies the research themes of big data and pervasive healthcare, 2) establishes the relationship between research themes, which later composes the big data architecture for pervasive healthcare, and 3) sheds a light on future research, such as semiosis and sense-making, and enables practitioners to implement big data in the pervasive healthcare through the proposed architecture.

What aspects of shiftwork influence off-shift well-being of healthcare workers?

Characteristics of shiftwork schedules have implications for off-shift well-being. We examined the extent to which several shift characteristics (e.g., shift length, working sundays) are associated with three aspects of off-shift well-being: work-to-family conflict, physical well-being, and mental wellbeing. We also investigated whether these relationships differed in four nations. The Survey of Work and Time was completed by 906 healthcare professionals located in Australia, Brazil, Croatia, and the USA. Hierarchical multiple regression analyses supported the hypothesis that shiftwork characteristics account for significant unique variance in all three measures of well-being beyond that accounted for by work and family demands and personal characteristics. The patterns of regression weights indicated that particular shiftwork characteristics have differential relevance to indices of work-to-family conflict, physical well-being, and mental well-being. Our findings suggest that healthcare organizations should carefully consider the implications of shiftwork characteristics for off-shift well-being. Furthermore, although our findings did not indicate national differences in the nature of relationships between shift characteristics and well-being, shiftwork characteristics and demographics for healthcare professionals differ in systematic ways among nations; as such, effective solutions may be context-specific. (c) 2008 Elsevier Ltd. All rights reserved.

Near-infrared integral field spectroscopy of the Homunculus nebula around eta Carinae using Gemini/CIRPASS

This work presents the first integral field spectroscopy of the Homunculus nebula around eta Carinae in the near-infrared spectral region (J band). We confirmed the presence of a hole on the polar region of each lobe, as indicated by previous near-IR long-slit spectra and mid-IR images. The holes can be described as a cylinder of height (i.e. the thickness of the lobe) and diameter of 6.5 and 6.0 x 10(16) cm, respectively. We also mapped the blue-shifted component of He I lambda 10830 seen towards the NW lobe. Contrary to previous works, we suggested that this blue-shifted component is not related to the Paddle but it is indeed in the equatorial disc. We confirmed the claim of N. Smith and showed that the spatial extent of the Little Homunculus matches remarkably well the radio continuum emission at 3 cm, indicating that the Little Homunculus can be regarded as a small H II region. Therefore, we used the optically thin 1.3 mm radio flux to derive a lower limit for the number of Lyman-continuum photons of the central source in eta Car. In the context of a binary system, and assuming that the ionizing flux comes entirely from the hot companion star, the lower limit for its spectral type and luminosity class ranges from O5.5 III to O7 I. Moreover, we showed that the radio peak at 1.7 arcsec NW from the central star is in the same line-of-sight of the `Sr-filament` but they are obviously spatially separated, while the blue-shifted component of He I lambda 10830 may be related to the radio peak and can be explained by the ultraviolet radiation from the companion star.

Phase portraits of quadratic polynomial vector fields having a rational first integral of degree 3

In this paper, we classify all the global phase portraits of the quadratic polynomial vector fields having a rational first integral of degree 3. (C) 2008 Elsevier Ltd. All rights reserved.

Measurement of thermal neutron cross section and resonance integral for the (165)Ho(n, gamma)(166g)Ho reaction

The ground state thermal neutron cross section and the resonance integral for the (165)Ho(n, gamma)(166)Ho reaction in thermal and 1/E regions, respectively, of a thermal reactor neutron spectrum have been measured experimentally by activation technique. The reaction product, (166)Ho in the ground state, is gaining considerable importance as a therapeutic radionuclide and precisely measured data of the reaction are of significance from the fundamental point of view as well as for application. In this work, the spectrographically pure holmium oxide (Ho(2)O(3)) powder samples were irradiated with and without cadmium covers at the IEA-RI reactor (IPEN, Sao Paulo), Brazil. The deviation of the neutron spectrum shape from 1/E law was measured by co-irradiating Co, Zn, Zr and Au activation detectors with thermal and epithermal neutrons followed by regression and iterative procedures. The magnitudes of the discrepancies that can occur in measurements made with the ideal 1/E law considerations in the epithermal range were studied. The measured thermal neutron cross section at the Maxwellian averaged thermal energy of 0.0253 eV is 59.0 +/- 2.1 b and for the resonance integral 657 +/- 36b. The results are measured with good precision and indicated a consistency trend to resolve the discrepant status of the literature data. The results are compared with the values in main libraries such as ENDF/B-VII, JEF-2.2 and JENDL-3.2, and with other measurements in the literature.

Pseudoclassical description of scalar particle in non-abelian background and path-integral representations

Path-integral representations for a scalar particle propagator in non-Abelian external backgrounds are derived. To this aim, we generalize the procedure proposed by Gitman and Schvartsman of path-integral construction to any representation of SU(N) given in terms of antisymmetric generators. And for arbitrary representations of SU(N), we present an alternative construction by means of fermionic coherent states. From the path-integral representations we derive pseudoclassical actions for a scalar particle placed in non-Abelian backgrounds. These actions are classically analyzed and then quantized to prove their consistency.

Path integral representations in noncommutative quantum mechanics and noncommutative version of Berezin-Marinov action

It is known that the actions of field theories on a noncommutative space-time can be written as some modified (we call them theta-modified) classical actions already on the commutative space-time (introducing a star product). Then the quantization of such modified actions reproduces both space-time noncommutativity and the usual quantum mechanical features of the corresponding field theory. In the present article, we discuss the problem of constructing theta-modified actions for relativistic QM. We construct such actions for relativistic spinless and spinning particles. The key idea is to extract theta-modified actions of the relativistic particles from path-integral representations of the corresponding noncommutative field theory propagators. We consider the Klein-Gordon and Dirac equations for the causal propagators in such theories. Then we construct for the propagators path-integral representations. Effective actions in such representations we treat as theta-modified actions of the relativistic particles. To confirm the interpretation, we canonically quantize these actions. Thus, we obtain the Klein-Gordon and Dirac equations in the noncommutative field theories. The theta-modified action of the relativistic spinning particle is just a generalization of the Berezin-Marinov pseudoclassical action for the noncommutative case.

Integral group ring of the Suzuki sporadic simple group

Using the Luthar-Passi method, we investigate the classical Zassenhaus conjecture for the normalized unit group of the integral group ring of the Suzuki sporadic simple group Suz. As a consequence, for this group we confirm the Kimmerle`s conjecture on prime graphs.