A healthcare space planning simulation model for Accident and Emergency (A&E)

The National Health Service (NHS) in the United Kingdom provides a range service for its population including primary care and hospital services. The impact of the 2008 economic and financial crises prompted a tightening of public budgets including health. Over the next few years, and most likely beyond, the NHS is planning for unprecedented levels of efficiency saving in the order of £ billions. With little doubt, the NHS will need to review its way of working will need to do more with less. Simulation is an established technique with applications in many industries including healthcare. Potentially, there are huge opportunities for simulation use to make further inroads in the field of healthcare. Despite the potential, arguably, simulation has failed to make a significant impact in health. Some evidence has tended to suggest that within health there has been poor adaption along with poor linkage to real-world problems, as perceived by healthcare stakeholders. The aim of this thesis is to develop a model to help address real-world healthcare issues as recognised by healthcare stakeholders. In doing so, this thesis will focus on a couple of real-world problems, namely: What space is needed to meet service demand, when is it needed and what will it cost? What space do we have, how can it be used to meet service demand and at what cost? The developed simulation space demand model will demonstrate its value modelling dynamic systems over static models. The developed models will also show its value highlighting space demand issues by groups of patients, by time of day. Real, readily available data (arrival and length of stay, by patient group) would drive the model inputs, supporting ease of use and clarity for healthcare stakeholders. The model was modular by design to support rapid reconfiguration. Dynamically modelled space information allows service managers and Healthcare Planners to better manage and organise their space in a flexible way to meet service requirements. This work will also describe how space demand can linked with building notes to determine Schedules of Accommodation which can be used to cost floor space and consequent building or refurbishment costs. Furthermore, this information could be used to drive business plans and to develop operational cost pertaining to the floor area. This body of work debates using function-to-space ratios and attaching facilities management cost. Our findings suggest great variance in function-to-space ratios. Our findings also suggest that moving to median or lower quartile function-to-space ratios could potentially save hospitals £ millions in facilities management costs. This thesis will reflect on the level of modelling taking place in the healthcare industry by non-academic healthcare modellers, sometimes collectively known as Healthcare Planners, the Healthcare Planning role in space planning and their links with healthcare stakeholders. This reflection will also consider whether healthcare stakeholders perceive a great need for academic healthcare modelling, if they believe their modelling needs are met by Healthcare Planners. A central theme of this thesis is that academic modelling and Healthcare Planning have great synergy and that bringing together Healthcare Planners’ industry knowledge and stakeholder relationships with academic know-how, can make a significant contribution to the healthcare simulation modelling arena

A system for patient management based discrete-event simulation and hierarchical clustering

Hospital Accident and Emergency (A&E) departments in England have a 4 hour target to treat 98% of patients from arrival to discharge, admission or transfer. Managing resources to meet the target and deliver care across the range of A&E services is a huge challenge for A&E managers. This paper develops an intelligent patient management tool to help managers and clinicians better understand patient length of stay and resources within an A&E area. The developed discrete-event simulation model gives a highlevel representation of ambulance arrivals into A&E. The model facilitates analysis in the following ways: visually interactive software showing patient length of stay in the A&E area; patient activity broken down into sub-groups so that intelligence might be gathered on how sub-groups affect the overall length of stay; understanding the number of patient treatment places and nurse resources required. To support ease of inputs for scenario and sensitivity testing, data is entered into the simulation model (Simul8) via Excel spreadsheets. The model discussed in this paper used patient length of stay grouped by A&E diagnosis codes and was limited to ambulance arrivals. The analysis was derived from A&E attendance in 2004 from an English hospital

Evaluating the Impact of an Interprofessional Practice Experience Involving Pharmacy and Dental Students on Medication Histories within an Urban Academic Dental Admissions Clinic

Primary Objective: To compare interprofessional (IP) care versus standard care on medication history clarifications in dental patients. Secondary Objectives: To assess the clinical significance of these clarifications with regards to the potential impact on dental treatment plans. To describe the interventions provided by IP care to clarify discrepancies and/or resolve medication-related problems

Observation of single collisionally cooled trapped ions in a buffer gas

Individual Ba ions are trapped in a gas-filled linear ion trap and observed with a high signal-to-noise ratio by resonance fluorescence. Single-ion storage times of ~5 min (~1 min) are achieved using He (Ar) as a buffer gas at pressures in the range 8e-5 - 4e-3 torr. Trap dynamics in buffer gases are experimentally studied in the simple case of single ions. In particular, the cooling effects of light gases such as He and Ar and the destabilizing properties of heavier gases such as Xe are studied. A simple model is offered to explain the observed phenomenology.Comment: 5 pages, 4 figures, accepted for publication in Phys. Rev. A. Minor text and figure change

Twenty Years of Galactic Observations in Searching for Bursts of Collapse Neutrinos with the Baksan Underground Scintillation Telescope

The results of twenty-year-long Galactic observations in neutrino radiation are summarized. Except for the recording of a neutrino signal from the supernova SN 1987A, no Galactic bursts of collapse neutrinos have been detected. An upper bound on the mean frequency of gravitational collapses in our Galaxy was obtained, $f_{collapse} (90$.Comment: latex, 7 pages, 2 eps figure

Measurement of the Total Active 8B Solar Neutrino Flux at the Sudbury Neutrino Observatory with Enhanced Neutral Current Sensitivity

The Sudbury Neutrino Observatory (SNO) has precisely determined the total active (nu_x) 8B solar neutrino flux without assumptions about the energy dependence of the nu_e survival probability. The measurements were made with dissolved NaCl in the heavy water to enhance the sensitivity and signature for neutral-current interactions. The flux is found to be 5.21 +/- 0.27 (stat) +/- 0.38 (syst) x10^6 cm^{-2}s^{-1}, in agreement with previous measurements and standard solar models. A global analysis of these and other solar and reactor neutrino results yields Delta m^{2} = 7.1^{+1.2}_{-0.6}x10^{-5} ev^2 and theta = 32.5^{+2.4}_{-2.3} degrees. Maximal mixing is rejected at the equivalent of 5.4 standard deviations.Comment: Submitted to Phys. Rev. Let

Searches For High-Frequency Variations In The B-8 Solar Neutrino Flux At The Sudbury Neutrino Observatory

We have performed three searches for high-frequency signals in the solar neutrino flux measured by the Sudbury Neutrino Observatory, motivated by the possibility that solar g-mode oscillations could affect the production or propagation of solar B-8 neutrinos. The first search looked for any significant peak in the frequency range 1-144 day(-1), with a sensitivity to sinusoidal signals with amplitudes of 12% or greater. The second search focused on regions in which g-mode signals have been claimed by experiments aboard the Solar and Heliospheric Observatory satellite, and was sensitive to signals with amplitudes of 10% or greater. The third search looked for extra power across the entire frequency band. No statistically significant signal was detected in any of the three searches.Natural Sciences and Engineering Research Council, CanadaIndustry Canada, CanadaNational Research Council, CanadaNorthern Ontario Heritage Fund, CanadaAtomic Energy of Canada, Ltd., CanadaOntario Power Generation, CanadaHigh Performance Computing Virtual Laboratory, CanadaCanada Foundation for InnovationDept. of Energy, USNational Energy Research Scientific Computing Center, USScience and Technologies Facilities Council, UKAstronom

On Possibilities of Studying of Supernova Neutrinos at BAKSAN

We consider the possibilities of studying a supernova collapse neutrino burst at Baksan Neutrino Observatory (Institute for Nuclear Research, Russian Academy of Sciences) using the prposed 5-kt target-mass liquid scintillation spectrometer. Attention is given to the influence of mixing angle ${\theta}_{13}$ on the expected rates and spectra of neutrino events

Induced pseudoscalar coupling of the proton weak interaction

The induced pseudoscalar coupling $g_p$ is the least well known of the weak coupling constants of the proton's charged--current interaction. Its size is dictated by chiral symmetry arguments, and its measurement represents an important test of quantum chromodynamics at low energies. During the past decade a large body of new data relevant to the coupling $g_p$ has been accumulated. This data includes measurements of radiative and non radiative muon capture on targets ranging from hydrogen and few--nucleon systems to complex nuclei. Herein the authors review the theoretical underpinnings of $g_p$, the experimental studies of $g_p$, and the procedures and uncertainties in extracting the coupling from data. Current puzzles are highlighted and future opportunities are discussed.Comment: 58 pages, Latex, Revtex4, prepared for Reviews of Modern Physic