Analyzing the proposed reconfiguration of accident-and-emergency facilities in England

The Keogh Report of 2013 proposed a major reconfiguration of the accident and emergency (A&E) system under National Health Service (NHS) England to improve service. The proposed reconfiguration includes centralized facilities with multiple specialties as well as small local minor-injury facilities. We use stylized queuing models to analyze cost and service implications of the proposed reconfiguration. We find that increasing numbers of specialty patients that require admission to hospital makes splitting off specialty A&Es from general ones more attractive. The same applies for patients with minor injuries. Our work generally supports the reconfiguration recommended in the Keogh report but with some fine-tuning: For instance, a merger of A&Es (pooling) does not always make sense even though it increases patient numbers when the patients in the two A&Es are of different types. We provide simple quantitative rules to indicate whether the proposed reconfiguration could lower costs in any particular region of the country. The results here are consistent with some NHS England providers attempting specialty A&Es for geriatric patients and mobile drunkenness treatment centers on weekends. Our rules and approach can be useful for identifying candidate reconfiguration opportunities not only for NHS England but also for any other context where pooling and arrival heterogeneity are important considerations

Turbulence Model Comparison for Compact Plate Heat Exchanger Design Application.

In the framework of the Gas-Power Conversion System for the Advanced Sodium Technological Reactor for Industrial Demonstration (ASTRID) project design, works done at CEA are focused on the design of the sodium-gas heat exchanger. Compact plate heat exchangers are indicated as the most suitable technology for such applications. An innovative compact heat exchanger geometry is proposed in this paper: its innovationconsists increatinga 3D mixing flow. The proposed geometry has also very good mechanical resistance to high pressure gradients, being suitable for a large variety of flow applications. The flowfield inside such a channel is experimentally studied using the Laser Doppler Velocimetry (LDV) technique. The main velocity, the radial velocity as well as the Reynolds stressesare measured: data show the high level of flow mixing and the 3D flow pattern inside the channel. The experimental measurements are then used to validate turbulence models: in particular Reynolds-Averaged Navier-Stokes (RANS) equations are closed using both isotropic 2-equation isotropic eddy viscosity models and a Non-Linear Eddy Viscosity Model (NLEVM). Presented results represent the first step in the assessment of innovative high-performance compact plate heat exchangers that can be used to increase the plant efficiency as well as decrease the capital cost of the single component

Effect of oxidoreduction potential and of gas bubbling on rheological properties and microstructure of acid skim milk gels acidified with glucono-delta-lactone

Milk oxidoreduction potential was modified using gases during the production of a model dairy product and its effect on gel setting was studied. Acidification by glucono-δ-lactone was used to examine the physicochemistry of gelation and to avoid variations due to microorganisms sensitive to oxidoreduction potential.Four conditions of oxidoreduction potential were appliedto milk: milk was gassed with air, nongassed, gassed with N2, or gassed with N2H2. The rheologicalproperties and microstructure of these gels were determined using viscoelasticimetry, measurement of whey separation, and confocal laser scanning microscopy. It appeared that a reducing environment led to less-aggregated proteins within the matrix and consequently decreased whey separation significantly. The use of gas to modify oxidoreduction potential is a possible way to improve the quality of dairy products

Decrease in Myelin-Associated Lipids Precedes Neuronal Loss and Glial Activation in the CNS of the Sandhoff Mouse as Determined by Metabolomics

Sandhoff disease (SD) is a lysosomal disease caused by mutations in the gene coding for the β subunit of β-hexosaminidase, leading to deficiency in the enzymes β-hexosaminidase (HEX) A and B. SD is characterised by an accumulation of gangliosides and related glycolipids, mainly in the central nervous system, and progressive neurodegeneration. The underlying cellular mecha-nisms leading to neurodegeneration and the contribution of inflammation in SD remain unde-fined. The aim of the present study was to measure global changes in metabolism over time that might reveal novel molecular pathways of disease. We used liquid chromatography-mass spec-trometry and 1H Nuclear Magnetic Resonance spectroscopy to profile intact lipids and aqueous metabolites, respectively. We examined spinal cord and cerebrum from healthy and Hexb -/- mice, a mouse model of SD, at ages one, two, three and four months. We report decreased concentrations in lipids typical of the myelin sheath, galactosylceramides and plasmalogen-phosphatidylethanolamines, suggesting that reduced synthesis of myelin lipids is an early event in the development of disease pathology. Reduction in neuronal density is pro-gressive, as demonstrated by decreased concentrations of N-acetylaspartate and amino acid neurotransmitters. Finally, microglial activation, indicated by increased amounts of myo-inositol correlates closely with the late symptomatic phases of the disease

Hematological changes among Beninese motor-bike taxi drivers exposed to benzene by urban air pollution

Exposure to high-concentration of benzene in polluted air has been associated with bone marrow deficiency, aplastic anemia and leukemia. However, epidemiological studies have reported conflicting data following human exposure to benzene levels below 1 ppm (that is, 3.2 mg/m3). Therefore we investigated the influence of outdoor air benzene on peripheral blood cells among exposed motor-biketaxi drivers (MBTD) in which specific IgG antibodies against reactive benzene metabolites, such as hydroquinone (HQ) and para-benzoquinone (p-BQ) are identified and quantified for further use as biomarker of exposure. We compared 144 MBTD with 30 unexposed age and sex-matched controls. The mean age ± SD (95% CI) were: MBTD 39.5 ± 7.82 (38.2 - 40.7) and village residents 40.3 ± 10.56 (39.1-43.0). Personal benzene exposure was assessed using GABIE diffusive samplers. The levels of specific IgG antibodies to HQ and p-BQ were determined by ELISA. The peripheral blood cells were counted by an automated analyzer. Benzene, Toluene and Xylene levels were much higher in MBTD in comparison to the control group. Benzene exposure levels ranged from 0.012 to 0.550 ppm in MBTD. Their average exposure level per one week was 0.126±0.206 ppm. Accordingly, MBTD had significantly higher levels of specific IgG antibodies to HQ and p-BQ compared to the controls (p< 0.001). WBC, lymphocytes, eosinophils and platelets were significantly decreased in MBTD, whereas RBC and other blood cell numbers remained unchanged. Total WBC, lymphocytes and eosinophils counts were decreased among exposed MBTD compared to unexposed controls. We suggest the use of these blood parameters together with specific IgG antibodies to HQ and p-BQ as biomarkers in biological monitoring of low level benzene exposure. Larger studies are however required to validate this new approach of health survey in workers exposed to benzene.Key words: Benzene, motor-bike-taxi drivers, specific immune responses, peripheral blood cell count

Sourcing Flexibility, Spot Trading, and Procurement Contract Structure

We analyze the structure and pricing of option contracts for an industrial good in the presence of spot trading. We combine the analysis of spot trading and buyers' disparate private valuations for different suppliers' products, and we jointly endogenize the determination of three major dimensions in contract design: (i) sales contracts versus options contracts, (ii) flat-price versus volume-dependent contracts, and (iii) volume discounts versus volume premia. We build a model in which a supplier of an industrial good transacts with a manufacturer who uses the supplier's product to produce an end good with an uncertain demand. We show that, consistent with industry observations, volume-dependent optimal sales contracts always demonstrate volume discounts (i.e., involve concave pricing). However, options are more complex agreements, and optimal option contracts can involve both volume discounts and volume premia. Three major contract structures commonly emerge in optimality. First, if the seller has a high discount rate relative to the buyer and the seller's production costs or the production capacity is low, the optimal contracts tend to be flat-price sales contracts. Second, when the seller has a relatively high discount rate compared to the buyer but production costs or production capacity are high, the optimal contracts are sales contracts with volume discounts. Third, if the buyer's discount rate is high relative to the seller's, then the optimal contracts tend to be volume-dependent options contracts and can involve both volume discounts and volume premia. However, when the seller's production capacity is sufficiently low, it is possible to observe flat-price option contracts. Furthermore, we provide links between production and spot market characteristics, contract design, and efficiency.National Science Foundation (U.S.) (contract CMMI-0758069)National Science Foundation (U.S.) (contract DMI-0245352

Establishing Nash equilibrium of the manufacturer-supplier game in supply chain management

We study a game model of multi-leader and one-follower in supply chain optimization where n suppliers compete to provide a single product for a manufacturer. We regard the selling price of each supplier as a pre-determined parameter and consider the case that suppliers compete on the basis of delivery frequency to the manufacturer. Each supplier’s profit depends not only on its own delivery frequency, but also on other suppliers’ frequencies through their impact on manufacturer’s purchase allocation to the suppliers. We first solve the follower’s (manufacturer’s) purchase allocation problem by deducing an explicit formula of its solution. We then formulate the n leaders’ (suppliers’) game as a generalized Nash game with shared constraints, which is theoretically difficult, but in our case could be solved numerically by converting to a regular variational inequality problem. For the special case that the selling prices of all suppliers are identical, we provide a sufficient and necessary condition for the existence and uniqueness of the Nash equilibrium. An explicit formula of the Nash equilibrium is obtained and its local uniqueness property is proved

Gene expression profile of the skin in the 'hairpoor' (HrHp) mice by microarray analysis

<p>Abstract</p> <p>Background</p> <p>The transcriptional cofactor, Hairless (HR), acts as one of the key regulators of hair follicle cycling; the loss of function mutations is the cause of the expression of the hairless phenotype in humans and mice. Recently, we reported a new <it>Hr </it>mutant mouse called 'Hairpoor' (<it>Hr^Hp</it>). These mutants harbor a gain of the function mutation, T403A, in the <it>Hr </it>gene. This confers the overexpression of HR and <it>Hr^Hp</it>is an animal model of Marie Unna hereditary hypotrichosis in humans. In the present study, the expression profile of <it>Hr^Hp/Hr^Hp</it>skin was investigated using microarray analysis to identify genes whose expression was affected by the overexpression of HR.</p> <p>Results</p> <p>From 45,282 mouse probes, differential expressions in 43 (>2-fold), 306 (>1.5-fold), and 1861 genes (>1.2-fold) in skin from <it>Hr^Hp/Hr^Hp</it>mice were discovered and compared with skin from wild-type mice. Among the 1861 genes with a > 1.2-fold increase in expression, further analysis showed that the expression of eight genes known to have a close relationship with hair follicle development, ascertained by conducting real-time PCR on skin RNA produced during hair follicle morphogenesis (P0-P14), indicated that four genes, <it>Wif1</it>, <it>Casp14</it>, <it>Krt71</it>, and <it>Sfrp1</it>, showed a consistent expression pattern with respect to HR overexpression in vivo.</p> <p>Conclusion</p> <p><it>Wif1 </it>and <it>Casp14 </it>were found to be upregulated, whereas <it>Krt71 </it>and <it>Sfrp1 </it>were downregulated in cells overexpressing HR in transient transfection experiments on keratinocytes, suggesting that HR may transcriptionally regulate these genes. Further studies are required to understand the mechanism of this regulation by the HR cofactor.</p