Modelling the neonatal system: A joint analysis of length of stay and patient pathways

© 2019 John Wiley & Sons, Ltd. This is the peer reviewed version of the following article: Modelling the neonatal system: A joint analysis of length of stay and patient pathways, which has been published on 27/11/2019 in final form at https://doi.org/10.1002/hpm.2928. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.In the United Kingdom, one in seven babies require specialist neonatal care after birth, with a noticeable increase in demand. Coupled with budgeting constraints and lack of investment means that neonatal units are struggling. This will inevitably have an impact on baby's length of stay (LoS) and the performance of the service. Models have previously been developed to capture individual babies' pathways to investigate the longitudinal cycle of care. However, no models have been developed to examine the joint analysis of LoS and babies' pathways. LoS at each stage of care is a critical driver of both the clinical outcomes and economic performance of the neonatal system. Using the generalized linear mixed modelling approach, extended to accommodate multiple outcomes, the association between neonate's pathway to discharge and LoS is examined. Using the data about 1002 neonates, we noticed that there is a high positive association between baby's pathway and total LoS, suggesting that discharge policies needs to be looked at more carefully. A novel statistical approach that examined the association of key outcomes and how it evolved over time is developed. Its applicability can be extended to other types of long-term care or diseases, such as heart failure and stroke.Peer reviewedFinal Accepted Versio

Anisotropic elasticity in confocal studies of colloidal crystals

We consider the theory of fluctuations of a colloidal solid observed in a confocal slice. For a cubic crystal we study the evolution of the projected elastic properties as a function of the anisotropy of the crystal using numerical methods based on the fast Fourier transform. In certain situations of high symmetry we find exact analytic results for the projected fluctuations.Comment: 6 pages, 7 figure

Impact of irreversibility and uncertainty on the timing of infrastructure projects

This paper argues that because of the irreversibility and uncertainty associated with Build - Operate - Transfer (BOT) infrastructure projects, their financial evaluation should also routinely include the determination of the value of the option to defer the construction start-up. This ensures that project viability is comprehensively assessed before any revenue or loan guarantees are considered by project sponsors to support the project. This paper shows that the framework can be used even in the context of the intuitive binomial lattice model. This requires estimating volatility directly from the evolution of the net operating income while accounting for the correlation between the revenue and costs functions. This approach ensures that the uncertainties usually associated with toll revenues, in particular, are thoroughly investigated and their impact on project viability is thoroughly assessed. This paper illustrates the usefulness of the framework with data from an actual (BOT) toll road project. The results show that by postponing the project for a couple of years the project turns out to be viable, whereas it was not without the deferral. The evaluation approach proposed therefore provides a better framework for determining when and the extent of government financial support, if any, that may be needed to support a BOT project on the basis of project economics. The analysis may also be applicable to private sector investment projects, which are characterized by irreversibility and a high rate of uncertainty

On Local Approximations to the Nonlinear Evolution of Large-Scale Structure

We present a comparative analysis of several methods, known as local Lagrangian approximations, which are aimed to the description of the nonlinear evolution of large-scale structure. We have investigated various aspects of these approximations, such as the evolution of a homogeneous ellipsoid, collapse time as a function of initial conditions, and asymptotic behavior. As one of the common features of the local approximations, we found that the calculated collapse time decreases asymptotically with the inverse of the initial shear. Using these approximations, we have computed the cosmological mass function, finding reasonable agreement with N-body simulations and the Press-Schechter formula.Comment: revised version with color figures, minor changes, accepted for publication in the Astrophysical Journal, 30 pages, 13 figure

Public leisure facilities: Managing customer expectations

This paper examines the impact of customer expectations on the management of public leisure services, arguing that public leisure providers will need to shift their attention from the management of service quality, to focus on the management of customer expectations of their services