Simulation Combined Approach to Police Patrol Services Staffing

Motivated by the squeeze on public service expenditure, staffing is an important issue for service systems, which are required to maintain or even improve their service levels in order to meet general public demand. This paper considers Police Patrol Service Systems (PPSSs) where staffing issues are extremely serious and important because they have an impact on service costs, quality and public-safety. Police patrol service systems are of particularly interest because the demand for service exhibits large time-varying characteristics. In this case, incidents with different urgent grades have different targets of patrol officers’ immediate attendances. A new method is proposed which aims to determine appropriate staffing levels. This method starts at a refinement of the Square Root Staffing (SRS) algorithm which introduces the possibility of a delay in responding to a priority incident. Simulation of queueing systems will then be implemented to indicate modifications in shift schedules. The proposed method is proved to be effective on a test instance generated from real patrol activity records in a local police force

A simulation of a police patrol service system with multi-grade time-varying incident arrivals

Due to the squeeze on public expenditure, the funding cuts imposed on the police provide a great impetus to find an efficient incident response sequence with limited resources. This is especially the case for police response systems which exhibit the characteristics of time-varying volume of demand. In this paper, we investigate two types of priority queues in the patrol service system. Both the incident arrival rate and the scheduled staff level change with time. For such a system, there is no analytical model available to give close-form performance, so simulation is used for the study. Although dynamic priority queues which enable more flexibility in setting the sequence of service requests are widely applied in many service systems, such as the NHS service system, the simulation model results show that in police patrol service systems static priority queue performs better

Clinical significance of elevated B-type natriuretic peptide in patients with acute lung injury with or without right ventricular dilatation: an observational cohort study

BackgroundThe primary objective of this study was to examine levels of B-type natriuretic peptide (BNP) in mechanically ventilated patients with acute lung injury and to test whether the level of BNP would be higher in patients with right ventricular dilatation and would predict mortality.MethodsThis was a prospective, observational cohort study of 42 patients conducted in the intensive care unit of a tertiary care university hospital. BNP was measured and transthoracic echocardiography was performed within 48 hours of the onset of acute lung injury. The left ventricular systolic and diastolic function, right ventricular systolic function, and cardiac output were assessed. BNP was compared in patients with and without right ventricular dilatation, as well as in survivors versus nonsurvivors.ResultsBNP was elevated in mechanically ventilated patients with acute lung injury (median 420 pg/ml; 25-75% interquartile range 156-728 pg/ml). There was no difference between patients with and without right ventricular dilatation (420 pg/ml, 119-858 pg/ml vs. 387 pg/ml, 156-725 pg/ml; p = 0.96). There was no difference in BNP levels between the patients who died and those who survived at 30 days (420 pg/ml, 120-728 pg/ml vs. 385 pg/ml, 159-1070 pg/ml; p = 0.71).ConclusionsIn patients with acute lung injury the level of BNP is increased, but there is no difference in the BNP level between patients with and without right ventricular dilatation. Furthermore, BNP level is not predictive of mortality in this population

Hydrogen sulfide inhibits the renal fibrosis of obstructive nephropathy

Hydrogen sulfide has recently been found decreased in chronic kidney disease. Here we determined the effect and underlying mechanisms of hydrogen sulfide on a rat model of unilateral ureteral obstruction. Compared with normal rats, obstructive injury decreased the plasma hydrogen sulfide level. Cystathionine-β-synthase, a hydrogen sulfide-producing enzyme, was dramatically reduced in the ureteral obstructed kidney, but another enzyme cystathionine-γ-lyase was increased. A hydrogen sulfide donor (sodium hydrogen sulfide) inhibited renal fibrosis by attenuating the production of collagen, extracellular matrix, and the expression of α-smooth muscle actin. Meanwhile, the infiltration of macrophages and the expression of inflammatory cytokines including interleukin-1β, tumor necrosis factor-α, and monocyte chemoattractant protein-1 in the kidney were also decreased. In cultured kidney fibroblasts, a hydrogen sulfide donor inhibited the cell proliferation by reducing DNA synthesis and downregulating the expressions of proliferation-related proteins including proliferating cell nuclear antigen and c-Myc. Further, the hydrogen sulfide donor blocked the differentiation of quiescent renal fibroblasts to myofibroblasts by inhibiting the transforming growth factor-β1-Smad and mitogen-activated protein kinase signaling pathways. Thus, low doses of hydrogen sulfide or its releasing compounds may have therapeutic potentials in treating chronic kidney disease

Plasma sTNFR1 and IL8 for prognostic enrichment in sepsis trials: a prospective cohort study.

BackgroundEnrichment strategies improve therapeutic targeting and trial efficiency, but enrichment factors for sepsis trials are lacking. We determined whether concentrations of soluble tumor necrosis factor receptor-1 (sTNFR1), interleukin-8 (IL8), and angiopoietin-2 (Ang2) could identify sepsis patients at higher mortality risk and serve as prognostic enrichment factors.MethodsIn a multicenter prospective cohort study of 400 critically ill septic patients, we derived and validated thresholds for each marker and expressed prognostic enrichment using risk differences (RD) of 30-day mortality as predictive values. We then used decision curve analysis to simulate the prognostic enrichment of each marker and compare different prognostic enrichment strategies.Measurements and main resultsAn admission sTNFR1 concentration > 8861 pg/ml identified patients with increased mortality in both the derivation (RD 21.6%) and validation (RD 17.8%) populations. Among immunocompetent patients, an IL8 concentration > 94 pg/ml identified patients with increased mortality in both the derivation (RD 17.7%) and validation (RD 27.0%) populations. An Ang2 level > 9761 pg/ml identified patients at 21.3% and 12.3% increased risk of mortality in the derivation and validation populations, respectively. Using sTNFR1 or IL8 to select high-risk patients improved clinical trial power and efficiency compared to selecting patients with septic shock. Ang2 did not outperform septic shock as an enrichment factor.ConclusionsThresholds for sTNFR1 and IL8 consistently identified sepsis patients with higher mortality risk and may have utility for prognostic enrichment in sepsis trials

FGF-23 and PTH levels in patients with acute kidney injury: A cross-sectional case series study

BackgroundFibroblast growth factor-23 (FGF-23), a novel regulator of mineral metabolism, is markedly elevated in chronic kidney disease and has been associated with poor long-term outcomes. However, whether FGF-23 has an analogous role in acute kidney injury is unknown. The goal of this study was to measure FGF-23 levels in critically ill patients with acute kidney injury to determine whether FGF-23 levels were elevated, as in chronic kidney disease.MethodsPlasma FGF-23 and intact parathyroid hormone (PTH) levels were measured in 12 patients with acute kidney injury and 8 control subjects.ResultsFGF-23 levels were significantly higher in acute kidney injury cases than in critically ill subjects without acute kidney injury, with a median FGF-23 level of 1948 RU/mL (interquartile range (IQR), 437-4369) in cases compared with 252 RU/mL (IQR, 65-533) in controls (p = 0.01). No correlations were observed between FGF-23 and severity of acute kidney injury (defined by the Acute Kidney Injury Network criteria); among patients with acute kidney injury, FGF-23 levels were higher in nonsurvivors than survivors (median levels of 4446 RU/mL (IQR, 3455-5443) versus 544 RU/mL (IQR, 390-1948; p = 0.02). Severe hyperparathyroidism (defined as intact PTH >250 mg/dL) was present in 3 of 12 (25%) of the acute kidney injury subjects versus none of the subjects without acute kidney injury, although this result did not meet statistical significance.ConclusionsWe provide novel data that demonstrate that FGF-23 levels are elevated in acute kidney injury, suggesting that FGF-23 dysregulation occurs in acute kidney injury as well as chronic kidney disease. Further studies are needed to define the short- and long-term clinical effects of dysregulated mineral metabolism in acute kidney injury patients

Design and implementation of the START (STem cells for ARDS Treatment) trial, a phase 1/2 trial of human mesenchymal stem/stromal cells for the treatment of moderate-severe acute respiratory distress syndrome

Background: Despite advances in supportive care, moderate-severe acute respiratory distress syndrome (ARDS) is associated with high mortality rates, and novel therapies to treat this condition are needed. Compelling pre-clinical data from mouse, rat, sheep and ex vivo perfused human lung models support the use of human mesenchymal stem (stromal) cells (MSCs) as a novel intravenous therapy for the early treatment of ARDS. Methods: This article describes the study design and challenges encountered during the implementation and phase 1 component of the START (STem cells for ARDS Treatment) trial, a phase 1/2 trial of bone marrow-derived human MSCs for moderate-severe ARDS. A trial enrolling 69 subjects is planned (9 subjects in phase 1, 60 subjects in phase 2 treated with MSCs or placebo in a 2:1 ratio). Results: This report describes study design features that are unique to a phase 1 trial in critically ill subjects and the specific challenges of implementation of a cell-based therapy trial in the ICU. Conclusions: Experience gained during the design and implementation of the START study will be useful to investigators planning future phase 1 clinical trials based in the ICU, as well as trials of cell-based therapy for other acute illnesses. Trial registration Clinical Trials Registration: NCT01775774 and NCT02097641

Down-regulation of microRNA-151a-5p inhibits proliferation, migration and invasion and enhances chemosensitivity of lung cancer A549 cells

Objective To investigate the effects of mir-151a-5p down-regulation on the proliferation, migration, invasion and chemosensitivity of A549 cells. Methods RT-qPCR was used to detect the expression of mir-151a-5P in 16 surgical specimens of lung adenocarcinoma and in different lung adenocarcinoma cell lines (H1975, H1299, H2228, A549 and HBE). CCK-8 assay, Transwell test and clonogenic assay were used to assess the changes in the proliferation, migration, invasion and clonogenic ability of A549 cells after transfection with a mir-151a-5p inhibitor. Western blotting was performed to detect the expression of epithelial-mesenchymal transition (EMT)-related proteins in the transfected cells; CCK-8 assay and flow cytometry were used to evaluate the changes in cisplatin sensitivity of A549 cells after the transfection. Results The expression of mir-151a-5p was significantly increased in human lung adenocarcinoma tissues as compared with normal lung tissues (P < 0.01). Among the 4 lung adenocarcinoma cell lines, A549 cells expressed the highest levels of mir-151a-5p (P < 0.01). Transfection with the mir-151a-5p inhibitor, compared with the negative control, significantly attenuated the proliferation, migration, invasion and clonogenic ability of A549 cells (P < 0.05). Western blotting revealed a significant enhancement of E-cadherin expression and obviously lowered expressions of N-candherin, vimentin and Notch1 in A549 cells transfected with the mir-151a-5p inhibitor (P < 0.01). CCK-8 assay showed that the IC50 of cisplatin was significantly lowered in mir-151a-5p inhibitor-transfected cells as compared with the negative control group (P < 0.01); the transfection also resulted in a significantly increased apoptotic rate of the cells in response to cisplatin treatment (P < 0.01). Conclusion Down-regulation of mir-151a-5p expression can significantly inhibit the proliferation, migration and invasion of A549 cells and increase their chemosensitivity to cisplati

Comparative and phylogenetic analyses based on the complete chloroplast genome of Cornus subg. Syncarpea (Cornaceae) species

This study presents a comprehensive analysis of the chloroplast (cp) genomes of Cornus species, including comparative and phylogenetic evaluations, as well as examinations of their genomic structure and composition. The cp genomes exhibit a typical circular quadripartite structure and demonstrate highly similar gene order and genomic structure. The complete cp genome size of the 10 taxa in this study is 156,965 bp to 157,383 bp, where the length of the large single-copy (LSC) region is 86,296 bp to 86,691 bp, small single-copy (SSC) region is 18,386 bp to 18,454 bp, and inverted repeat (IR) region is 23,143 bp to 26,112 bp. A total of 131 genes were found, including 86 protein-coding genes (PCGs), eight rRNA genes, and 37 tRNA genes. The mean GC content of the 10 taxa is 38.145%, where the LSC region is 36.396%, the SSC region is 32.372%, and the IR region is 43.076%. Despite the relatively conserved nature of the cp genome within the species of Cornus, 25–31 simple sequence repeats (SSRs) were identified in the 10 taxa in our study. The SSRs were found to be distributed in the LSC, SSC, and IR regions in Cornus hongkongensis subsp. hongkongensis, C. hongkongensis subsp. elegans, C. hongkongensis subsp. gigantea, and C. hongkongensis subsp. tonkinensis, while the SSR was not found in the IR region of the other six taxa. Thus, whole cp genomics is a valuable tool for species identification, taxonomic clarification, and genomic evolutionary analysis. Furthermore, our findings reveal that C. hongkongensis and C. hongkongensis subsp. gigantea, along with Cornus kousa and Cornus elliptica, form sister groups. Notably, C. hongkongensis subsp. ferruginea and C. hongkongensis subsp. melanotricha did not exhibit affinity with C. hongkongensis subsp. hongkongensis. Our study furnishes essential data for further research on their classification and provides novel insights into the relationship within Cornus subg. Syncarpea

Free-Standing and Heteroatoms-Doped Carbon Nanofiber Networks as a Binder-Free Flexible Electrode for High-Performance Supercapacitors

Flexible and heteroatoms-doped (N, O and P) activated carbon nanofiber networks (ACFNs) have been successfully prepared with a mixture of polyamic acid (PAA) and poly(diaryloxyphosphazene) (PDPP) as a solution through electrospinning, followed by a heat post-treatment. The resultant heteroatoms-doped ACFNs can be used as binder-free electrodes for high-performance flexible supercapacitors (SCs) due to lightweight, three-dimensional open-pore structure and good mechanical strength. Despite its surface area being lower than 130.6 m2&middot;g&minus;1, the heteroatoms-doped ACFNs exhibited a high heteroatoms (N, O and P) content of 17.9%, resulting in a highly specific capacitance of 182 F&middot;g&minus;1 at a current density of 1 A&middot;g&minus;1 in 6 M KOH electrolyte in a two-electrode cell and an excellent rate capability of 74.7% of its initial capacitance from 1 A&middot;g&minus;1 to 10 A&middot;g&minus;1 under the mass loading of 1.5 mg&middot;cm&minus;2. The electrical double-layer (EDL) capacitance and pseudocapacitance can be easily decoupled in the heteroatoms-doped mesoporous ACFNs. SCs device based on heteroatoms-doped ACFNs exhibited a high energy density of 6.3 W&middot;h&middot;kg&minus;1 with a power density of 250 W&middot;kg&minus;1, as well as excellent cycling stability with 88% capacitance retention after 10,000 charge&ndash;discharge cycles. The excellent electrochemical performance was attributed to the mesoporous structure of ACFNs and pseudocapacitive heteroatoms