Application of simulation and modelling in managing unplanned healthcare demand

Patients who attend Accident and Emergency (A & E) departments with problems that could be dealt with by their general practitioners (GPs) use time and resources of the department that could be otherwise used for patients with more appropriate needs. Hospital managers throughout the world are facing increasing pressure to introduce measures and initiatives to significantly ease the problem of such inappropriate attendances at A&E departments. This study looks at an initiative in which primary care clinicians are used to help deflect patients with non-urgent needs away from A&E. Simulation and modelling was used to assess the impact that this initiative would have on A&E workflow. The results suggest that the deflection of patients attending A&E with non-urgent needs may reduce the time spent in A&E by all patients attending A&E

A multi-faceted approach to optimising a complex unplanned healthcare system

Unscheduled and urgent health care represents the largest area of activity and cost for the UK’s National Health Service (NHS). Like typical complex systems unplanned care has the features of interdependence and having structures at different scales which requires modelling at different levels. The aim of this paper is to discuss the development of a multifaceted approach to study and optimise this complex system. We aim to integrate four different methodologies to gain better understanding of the nature of the system and to develop ways to enhance its performance. These methodologies are: (a) Lean/ Flow theory to look at the process and patients and other flows; (b) Simulation/ System Dynamics to undertake analytical analysis and multi-level modelling; (c) stakeholder consultation and use of system thinking to analyse the system and identify options, barriers and good practice; and (d) visual analytic modelling to facilitate effective decision making in this complex environment. Of particular concern are the boundary issues i.e. how changes in unplanned care will impact on the adjacent facilities and ultimately on the whole Healthcare system

Conversation Exchange Dynamics: A New Signal Primitive for Computer Network Intrusion Detection

As distributed network intrusion detection systems expand to integrate hundreds and possibly thousands of sensors, managing and presenting the associated sensor data becomes an increasingly complex task. Methods of intelligent data reduction are needed to make sense of the wide dimensional variations. We present a new signal primitive we call conversation exchange dynamics (CED) that accentuates anomalies in traffic flow. This signal provides an aggregated primitive that may be used by intrusion detection systems to base detection strategies upon. Indications of the signal in a variety of simulated and actual anomalous network traffic from distributed sensor collections are presented. Specifically, attacks from the MIT Lawrence Livermore IDS data set are considered. We conclude that CED presents a useful signal primitive for assistance in conducting IDS

Subaqueous shrinkage cracks in the Sheepbed mudstone: Implications for early fluid diagenesis, Gale crater, Mars

The Sheepbed mudstone, Yellowknife Bay formation, Gale crater, represents an ancient lakebed now exhumed and exposed on the Martian surface. The mudstone has four diagenetic textures, including a suite of early diagenetic nodules, hollow nodules, and raised ridges and later diagenetic light-toned veins that crosscut those features. In this study, we describe the distribution and characteristics of the raised ridges, a network of short spindle-shaped cracks that crosscut bedding, do not form polygonal networks, and contain two to four layers of isopachous, erosion-resistant cement. The cracks have a clustered distribution within the Sheepbed member and transition laterally into concentrations of nodules and hollow nodules, suggesting that these features formed penecontemporaneously. Because of the erosion-resistant nature of the crack fills, their three-dimensional structure can be observed. Cracks that transition from subvertical to subhorizontal orientations suggest that the cracks formed within the sediment rather than at the surface. This observation and comparison to terrestrial analogs indicate that these are syneresis cracks—cracks that formed subaqueously. Syneresis cracks form by salinity changes that cause sediment contraction, mechanical shaking of sediment, or gas production within the sediment. Examination of diagenetic features within the Sheepbed mudstone favors a gas production mechanism, which has been shown to create a variety of diagenetic morphologies comparable to the raised ridges and hollow nodules. The crack morphology and the isopachous, layered cement fill show that the cracks were filled in the phreatic zone and that the Sheepbed mudstone remained fluid saturated after deposition and through early burial and lithification

Turbulent Combustion of Polydisperse Evaporating Sprays with Droplet Crossing: Eulerian Modeling and Validation in the Infinite Knudsen Limit

The accurate simulation of the dynamics of polydisperse evaporating sprays in unsteady gaseous flows with large-scale vortical structures is both a crucial issue for industrial applications and a challenge for modeling and scientific computing. The difficulties encountered by the usual Lagrangian approaches make the use of Eulerian models attractive, aiming at a lower cost and an easier coupling with the carrier gaseous phase. Among these models, the multi-fluid model allows for a detailed description of the polydispersity and size-velocity correlations for droplets of various sizes. The purpose of the present study is twofold. First, we extend the multi-fluid model in order to cope with crossing droplet trajectories by using the quadrature method of moments in velocity phase space conditioned by size. We identify the numerical difficulties and provide dedicated numerical schemes in order to preserve the velocity moment space. Second, we conduct a comparison study and demonstrate the capability of such an approach to capture the dynamics of an evaporating polydisperse spray in a 2-D free jet configuration. We evaluate the accuracy and computational cost of Eulerian models and related discretization schemes vs. Lagrangian solvers and show that, even for finite Stokes number, the standard Eulerian multi-fluid model can be accurate at reasonable cost

Steroid modulation of neurogenesis: Focus on radial glial cells in zebrafish

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The Stratigraphy of Central and Western Butte and the Greenheugh Pediment Contact

The Greenheugh pediment at the base of Aeolis Mons (Mt. Sharp), which may truncate units in the Murray formation and is capped by a thin sandstone unit, appears to represent a major shift in climate history within Gale crater. The pediment appears to be an erosional remnant of potentially a much more extensive feature. Curiositys traverse through the southern extent of Glen Torridon (south of Vera Rubin ridge) has brought the rover in contact with several new stratigraphic units that lie beneath the pediment. These strata were visited at two outcrop-forming buttes (Central and Western butte- both remnants of the retreating pediment) south of an orbitally defined boundary marking the transition from the Fractured Clay-bearing Unit (fCU) and the fractured Intermediate Unit (fIU). Here we present preliminary interpretations of the stratigraphy within Central and Western buttes and propose the Western butte cap rocks do not match the pediment capping unit

Evidence for direct CP violation in the decay B->D(*)K, D->KsPi+Pi- and measurement of the CKM phase phi3

We present a new measurement of the unitarity triangle angle phi3 using a Dalitz plot analysis of the KsPi+Pi- decay of the neutral D meson produced in B->D(*)K decays. The method exploits the interference between D0 and D0bar to extract the angle phi3, strong phase delta and the ratio r of suppressed and allowed amplitudes. We apply this method to a 605 fb-1 data sample collected by the Belle experiment. The analysis uses three decays: B->DK, and B->D*K with D*->DPi0 and D*->Dgamma, as well as the corresponding charge-conjugate modes. From a combined maximum likelihood fit to the three modes, we obtain phi3 = 78.4^+10.8_-11.6 +- 3.6 (syst) +- 8.9 (model) degrees. CP conservation in this process is ruled out at the confidence level (1-CL)=5x10^-4, or 3.5 standard deviations.Comment: 10 pages, 5 figures, 4 tables. Replaced by version published in Phys. Rev.

Ghrelin induces clock gene expression in the liver of goldfish in vitro via protein kinase C and protein kinase A pathways

The liver is the most important link between the circadian system and metabolism. As a food-entrainable oscillator, the hepatic clock needs to be entrained by food-related signals. The objective of the present study was to investigate the possible role of ghrelin (an orexigenic peptide mainly synthesized in the gastrointestinal tract) as an endogenous synchronizer of the liver oscillator in teleosts. To achieve this aim, we first examined the presence of ghrelin receptors in the liver of goldfish. Then, the ghrelin regulation of clock gene expression in the goldfish liver was studied. Finally, the possible involvement of the phospholipase C/protein kinase C (PLC/PKC) and adenylate cyclase/protein kinase A (AC/PKA) intracellular signalling pathways was investigated. Ghrelin receptor transcripts, ghs-r1a, are present in the majority of goldfish hepatic cells. Ghrelin induced the mRNA expression of the positive (gbmal1a, gclock1a) and negative (gper genes) elements of the main loop of the molecular clock machinery, as well as grev-erbα (auxiliary loop) in cultured liver. These effects were blocked, at least in part, by a ghrelin antagonist. Incubation of liver with a PLC inhibitor (U73122), a PKC activator (phorbol 12-myristate 13-acetate) and a PKC inhibitor (chelerythrine chloride) demonstrated that the PLC/PKC pathway mediates such ghrelin actions. Experiments with an AC activator (forskolin) and a PKA inhibitor (H89) showed that grev-erbα regulation could be due to activation of PKA. Taken together, the present results show for the first time in vertebrates a direct action of ghrelin on hepatic clock genes and support a role for this hormone as a temporal messenger in the entrainment of liver circadian functions