Erlang could have told you so—A case study of health policy without maths

Little consideration is given to the operational reality of implementing national policy at local scale. Using a case study from Norway, we examine how simple mathematical models may offer powerful insights to policy makers when planning policies. Our case study refers to a national initiative requiring Norwegian municipalities to establish acute community beds (municipal acute units or MAUs) to avoid hospital admissions. We use Erlang loss queueing models to estimate the total number of MAU beds required nationally to achieve the original policy aim. We demonstrate the effect of unit size and patient demand on anticipated utilisation. The results of our model imply that both the average demand for beds and the current number of MAU beds would have to be increased by 34% to achieve the original policy goal of transferring 240 000 patient days to MAUs. Increasing average demand or bed capacity alone would be insufficient to reach the policy goal. Day-to-day variation and uncertainty in the numbers of patients arriving or leaving the system can profoundly affect health service delivery at the local level. Health policy makers need to account for these effects when estimating capacity implications of policy. We demonstrate how a simple, easily reproducible, mathematical model could assist policy makers in understanding the impact of national policy implemented at the local level

Transparent Development of the WHO Rapid Advice Guidelines

Emerging health problems require rapid advice. We describe the development and pilot testing of a systematic, transparent approach used by the World Health Organization (WHO) to develop rapid advice guidelines in response to requests from member states confronted with uncertainty about the pharmacological management of avian influenza A (H5N1) virus infection. We first searched for systematic reviews of randomized trials of treatment and prevention of seasonal influenza and for non-trial evidence on H5N1 infection, including case reports and animal and in vitro studies. A panel of clinical experts, clinicians with experience in treating patients with H5N1, influenza researchers, and methodologists was convened for a two-day meeting. Panel members reviewed the evidence prior to the meeting and agreed on the process. It took one month to put together a team to prepare the evidence profiles (i.e., summaries of the evidence on important clinical and policy questions), and it took the team only five weeks to prepare and revise the evidence profiles and to prepare draft guidelines prior to the panel meeting. A draft manuscript for publication was prepared within 10 days following the panel meeting. Strengths of the process include its transparency and the short amount of time used to prepare these WHO guidelines. The process could be improved by shortening the time required to commission evidence profiles. Further development is needed to facilitate stakeholder involvement, and evaluate and ensure the guideline's usefulness

How Can We Support the Use of Systematic Reviews in Policymaking?

John Lavis discusses how health policymakers and their stakeholders need research evidence, and the best ways evidence can be synthesized and packaged to optimize its use

A Bayesian Analysis of the Correlations Among Sunspot Cycles

Sunspot numbers form a comprehensive, long-duration proxy of solar activity and have been used numerous times to empirically investigate the properties of the solar cycle. A number of correlations have been discovered over the 24 cycles for which observational records are available. Here we carry out a sophisticated statistical analysis of the sunspot record that reaffirms these correlations, and sets up an empirical predictive framework for future cycles. An advantage of our approach is that it allows for rigorous assessment of both the statistical significance of various cycle features and the uncertainty associated with predictions. We summarize the data into three sequential relations that estimate the amplitude, duration, and time of rise to maximum for any cycle, given the values from the previous cycle. We find that there is no indication of a persistence in predictive power beyond one cycle, and conclude that the dynamo does not retain memory beyond one cycle. Based on sunspot records up to October 2011, we obtain, for Cycle 24, an estimated maximum smoothed monthly sunspot number of 97 +- 15, to occur in January--February 2014 +- 6 months.Comment: Accepted for publication in Solar Physic

Using stochastic simulation modelling to study occupancy levels of decentralised admission avoidance units in Norway

Identifying alternatives to acute hospital admission is a priority for many countries. Over 200 decentralised municipal acute units (MAUs) were established in Norway to divert low-acuity patients away from hospitals. MAUs have faced criticism for low mean occupancy and not relieving pressures on hospitals. We developed a discrete time simulation model of admissions and discharges to MAUs to test scenarios for increasing absolute mean occupancy. We also used the model to estimate the number of patients turned away as historical data was unavailable. Our experiments suggest that mergers alone are unlikely to substantially increase MAU absolute mean occupancy as unmet demand is generally low. However, merging MAUs offers scope for up to 20% reduction in bed capacity, without affecting service provision. Our work has relevance for other admissions avoidance units and provides a method for estimating unconstrained demand for beds in the absence of historical data

Synthesis of Some Novel Thieno[2, 3-d] pyrimidines and their Antibacterial Activity

Bromination of intermediate 1-[4-(6, 7-dihydro-5H-cyclopenta [4, 5] thieno[2, 3-d]pyrimidin-4-yl amino) phenyl] ethanone (4) yielded (5). Which upon reaction with different substituted benzothiazoles give a novel series of pyrimidine [6(a-g)]. However reaction of (5) with 4-chloro-2-triflouro acetyl aniline provided (6h). Similarly reaction of (5) with 5-amino tetrazole & 2-amino benzimidazole produced (6i) & (6j) respectively. All the synthesized compounds were tested against bacteria (Gram positive and Gram negative)

Detumbling and Reorientation Maneuvers and Stabilization of NASA SCOLE System

The questions of rotational maneuver and vibration stabilization of the NASA Spacecraft Control Laboratory Experiment (SCOLE) system is considered. The mathematical model of the SCOLE system includes the rigid body dynamics as well as the elastic dynamics representing transverse and torsional deformations of the elastic beam connecting the orbiter and end body (reflector). For the rotational maneuver, a new control law (orbiter control law) is derived using an orbiter input torque vector. Detumbling and reorientation maneuvers of the SCOLE system are accomplished using this control law; however, this excites the elastic modes of the beam. The orbiter control law asymptotically linearizes the flexible dynamics. Using the linearized model, a linear feedback control law is designed for vibration suppression. An observer is designed for estimating the state variables using sensor outputs which are also used for the synthesis of the control law. Simulation results are presented to show that in the closed-loop system detumbling and reorientation maneuvers can be accomplished and the effect of control and observation spillover is insignificant